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The standardized extract (EGb 761) contains flavone glycosides (24%) and terpene lactones (6% — ginkgolides and bilobalide). Mechanisms include: increased cerebral blood flow, platelet-activating factor (PAF) antagonism, antioxidant activity, and neuroprotective effects. The PAF antagonism is why ginkgo increases bleeding risk — it literally blocks platelet activation.
PAF antagonism → increased bleeding risk; case reports of hemorrhage
Additive antiplatelet effects → bleeding risk
Ginkgo has serotonergic properties; additive effects + bleeding risk
May reduce seizure threshold (controversial)
In vitro CYP induction; clinical significance variable
May reduce alprazolam levels via CYP3A4 induction
Case report of coma when combined with ginkgo
Discontinue ginkgo at least 2 weeks before surgery due to antiplatelet effects.
Not Prohibited
DeKosky ST et al. Ginkgo biloba for prevention of dementia (GEM study). *JAMA.* 2008.
(2008). PMID: 19017911
Pittler MH, Ernst E. Ginkgo biloba extract for treatment of intermittent claudication.
Laws KR et al. Is Ginkgo biloba a cognitive enhancer in healthy individuals? A meta-analysis.
Bent S et al. Spontaneous bleeding associated with ginkgo biloba.
Independently graded against 173,636 indexed supplements with 177 published clinical interactions, sourced from PubMed, FDA CAERS, openFDA, and NIH DSLD | Last updated: April 2026
Not medical advice. Based on published clinical research and systematic reviews.
Safety
Clinically significant interactions per published research. Talk to your prescriber or pharmacist before using this supplement if you take any of these.
Warfarin and other anticoagulants
SourceFDA MedWatch reports
Aspirin and NSAIDs
SourceClinical pharmacology
Moderate interactions. Monitoring, timing separation, or dose adjustment may be required.
Seizure medications (valproate, phenytoin)
SourceCase reports
CYP2C9 substrates
SourceIn vitro data
Stop 2 weeks before surgery
Bleeding risk from PAF inhibition.
Educational information only. This is not medical advice. These statements have not been evaluated by the FDA. Talk to your prescriber before starting, stopping, or combining any supplement with prescription medication.