Sertraline and Ginkgo: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Sertraline
No brand names on recordGinkgo
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.
Sertraline is an antidepressant (an SSRI) that raises serotonin, a chemical messenger in your brain. Ginkgo is an herbal supplement that some people take for memory or energy. There is a chance that ginkgo also nudges serotonin activity a little. When you combine them, serotonin levels could climb too high, which in rare cases leads to a reaction called serotonin syndrome (things like a racing heart, high fever, muscle twitching, sweating, or feeling confused or agitated).
Please know this is not common, and the evidence is limited. The good news is your care team can watch for it. Talk with your pharmacist or doctor before starting or stopping ginkgo so they can keep you safe.
Mechanism: Additive serotonergic effects. Sertraline is an SSRI; ginkgo has shown serotonergic activity in animal models and possible (but questionable) MAO inhibition in vitro. Neither agent is dependent on activation, so the effect is additive PD, not a PK shift.
- Direction: Increased serotonergic tone, raising theoretical risk of serotonin syndrome (hyperthermia, hypertension, myoclonus, altered mental status).
- Onset: Delayed.
- Evidence: Probable but largely theoretical/case-based; human data did not confirm central MAO inhibition.
- Severity: Moderate.
- Management: Monitor for serotonin syndrome; counsel especially if ginkgo is used for SSRI-related sexual dysfunction.
What happens
Increased risk of serotonin syndrome (hypertension, hyperthermia, myoclonus, mental status changes)
Interaction Deep Dive
In one case report, incorporating Ginkgo biloba and/or St. John's Wort into a regimen that already included buspirone and fluoxetine may have triggered a hypomanic episode1. Whether the effect stemmed from Ginkgo, from St. John's Wort, from the two used together, or from other characteristics of the patient remains uncertain. From a theoretical standpoint, Ginkgo could heighten the likelihood of serotonin syndrome when combined with selective serotonin reuptake inhibitors (SSRIs). Care should be taken, particularly when ginkgo is used to offset the sexual dysfunction linked to SSRIs. Ginkgo may suppress monoamine oxidase23 and has shown serotonergic effects in animals4, which could raise the risk of serotonin syndrome when ginkgo is paired with SSRIs. However, the proposed MAO inhibitory action of ginkgo is open to doubt. In a human study, no MAO inhibition was observed in the brain after oral intake5. Ginkgo biloba extract suppressed MAO-A/MAO-B in the rat brain in vitro23 as well as MAO-B in human platelets in vitro3. In mice, oral consumption produced no meaningful MAO inhibition6.
Why it happens (mechanism)
Additive pharmacologic effects resulting in excessive serotonergic stimulation
How to manage this interaction
If you take both sertraline and ginkgo, here is how a care team usually handles it:
- Keep taking your sertraline as prescribed unless your doctor tells you otherwise.
- Let your pharmacist or prescriber know you are taking (or want to start) ginkgo, since it is a supplement they may not have on your record.
- Your team may monitor you more closely for signs of serotonin syndrome.
- Watch for symptoms like rapid heartbeat, fever, heavy sweating, muscle twitching or stiffness, agitation, or confusion. Seek care promptly if these appear.
This is especially worth raising if you are using ginkgo to help with SSRI-related sexual side effects.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A 42-year-old woman developed symptoms consistent with a mixed hypomanic episode after using fluoxetine, buspirone, Ginkgo biloba, and St. John's Wort together. Her symptoms cleared after Ginkgo and St. John's Wort were stopped. She was receiving treatment for depression that followed a mild traumatic brain injury, with fluoxetine 20 milligrams (mg) twice daily and buspirone 15 mg twice daily. Several weeks before she presented, her buspirone dose was raised to 20 mg twice daily because of ongoing anxiety, and she started taking Ginkgo biloba, melatonin, and St. John's Wort at unspecified doses. Melatonin was judged unlikely to have played a role in her symptoms. Ginkgo and St. John's Wort were regarded as possible contributors because they may potentiate antidepressants, and in light of the temporal relationship between starting the herbs and the onset of symptoms as well as stopping the herbs and the resolution of symptoms. Nevertheless, the brain injury was viewed as a possible contributor 1.
Common questions
Can I take Sertraline and Ginkgo together?
Combining sertraline with ginkgo may slightly raise the risk of serotonin syndrome, so keep taking your prescribed medication but tell your pharmacist or doctor about the ginkgo and watch for symptoms like fever, racing heart, or muscle twitching. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Sertraline 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 is the Sertraline and Ginkgo interaction managed?
If you take both sertraline and ginkgo, here is how a care team usually handles it: Keep taking your sertraline as prescribed unless your doctor tells you otherwise. Let your pharmacist or prescriber know you are taking (or want to start) ginkgo, since it is a supplement they may not have on your record. Your team may monitor you more closely for signs of serotonin syndrome. Watch for symptoms lik… Management is individual — always follow your own care team's guidance.
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 Sertraline 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 (6)
- Spinella M & Eaton LA: Hypomania induced by herbal and pharmaceutical psychotropic medicines following mild traumatic brain injury. Brain Injury 2002; 16(4):359-367. PubMed
- Sloley BD, Urichik LJ, Morley P, et al: Identification of kaempferol as a monoamine oxidase inhibitor and potential neuroprotectant in extracts of ginkgo biloba leaves. J Pharm Pharmacol 2000; 52:451-459.
- White HL, Scates PW, & Cooper BR: Extracts of Ginkgo biloba leaves inhibit monoamine oxidase. Life Sci 1996; 58(16):1315-1321. PubMed
- Ramassamy C, Christen Y, Clostre F, et al: The Ginkgo biloba extract, EGb761, increases synaptosomal uptake of 5-hydroxytryptamine: in-vitro and ex-vivo studies. J Pharm Pharmacol 1992; 44:943-945.
- Fowler JS, Wang GJ, Volkow ND, et al: Evidence that ginkgo biloba extract does not inhibit MAO A and B in living human brain. Life Sci 2000; 66(9):141-146. DOI
- Porsolt RD, Roux S, & Drieu K: Evaluation of a ginkgo biloba extract (EGb 761) in functional tests for monoamine oxidase inhibition. Arzneim-Forsch/Drug Res 2000; 50:232-235. PubMed
Keep reading about Sertraline
Keep reading about Ginkgo
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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