Ginkgo can increase bleeding risk with anticoagulants, antiplatelet medicines, or NSAIDs and can raise seizure risk in susceptible people. It may also alter insulin response and the exposure or effect of efavirenz, midazolam, and other enzyme-dependent medicines.

Use with caution. Healthcare professional review recommended before use.

Contraindications

Bleeding disorders
Perioperative use
Seizure disorders in the setting of unverified ginkgo products

Cautions

MSK notes potential interactions with anticoagulants, NSAIDs, certain anticonvulsants, and some diabetes medications, so standardized ginkgo extract should not be treated like a benign tea.
Commercial extract quality matters because ginkgolic-acid content and standardization strongly affect safety.
Most modern evidence concerns standardized leaf extract rather than crude leaf decoction.

Drug Interactions

Drug Class / Substrate	Mechanism	Severity	Source
Anticoagulants and antiplatelet medicines	Human studies and case reports indicate that ginkgo may induce or prolong bleeding time.	Major	Memorial Sloan Kettering About Herbs
Nonsteroidal anti-inflammatory drugs	Additive antiplatelet effects may increase bleeding risk.	Major	Memorial Sloan Kettering About Herbs
Antipsychotics and other medicines that lower seizure threshold	Case reports suggest that ginkgo can increase seizure risk when combined with medicines such as prochlorperazine.	Major	Memorial Sloan Kettering About Herbs
Insulin	Laboratory and human studies suggest ginkgo can alter insulin secretion and blood glucose response.	Moderate	Memorial Sloan Kettering About Herbs
Efavirenz and midazolam	Case and human pharmacokinetic data suggest ginkgo may reduce the effect of efavirenz and lower midazolam concentrations.	Major	Memorial Sloan Kettering About Herbs
CYP, P-glycoprotein, UGT, and MATE1 substrate medicines	Preclinical and limited human evidence suggests altered metabolism or transport, but clinical relevance is not established for many substrates.	Uncertain	Memorial Sloan Kettering About Herbs

This information is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before using herbal medicines, especially if you take prescription medications.