Ginkgo and Ethosuximide: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ethosuximide
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
Decreased anticonvulsant effectiveness
Interaction Deep Dive
In a case report, 2 patients with epilepsy previously well controlled by valproate sodium developed a recurrence of seizures after ingesting ginkgo extract. Seizure control was regained after ginkgo was withdrawn3. An infant developed seizures after exposure to 4'-O-methylpyridoxine arising from ingestion of ginkgo seeds 4. The compound 4'-O-methylpyridoxine, a neurotoxin, is found in ginkgo seeds (used as food in Japan) as well as in leaves, the ginkgo component from which commercially available extracts are derived 5. The majority of ginkgo leaf products should not contain sufficient amounts of 4'-O-methylpyridoxine to cause seizures. However, ginkgo products are not commonly assayed to assure that 4'-O-methylpyridixone is not contained in the commercial product. Of concern are those instances where, depending on the harvest season and the potential introduction of contamination, 4'-O-methylpyridoxine may be present in sufficient amounts to be problematic in vulnerable populations (eg, infants or those with known seizure disorders).
Why it happens (mechanism)
Neurotoxin 4'-O-methylpyridoxine (found in leaves and seeds of ginkgo biloba) may cause seizures
Literature reports
3 reports — tap to read
a) The serum of a 21-month-old patient with gin-nan food poisoning was assayed for 4'-O-methylpyridoxine levels. The serum concentration was 0.9 micrograms/milliliter (mcg/mL) at 8.5 hours after ingesting ginkgo seeds, decreasing to 0.05 mcg/mL at 15.5 hours. The authors concluded that the 4'-O-methylpyridoxine content was responsible for the tonic/clonic convulsions and loss of consciousness observed. They further observed that infants are particularly vulnerable 1.
b) Four to six milligrams of the neurotoxin 4'-O-methylpyridoxine have been isolated from 2 kilograms of Ginkgo biloba leaves which is the source of commercially-available products. Highest amounts were found in seeds (85 micrograms (mcg)/seed) and leaves (5 mcg/leaf) derived from the tree at the end of July and beginning of August. The albumen of the seed can contain 105.15 mcg/gram dry weight, but this is reduced to 0.75-1.32 mcg/gram dry weight when boiled. The unprocessed seed coats contain from 5.44-7.15 mcg/gram dry weight. The neurotoxin in ginkgo leaf was detected in medications and it was even detectable in homeopathic preparations. Specifically, 8.13 mcg/mL of 4'-O-methylpyridoxine was found in Tebonin Forte(R), 9.77 mcg/mL in Rokan(R), 3.80 mcg/mL in Kaveri Forte(R), and 7.18 mcg/mL in Gingium(R). Based on recommended daily intake, this translates into a maximum daily intake of 4'-O-methylpyridoxine of 48.78 mcg, 58.62 mcg, 11.40 mcg, and 43.08 mcg for Tebonin Forte(R), Rokan(R), Kaveri Forte(R), and Gingium(R), respectively. Among the homeopathic products, Ginkgo biloba Urtinktur Hanosan(R) and Ginkgo biloba Urtinktur DHU(R) contained 0.301 mcg/mL and 0.589 mcg/mL of 4'-O-methylpyridoxine, respectively. However, the authors note that the amount contained in medicinal extracts of ginkgo leaves may be too low to be of clinical significance. Concern remains with the variance in 4'-O-methylpyridoxine content depending on the season during which the ginkgo was harvested 2.
c) Seizures recurred in 2 patients, both with epilepsy that was well controlled prior to ingesting ginkgo biloba (Gb). The patients (an 84-year-old woman and a 78-year-old man) had been free of seizures for at least 18 months prior to beginning therapy with Gb 120 milligrams daily to treat cognitive decline. Both patients developed seizures within 2 weeks of beginning Gb therapy, and both remained seizure-free (without changing anticonvulsant therapy) after discontinuing Gb 3.
Common questions
Can I take Ginkgo and Ethosuximide together?
Decreased anticonvulsant effectiveness Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ginkgo and Ethosuximide 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 Ethosuximide 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 (5)
- Yagi M, Wada K, Sakata M, et al: Studies on the constituents of edible and medicinal plants. IV. Determination of 4'-O-methylpyridoxine in serum of the patient with Gin-nan food poisoning. Yakugaku Zasshi 1993; 113:596-99. PubMed
- Arenz A, Klein M, Fiehe K, et al: Occurrence of neurotoxic 4'-0-methylpyridoxine in Ginkgo biloba leaves, Ginkgo medications and Japanese Ginkgo food. Planta Medica 1996; 62:548-51.
- Granger AS: Ginkgo biloba precipitating epileptic seizures. Age Ageing 2001; 30(6):523-525. DOI
- Yagi M, Wada K, Sakata M, et al: Studies on the constituents of edible and medicinal plants. IV. Determination of 4'-O-methylpyridoxine in serum of the patient with Gin-nan food poisoning. Yakugaku Zasshi 1993; 113:596-599. PubMed
- Arenz A, Klein M, Fiehe K, et al: Occurrence of neurotoxic 4'-0-methylpyridoxine in Ginkgo biloba leaves, Ginkgo medications and Japanese Ginkgo food. Planta Medica 1996; 62:548-551.
Keep reading about Ethosuximide
Keep reading about Ginkgo
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