Apixaban and Ginkgo: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Aug 8, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Apixaban
Ginkgo
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Apixaban (Eliquis) is a blood thinner, and ginkgo is an herbal supplement that can also make it a little harder for your blood to clot. Taking them together may nudge up the amount of apixaban in your body and add to its blood-thinning effect. That could raise your chance of bleeding or bruising more easily.
The good news is this concern is mostly theoretical, meaning it is based on how these two work rather than strong studies. Please don't stop either one on your own. Just let your pharmacist or doctor know you take ginkgo, and watch for unusual bruising, nosebleeds, or bleeding that won't stop. Your care team can help you manage this safely.
Effect: Possible increased apixaban exposure and additive bleeding risk. Apixaban is a substrate of P-glycoprotein; ginkgo may inhibit P-gp efflux, potentially raising apixaban AUC/Cmax. Ginkgo also has intrinsic antiplatelet/anticoagulant activity, adding a pharmacodynamic bleeding contribution.
- Direction: Increased apixaban effect and bleeding risk (neither is a prodrug).
- Magnitude: Not quantified.
- Onset: Unspecified.
- Evidence: Theoretical.
- Management: Use with caution, especially with other bleeding risk factors or additional P-gp inhibitors. Monitor for bleeding/bruising; individualize based on overall risk.
What happens
Increased exposure of apixaban and an increased risk of bleeding
Interaction Deep Dive
Taking apixaban together with ginkgo may raise apixaban exposure. Ginkgo can also produce anticoagulant or antiplatelet actions, and coadministration may therefore heighten bleeding risk. Caution is advised, particularly when other bleeding risk factors are present or when other agents that can elevate apixaban levels are being used1.
Why it happens (mechanism)
Possible inhibition of P-glycoprotein-mediated efflux transport by ginkgo; additive effects on hemostasis
How to manage this interaction
If you take both, the main goal is to watch for bleeding and keep your care team informed.
- Keep taking your apixaban as prescribed and do not start or stop the ginkgo on your own.
- Tell your pharmacist or prescriber that you use ginkgo so they can review your overall bleeding risk.
- Watch for signs of bleeding: easy bruising, nosebleeds, bleeding gums, pink or red urine, black stools, or cuts that won't stop.
- Your team may monitor you more closely, especially if you have other bleeding risk factors or take other medicines that raise apixaban levels.
- Seek prompt care for any heavy or unexplained bleeding.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Apixaban and Ginkgo together?
Ginkgo may raise apixaban levels and add to its blood-thinning effect, so watch for easy bruising or bleeding and tell your pharmacist or doctor you take ginkgo. Keep taking your medicine as prescribed unless they advise otherwise. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Apixaban and Ginkgo interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Apixaban and Ginkgo interaction managed?
If you take both, the main goal is to watch for bleeding and keep your care team informed. Keep taking your apixaban as prescribed and do not start or stop the ginkgo on your own. Tell your pharmacist or prescriber that you use ginkgo so they can review your overall bleeding risk. Watch for signs of bleeding: easy bruising, nosebleeds, bleeding gums, pink or red urine, black stools, or cuts that w… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Apixaban or Ginkgo need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there anything you'd monitor while I'm on both?
References (1)
- Steffel J, Collins R, Antz M, et al: 2021 European Heart Rhythm Association Practical Guide on the use of non-vitamin K antagonist oral anticoagulants in patients with atrial fibrillation. Europace 2021; 23(10):1612-1676.
Keep reading about Apixaban
Keep reading about Ginkgo
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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