Ginkgo and Midazolam Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Midazolam Injection
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 or decreased midazolam plasma concentrations
Interaction Deep Dive
Administration of ginkgo biloba for 28 days reduced the AUC and Cmax of midazolam approximately 30% in a single-center, open-label study (n=13). Concurrent use of gingko biloba and midazolam results in reduced plasma concentrations of midazolam and possibly reduced effectiveness. This interaction may be attributed to gingko biloba-mediated induction of CYP3A4 metabolism1. In contrast, the administration of ginkgo biloba for 28 days in 10 healthy Japanese men significantly increased the AUC of midazolam and decreased its oral clearance 2. Monitor the effectiveness of midazolam and adjust dose as needed.
Why it happens (mechanism)
Unknown
Literature reports
2 reports — tap to read
a) Administration of ginkgo biloba for 28 days reduced the AUC and Cmax of midazolam approximately 30% in a single-center, open-label study (n=13). Healthy volunteers were administered 4 weeks of oral ginkgo biloba 120 mg twice daily (35 +/- 1.7 mg/capsule (29.2% of total content) of flavonol glycosides, 6.1 +/- 0.7 mg/capsule (5.1% of total content) of terpene lactones). After 4 weeks of ginkgo, a single 8-mg oral dose of midazolam syrup was administered. The geometric mean ratio (GMR) of the AUC of midazolam was 0.66 (90% CI, 0.49 to 0.83; p=0.03). The GMR of the Cmax of midazolam was 0.69 (90% CI, 0.54 to 0.84; p=0.03). In 10 of 13 volunteers, the apparent oral clearance of midazolam increased after administration of ginkgo, with a GMR of 1.53 (90% CI, 1.02 to 2.04; p=0.06). The half-life and Tmax did not change after ginkgo administration 1.
b) Administration of ginkgo biloba for 28 days significantly increased the AUC (25%) and significantly decreased the oral clearance (26%) of midazolam in 10 healthy, Japanese males who were assessed for the activities of gingko biloba on CYP2C9 and CYP3A4. In a pretrial phase, subjects received a standard 75 g glucose solution, and blood samples were taken prior to and after intake. Two weeks after the fast, subjects were administered oral tolbutamide 120 mg followed by oral midazolam 8 mg 1 hour later. Blood and urine samples were intermittently collected up to 24 hours. The following day, subjects were given an oral doses of ginkgo biloba (120 mg 3 times daily) for 28 days. Following treatment with ginkgo biloba, subjects received tolbutamide, midazolam, and glucose. Again, blood and urine samples were collected. Before gingko treatment, the AUC of midazolam was 167 hr x ng/mL, which increased to 208 hr x ng/mL (p=0.0062). The oral clearance of midazolam decreased from 0.865 L/hr/kg compared to 0.639 L/hr/kg (p=0.0072) before and after ginkgo treatment, respectively 2.
Common questions
Can I take Ginkgo and Midazolam Injection together?
Increased or decreased midazolam plasma concentrations Always confirm with your pharmacist or prescriber before making any change.
How serious is the Ginkgo and Midazolam Injection interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "rapid". Effects can appear quickly, often within about 24 hours of combining the drugs.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
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 Midazolam Injection 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 (2)
- Robertson SM, Davey RT, Voell J, et al: Effect of Ginkgo biloba extract on lopinavir, midazolam and fexofenadine pharmacokinetics in healthy subjects. Curr Med Res Opin 2008; 24(2):591-599. PubMed
- Uchida S, Yamada H, Li XD, et al: Effects of Ginkgo biloba extract on pharmacokinetics and pharmacodynamics of tolbutamide and midazolam in healthy volunteers. J Clin Pharmacol 2006; 46(11):1290-1298. DOI
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