Dipyridamole with Ginkgo Interaction Details
Brand Names Associated with Dipyridamole
- Dipyridamole
- Permole®
- Persantine®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Jan 08, 2024
Interaction Effect
Increased risk of bleeding
Interaction Summary
Although not specifically identified in studies with dipyridamole, concurrent use of dipyridamole and ginkgo may increase the risk of bleeding complications as reported with other antiplatelet agents. Spontaneous hyphema, subphrenic hematoma, and vitreous hemorrhage have been reported following concomitant use of aspirin and ginkgo. Concurrent use of ginkgo biloba has potentiated the prolonged bleeding time associated with cilostazol . However, cases of subarachnoid hemorrhage, subdural hematoma, and postoperative bleeding have been reported in patients taking ginkgo alone . Ginkgolide B has been shown to inhibit platelet activating factor (PAF)-induced platelet aggregation . Patients taking medications which affect platelet aggregation may be at increased risk for potentially serious bleeding disorders. Until this potential interaction is better characterized, concomitant use of dipyridamole and ginkgo should be avoided.
Severity
Moderate
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant use of dipyridamole and ginkgo may increase the risk of bleeding. If both agents are taken simultaneously, consider monitoring bleeding time and signs and symptoms of excessive bleeding or bruising.
Mechanism Of Interaction
Inhibition of platelet activating factor (PAF) induced platelet aggregation by ginkgolide B
Literature Reports
A) The combination of ginkgo biloba with either cilostazol or clopidogrel did not enhance antiplatelet effect compared with individual agents; however, ginkgo biloba potentiated the prolonged bleeding time associated with cilostazol. In an open-label, randomized, crossover, pharmacodynamic study, 10 healthy male adults (aged 27 +/- 4 years) were randomized to receive a single administration of the following: cilostazol 100 milligrams (mg), cilostazol 200 mg, ginkgo 120 mg, ginkgo 240 mg, clopidogrel 75 mg, clopidogrel 150 mg, clopidogrel 75 mg plus ginkgo 120 mg, and cilostazol 100 mg plus ginkgo 120 mg. The washout period was 48 hours with overnight fasting. Platelet aggregation, coagulation parameters, and hemodynamic parameters were assessed zero and 6 hours after drug administration. Coadministration of a single dose of ginkgo biloba 120 mg with either cilostazol 100 mg or clopidogrel 75 mg did not significantly enhance adenosine diphosphate (ADP)- or collagen-induced inhibition of platelet aggregation. While cilostazol, ginkgo biloba, clopidogrel and their combinations are associated with significant prolongation of bleeding time from baseline (mean bleeding time 107 +/- 33 seconds (sec)), the combination use of cilostazol 100 mg and ginkgo 120 mg was associated with marked potentiation in prolongation of bleeding time (211 +/- 70 sec) compared with individual doses of cilostazol (150 +/- 42 sec) and ginkgo alone (144 +/- 28 sec) (p less than 0.05 compared with baseline). There were no significant changes in clotting time or platelet count observed with any of the treatment groups. Of note, there was no observable correlation between platelet inhibition and bleeding time prolongation in the study .
B) Subphrenic hematoma and vitreous hemorrhage were reported in a 59-year-old patient following a second liver transplant. It was discovered that the patient had been taking an unknown dose of ginkgo biloba for an unknown period of time prior to transplantation and during his hospital stay. The patient was also taking aspirin 81 mg daily postoperatively. The patient's hematocrit decreased from 34.3% to 20.5% and platelet count ranged from 28,000 to 173,000 after transplant until the day of exploratory laparotomy during which the subphrenic hematoma was discovered. Prothrombin and partial thromboplastin were within normal limits. The patient complained of blurred vision three weeks post-transplantation, which was determined to be due to vitreous hemorrhage. During the time of blurred vision, the patient's platelet count ranged from 102,000 to 174,000, with normal prothrombin and partial thromboplastin time. No further bleeding episodes occurred following discontinuation of ginkgo .
C) A 70-year-old male developed blurred vision of the right eye with red discoloration through his cornea one week after taking ginkgo 50 mg twice daily. Other medications were aspirin 325 mg daily for 3 years post-coronary artery bypass surgery without complaint or incident. The patient was diagnosed with hyphema (bleeding from the iris into the anterior chamber of the eye), and advised to discontinue ginkgo use. The bleeding stopped spontaneously with no bleeding recurrence during a 3-month follow-up period despite continued aspirin use .
Dipyridamole Overview
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Dipyridamole is used with other drugs to reduce the risk of blood clots after heart valve replacement. It works by preventing excessive blood clotting.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.