Table 2. Drug interactions of Ginkgonis folium.
| ATC therapeutic subgroup | ATC pharmacological/chemical subgroup | Drugs | Pharmacokinetic basis of interaction | Pharmacodynamic basis of interaction | Manifestation of interaction | |
|---|---|---|---|---|---|---|
| Stomatological preparation, in dentistry (A01) | Salicylic acid and derivatives | Acetylsalicylic acid | CYP1A2 CYP2C9 CYP3A4 |
EGb 761 is a PAF antagonist. | synergistic effect ↑ antiplatelet effect ! bleeding risk (hyphema) |
Ke et al. (2021) |
| Antithrombotic agents (B01) | ||||||
| Analgetics (N02) | ||||||
| Drugs for acid related disorders (A02) | H2-receptor antagonists | Cimetidine | CYP2C9 | EGb 761 has a mucoprotective effect. | ↑ mucoprotective effect | Wang, Zhao & Ma (2000) |
| Drugs used in diabetes (A10) | Insulins and analogues | Insulin | EGb 761 increases the function of Langerhans islets β cells. | additive effect ! patient monitoring necessary |
Banin et al. (2014) | |
| Antithrombotic agents (B01) | Platelet aggregation inhibitors excl. heparin | Clopidogrel Dipyridamol Ticlopidine |
CYP1A2 CYP2D6 P-gp |
EGb 761 is a PAF antagonist. | synergistic effect ↑ antithrombotic effect ! bleeding risk (hyphema) |
Williamson, Driver & Baxter (2013, 2018) |
| Direct thrombin inhibitors | Dabigatran etexilate | EGb 761 is a PAF antagonist. | additive effect ! bleeding risk |
Williamson, Driver & Baxter (2013, 2018) | ||
| Vitamin K antagonists | Warfarin | CYP1A2 CYP2C9 |
EGb 761 affects hemorheology. | additive effect ! bleeding risk |
Stoddard et al. (2015) | |
| Heparin group | Dalteparin Enoxaparin Heparin |
CYP1A2 CYP2D6 CYP3A4 |
EGb 761 affects hemorheology. | additive effect ! bleeding risk |
Williamson, Driver & Baxter (2009, 2018). | |
| Cardiac therapy (C01) | Cardiac glycosides | Digoxin | CYP3A4 |
↑ plasma level ! hypokalemia |
Mauro et al. (2003) | |
| Diuretics (C03) | Low-ceiling diuretics, thiazides/sulfonamides | Hydrochlorothiazide Chlorothiazide Indapamide |
EGb 761 affects vasopressin level. |
↓ diuretic effect ! hypertension risk |
Williamson, Driver & Baxter (2013, 2018) | |
| Calcium channel blockers (C08) | Selective calcium channel blockers with mainly vascular effects, or with direct cardiac effects | Nicardipine Nifedipine Verapamil |
CYP3A4 CYP1A2 |
↑ plasma level ! do not use combination |
Williamson, Driver & Baxter (2013, 2018) | |
| Immunosuppressants (L04) | Calcineurin inhibitors | Ciclosporin | CYP3A4 P-gp |
↑ plasma level | Williamson, Driver & Baxter (2013, 2018) | |
| Anti-inflammatory and antirheumatic products (M01) | Anti-inflammatory and antirheumatic products, non-steroids | Celecoxib Diclofenac Ibuprofen Indometacin Naproxen Piroxicam |
CYP2C9 | EGb 761 is a PAF antagonist. | ! gastric bleeding risk | Williamson, Driver & Baxter (2009, 2018) |
| Antiepileptics (N03) | Antiepileptics, carboxamide derivatives | Carbamazepine | CYP3A4 CYP2C8 |
Neurotoxic ginkgotoxin (mainly in seeds). | ↓ anticonvulsive effect | Williamson, Driver & Baxter (2013, 2018) |
| Antiepileptics, fatty acid derivatives | Valproic acid | CYP2C9 CYP2A6 |
Neurotoxic ginkgotoxin (mainly in seeds). | ↓ anticonvulsive effect | Williamson, Driver & Baxter (2009, 2013, 2018) | |
| Antiepileptics, barbiturates and derivatives | Phenobarbital | CYP2C9 | Neurotoxic ginkgotoxin (mainly in seeds). | ↓ anticonvulsive effect | Czigle & Tóth (2016), Williamson, Driver & Baxter (2013, 2018) | |
| Antiepileptics, hydantoin derivatives | Primidone Phenytoin Gabapentin |
Neurotoxic ginkgotoxin (mainly in seeds). | ↓ anticonvulsive effect | Williamson, Driver & Baxter (2009, 2018) | ||
| Psycholeptics (N05) | Antipsychotics | Haloperidol | CYP2D6 | ↑ antipsychotic effect | Zhang et al. (2001) | |
| Anxiolytics, benzodiazepine derivatives | Alprazolam Diazepam |
Absorption CYP2C9 CYP3A4 |
↑ anxiolytic effect | Williamson, Driver & Baxter (2009, 2018), Zuo et al. (2010) | ||
| Anxiolytic drugs, azaspirodecanedione derivatives | Buspirone | absorption |
↓ absorption ↓ anxiolytic effect |
Spinella & Eaton (2002) | ||
| Hypnotics and sedatives, benzodiazepine derivatives | Midazolam | Williamson, Driver & Baxter (2009, 2018) | ||||
| Psychoanaleptics (N06) | Antidepressants; monoamine oxidase inhibitors, non-selective; selective serotonin reuptake inhibitors; other antidepressants |
Tranylcypromin Trazodon Fluoxetine |
CYP3A4 CYP2C19 CYP2D6 |
EGb 761 is a serotonin inhibitor; and GABAA-agonist. |
↑ antidepressant/sedative effect ↑ adverse reaction (coma risk) |
Czigle & Tóth (2016) |
| Psychostimulants, agents used for ADHD and nootropics | Caffeine | CYP1A2 | ↑ psychostimulant effect | Czigle & Tóth (2016) |
Note:
ATC, Anatomical Therapeutic Chemical Classification System (WHO, 2023); ↑, increase (of); ↓, decrease (of); !, warning; EGb 761, refined and quantified dry extract produced from Ginkgo leaf; GABA, γ-aminobutyric acid; PAF, platelet-activating factor; P-gp, P-glycoprotein.