Ginkgo and Anagrelide: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Anagrelide
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.
What happens
Increased platelet inhibition which may increase the risk of bleeding
Interaction Deep Dive
Coadministration of ginkgo with medications that inhibit platelet aggregation, such as antiplatelet agents, may increase bleeding. Ginkgo inhibits platelet-activating factor. Normal hemostasis occurs 36 hours after discontinuation of ginkgo1. In a study, concomitant use of ginkgo biloba with clopidogrel or aspirin significantly increased the occurrence of bleeding and abnormal coagulation tests, however no significant differences occurred with ticagrelor use for either outcome 2. Although the combination of gingko biloba with either cilostazol or clopidogrel did not enhance antiplatelet effect compared with individual agents, ginkgo biloba potentiated the prolonged bleeding time associated with cilostazol in another study 3.
Why it happens (mechanism)
Inhibition of platelet activating factor (PAF)-induced platelet aggregation by ginkgo; additive antiplatelet effects
Literature reports
6 reports — tap to read
a) Coadministration of ginkgo biloba in subjects with at least 1 known interacting drug (drug-drug interaction group; n=258) was significantly correlated with increased occurrence of bleeding (OR, 1.08; 95% CI, 1.04 to 1.11) and abnormal coagulation tests (OR, 1.49; 95% CI, 1.38 to 1.58) compared subjects receiving ginkgo biloba without any known interacting drugs (non-drug-drug interaction group; n=489) in a retrospective, observation study. Significantly increased occurrence of bleeding and abnormal coagulation tests were demonstrated with use of ginkgo biloba and clopidogrel (OR, 1.1 and 1.58), aspirin (OR, 1.12 and 1.48), or omeprazole (OR, 1.1 and 1.51), respectively. Coadministration of etoricoxib (OR, 1.37), insulin (OR, 1.34), or domperidone (OR, 1.29) significantly increased the abnormal coagulations tests outcome only; loxoprofen (OR, 1.58) or nifedipine (OR, 1.09) significantly increased the occurrence of bleeding outcome only. There were no significant differences detected between groups for either outcome with ticagrelor, acenocoumarol, meloxicam, celecoxib, or direct oral anticoagulants (enoxaban or rivaroxaban). Patients were a mean of about 63 years and most were female (66.67%). Most patients had 1 interacting drug pair (71.71%), however 24.81% had 2, 2.71% had 3, and 0.77% had 4 interacting pairs 2.
b) 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 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). 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 3.
c) 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 4.
d) 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 5.
e) Cases of subarachnoid hemorrhage, subdural hematoma, and postoperative bleeding have been reported in patients taking ginkgo alone 67891011.
f) Ginkgolide B has been shown to inhibit platelet activating factor (PAF)-induced platelet aggregation 1213.
Common questions
Can I take Ginkgo and Anagrelide together?
Increased platelet inhibition which may increase the risk of bleeding Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ginkgo and Anagrelide interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Ginkgo or Anagrelide 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 (13)
- Kopp SL, Vandermeulen E, McBane RD, et al: Regional anesthesia in the patient receiving antithrombotic or thrombolytic therapy: American Society of Regional Anesthesia and Pain Medicine evidence-based guidelines (fifth edition). Reg Anesth Pain Med 2025; Epub:Epub.
- Mai NTQ, Hieu NV, Ngan TT, et al: Impact of Ginkgo biloba drug interactions on bleeding risk and coagulation profiles: a comprehensive analysis. PLoS One 2025; 20(4):e0321804. PubMed
- Aruna D & Naidu MU: Pharmacodynamic interaction studies of Ginkgo biloba with cilostazol and clopidogrel in healthy human subjects. Br J Clin Pharmacol 2007; 63(3):333-338.
- Hauser D, Gayowski T, & Singh N: Bleeding complications precipitated by unrecognized Ginkgo biloba use after liver transplantation. Transpl Int 2002; 15(7):377-379.
- Rosenblatt M & Mindel J: Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997; 336:1108.
- Benjamin J, Muir T, Briggs K, et al: A case of cerebral haemorrhage - can Ginkgo biloba be implicated?. Postgrad Med J 2001; 77(904):112-113.
- Fessenden JM, Wittenborn W, & Clarke L: Ginkgo biloba: A case report of herbal medicine and bleeding postoperatively from a laparoscopic cholescystectomy. Am Surg 2001; 67(1):33-35.
- Norred CL & Finlayson CA: Hemorrhage after the preoperative use of complementary and alternative medicines. AANA J 2000; 68:217-220.
- Vale S: Subarachnoid hemorrhage associated with Ginkgo biloba. Lancet 1998; 352:36.
- Lewis SL & Rowin J: Ginkgo biloba. Neurology 1997; 48:1137.
- Rowin J & Lewis SL: Spontaneous bilateral subdural hematomas associated with chronic Ginkgo biloba ingestion. Neurology 1996; 46:1775-1776. PubMed
- Wilkens JH, Wilkens H, Uffmann J, et al: Effects of a PAF-antagonist (BN 52063) on bronchoconstriction and platelet activation during exercise induced asthma. Br J Clin Pharmac 1990; 29:85-91. PubMed
- Chung KF, McCusker M, Page CP, et al: Effect of a ginkgolide mixture (BN 52063) in antagonizing skin and platelet responses to platelet activating factor in man. Lancet 1987; 1:248-251.
Keep reading about Anagrelide
Keep reading about Ginkgo
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