The Polypharmacy Network

Polypharmacy Prevention
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What You Should Know About Ginkgo Biloba?
By: Joanne Jansen PharmD and Anjanette Dymerski PharmD
Many people consider herbal supplements safe since they are natural. However, even natural things can be bad for you; for example, a bite from a black widow spider is natural and not good. Always discuss any new supplements with your doctor or pharmacist before taking them to make sure they do not interact with your medications or cause worsening of a disease you have.

It is important to remember that natural supplements and vitamins are not regulated by the Food and Drug Administration (FDA). This means that there may be ingredients in the products that are not listed. There is also no guarantee that the ingredients listed on the bottle are accurate.

Ginkgo is often used to improve memory, to decrease high blood pressure, to reduce the risk of heart disease, to prevent you from getting Alzheimer’s and to slow the disease in someone who already has Alzheimer’s. In large recent studies, ginkgo has not been shown to be beneficial for any of these.

Although some people may feel that they do get some benefit from ginkgo, there are many reasons you may not want to take it. Ginkgo may interact with some drugs and change or increase their effects. For instance, ginkgo interacts with all of these drugs and more:
• Anticoagulants / Antiplatelets (blood thinners)
     o warfarin (Coumadin®)
     o clopidogrel (Plavix®)
     o dipyridamole (Persantine®, Aggrenox®)
     o aspirin
     o ticlopidine (Ticlid®)
     o enoxaparin (Lovenox®)
     o heparin
• NSAIDs
     o Ibuprofen (Advil®, Motrin®)
     o Naproxen (Aleve®, Naprosyn®)
     o Indomethacin (Indocin®)
     o Ketoprofen
     o Meloxicam (Mobic®)
     o Diclofenac (Voltaren®)
     o Oxaprozin (Daypro®)
     o Celecoxib (Celebrex®)
     o Piroxicam (Feldene®)

Ginkgo can cause problems in people with certain diseases. If you have one of the following, discuss with your doctor or pharmacist whether you should take ginkgo:
• Bleeding problems
• Diabetes
• Epilepsy

Other things you should know about ginkgo:
• Tell your doctor you are taking this drug before you have surgery. You may need to stop it two weeks before surgery to prevent bleeding problems.
• Tell your doctor or pharmacist you are taking this drug before you start any new medications.
• Some side effects of ginkgo can be bleeding, stomach upset, dizziness, constipation, allergic skin reactions, heart palpitations or irregular heart beat, and headache.
• Avoid ginkgo seeds because they contain toxins if raw or not cooked correctly.

More information available at the Natural Products Database of The Pharmacist’s Letter.