Ginkgo and Blood Thinners: The Interaction Everyone Should Know

By Dr. Paulette Y. Jones, DNP-L, RN · N&O LLC

Ginkgo and Blood Thinners: The Interaction Everyone Should Know

Ginkgo biloba

Ginkgo is one of the oldest and most-studied herbs for memory and circulation, and it carries one of the clearest herb–drug warnings in the literature. If you take any medication that affects clotting, this is the article to read before you add ginkgo to anything.

What it is

Ginkgo is the leaf of one of the oldest tree species on earth. The standardized extract used in research — often labeled 24/6 — contains 24% flavone glycosides and 6% terpene lactones (ginkgolides and bilobalide). Those compounds are antioxidant, improve blood flow in small vessels, and inhibit platelet-activating factor, which is both the reason for its benefits and the reason for its main interaction.

What the research has looked at

Large trials in older adults have used 120–240 mg per day of standardized extract for months to years. Results on preventing cognitive decline have been mixed; results on symptoms in people who already have mild cognitive complaints have been more consistently positive.
Trials of 120–240 mg daily have reported improvements in attention and working memory in some healthy adults, generally after several weeks.
Ginkgo has also been studied for circulation-related complaints such as intermittent claudication and tinnitus, with modest effects.

Doses used in research

Almost all human trials used 120–240 mg per day of the 24/6 standardized extract, divided into two or three doses, for at least 6–12 weeks. Our Myco Shield™ uses 240 mg of 24/6 extract in the morning.

Interactions and cautions

Ginkgo's effect on platelets means it can increase bleeding risk when combined with warfarin, aspirin, clopidogrel, NSAIDs such as ibuprofen, or the newer anticoagulants. There are published case reports of serious bleeding with these combinations, including one fatal brain bleed with regular ibuprofen use. It can lower the seizure threshold and interact with seizure medications, and it induces liver enzymes (CYP2C19) that clear drugs such as omeprazole. Stop ginkgo at least two weeks before any surgery or dental procedure.

Drug / condition	Severity	Why	What to do
Anticoagulants / antiplatelets (warfarin, aspirin, clopidogrel, NSAIDs)	MAJOR	Inhibits platelet-activating factor; bleeding case reports	Avoid or monitor closely; stop 2 weeks pre-surgery
Anticonvulsants (valproate, phenytoin, carbamazepine)	MODERATE	May lower seizure threshold / induce CYP2C19	Avoid in seizure disorders
SSRIs, trazodone, buspirone, St. John's Wort	MODERATE	Case reports of serotonin syndrome / hypomania	Monitor
CYP2C19 / CYP3A4 substrates (omeprazole, tolbutamide, midazolam, efavirenz)	MODERATE	Induction reduces drug levels	Monitor effect
Antidiabetic drugs	MINOR	Alters insulin/glucose	Monitor
Ibuprofen	MAJOR	Fatal intracerebral bleed case report	Avoid regular NSAID use

Who should not take it without a provider's approval: Anyone on blood thinners or regular NSAID/aspirin use without provider approval; seizure disorders; two weeks before surgery; pregnancy.

Where we use it

Ginkgo Biloba 24/6 extract, 240 mg, is in Myco Shield™. It is not in any other N&O LLC formula. If you take a blood thinner, please review Myco Shield™ with your provider before starting.

Dr. Paulette Y. Jones holds a Doctor of Nursing Practice in Leadership (DNP-L) and is a Registered Nurse with nearly thirty years of clinical experience. She is the founder and formulator of N&O LLC. This article is for education only and is not medical advice. *These statements have not been evaluated by the Food and Drug Administration. N&O LLC products are not intended to diagnose, treat, cure, or prevent any disease. Always consult your healthcare provider before starting, stopping, or combining any supplement with a medication.

Ginkgo Biloba