Drug Interaction Report

Mefenamic Acid and Ginkgo: Interaction Details

A pharmacist-reviewed analysis of the Mefenamic Acid and Ginkgo interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Mefenamic Acid

Ponstel®
+

Ginkgo

No brand names on record
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Moderate
Can be significant — usually manageable with monitoring.
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.

Of 309 documented Mefenamic Acid interactions, 59 are rated moderate — including this one.
Onset
delayed
Evidence
probable
Severity
Moderate

What happens

An increased risk of bleeding

Interaction Deep Dive

Coadministration of ginkgo with medications that inhibit platelet aggregation may increase bleeding. Ginkgo inhibits platelet-activating factor. Normal hemostasis occurs 36 hours after discontinuation of ginkgo1. One case report describes a fatal intracerebral hemorrhage associated with concomitant use of ginkgo and ibuprofen, though definite causality could not be proven 3. Additionally, in a study, concomitant use of ginkgo biloba with etoricoxib significantly increased abnormal coagulation tests compared with use of ginkgo biloba without any known interacting drugs, and concomitant use with loxoprofen significantly increased the occurrence of bleeding 2.

Why it happens (mechanism)

Ginkgolide B may inhibit platelet activating factor (PAF) induced platelet aggregation

Literature reports

4 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) A 71-year-old man suffered a fatal intracerebral hemorrhage considered likely associated with concomitant use of Ginkgo biloba and ibuprofen. The patient was normotensive, nondiabetic, and did not drink alcohol. His medical history included total hip replacement and benign prostatic hyperplasia. No regular medication use was mentioned, including no long-term anticoagulation therapy post hip replacement. He had been taking Ginkgo biloba extract (Gingium(R), Biocur, Germany) 40 mg twice daily for at least 2.5 years prior to his death. He started taking ibuprofen 600 mg daily 4 weeks prior to his death for osteoarthritic hip pain. Since the patient did not have any risk factors for cerebral hemorrhage, the event was considered associated with the use of gingko and ibuprofen 3.

c) Cases of subarachnoid hemorrhage, subdural hematoma, intracerebral hemorrhage, and postoperative bleeding have been reported in patients taking ginkgo alone 456789 as well as with warfarin 10 and aspirin 11.

d) Ginkgolide B has been shown to inhibit PAF-induced platelet aggregation 1213.

Common questions

Can I take Mefenamic Acid and Ginkgo together?

An increased risk of bleeding Always confirm with your pharmacist or prescriber before making any change.

How serious is the Mefenamic Acid and Ginkgo 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 Mefenamic Acid 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 (13)

  1. 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.
  2. 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
  3. Meisel C, Johne A, & Roots I: Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen. Atherosclerosis 2003; 167(2):367. DOI
  4. 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.
  5. 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.
  6. Norred CL & Finlayson CA: Hemorrhage after the preoperative use of complementary and alternative medicines. AANA J 2000; 68:217-220.
  7. Vale S: Subarachnoid hemorrhage associated with Ginkgo biloba. Lancet 1998; 352:36.
  8. Lewis SL & Rowin J: Ginkgo biloba. Neurology 1997; 48:1137.
  9. Rowin J & Lewis SL: Spontaneous bilateral subdural hematomas associated with chronic Ginkgo biloba ingestion. Neurology 1996; 46:1775-1776. PubMed
  10. Matthews MK: Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998; 50:1933-1934.
  11. Rosenblatt M & Mindel J: Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997; 336:1108.
  12. 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
  13. 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.
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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.