Drug & supplement interaction

Ginkgo + Alteplase, tPA

Alteplase, tPA brand names: Activase, Actilyse.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Ginkgo has a moderate interaction with Alteplase, tPA. Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceA
What do Severity, Likelihood & Evidence mean?
Know someone taking this? Share
Facebook Post Reddit Email
On this page
Interaction report

Ginkgo and Alteplase, tPA

Here is the interaction we found between these two, with the evidence behind it.

Moderate

ANTICOAGULANT/ANTIPLATELET DRUGS

Why this applies to Alteplase, tPA

Alteplase, tPA falls under ANTICOAGULANT/ANTIPLATELET DRUGS — the group Ginkgo interacts with.

Ginkgo has been shown to increase the risk of bleeding in some people when taken with warfarin. Theoretically, ginkgo might increase the risk of bleeding if used with other anticoagulant or antiplatelet drugs.
Several pharmacodynamic studies suggest that ginkgo inhibits platelet aggregation. It is thought that the ginkgo constituent, ginkgolide B, displaces platelet-activating factor (PAF) from its binding sites, decreasing blood coagulation. Several case reports have documented serious bleeding events in patients taking ginkgo. However, population and clinical studies have produced mixed results. Some evidence shows that short-term use of ginkgo leaf does not significantly reduce platelet aggregation and blood clotting. A study in healthy males who took a specific ginkgo leaf extract (EGb 761) 160 mg twice daily for 7 days found no change in prothrombin time. An analysis of a large medical record database suggests that ginkgo increases the risk of a bleeding adverse event by 38% when taken concurrently with warfarin. It has been suggested that ginkgo has to be taken for at least 2-3 weeks to have a significant effect on platelet aggregation. However, a meta-analysis of 18 studies using standardized ginkgo extracts, 80-480 mg daily for up to 32 weeks, did not find a significant effect on platelet aggregation, fibrinogen concentration, or PT/aPTT. In addition, a single dose of ginkgo plus clopidogrel or ticlopidine does not seem to significantly increase bleeding time or platelet aggregation. Also, taking ginkgo leaf extract daily for 8 days in conjunction with rivaroxaban does not affect anti-factor Xa activity; however, this study did not evaluate bleeding time.
Severity Moderate Likelihood Possible Evidence A

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the thing about alteplase (tPA): it's a powerful clot-buster given in the hospital during emergencies like a stroke, heart attack, or serious blood clot. It works by actively breaking down clots, which already carries a real risk of bleeding. Ginkgo can lightly thin the blood too, mainly by making platelets a little less sticky, so stacking the two could add to that bleeding risk.

In practice, this isn't a daily worry for most people. Alteplase is given by a medical team in a controlled setting, and they'll know your medication and supplement history. Still, it's worth telling your doctor and pharmacist if you take ginkgo, since even small extra bleeding effects matter with a drug this strong. Never start or stop anything on your own; let your care team guide you.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Benjamin J, Muir T, Briggs K, Pentland B. A case of cerebral haemorrhage-can Ginkgo biloba be implicated? Postgrad Med J 2001;77:112-3.
  2. Rowin J, Lewis SL. Spontaneous bilateral subdural hemotomas with chronic Ginkgo biloba ingestion. Neurology 1996;46:1775-6.
  3. Rosenblatt M, Mindel T. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997;336:1108.
  4. Heck AM, DeWitt BA, Lukes AL. Potential interactions between alternative therapies and warfarin. Am J Health Syst Pharm 2000;57:1221-7. DOI
  5. Miller LG, Freeman B. Possible subdural hematoma associated with Ginkgo biloba. J Herb Pharmacother 2002;2:57-63.
  6. Kudolo GB, Dorsey S, Blodgett J. Effect of the ingestion of Ginkgo biloba extract on platelet aggregation and urinary prostanoid excretion in healthy and Type 2 diabetic subjects. Thromb Res 2002;108:151-60.. PubMed
  7. Kohler S, Funk P, Kieser M. Influence of a 7-day treatment with Ginkgo biloba special extract EGb 761 on bleeding time and coagulation: a randomized, placebo-controlled, double-blind study in healthy volunteers. Blood Coagul Fibrinolysis 2004;15:303–9. PubMed
  8. Destro MW, Speranzini MB, Cavalheiro Filho C, et al. Bilateral haematoma after rhytidoplasty and blepharoplasty following chronic use of Ginkgo biloba. Br J Plast Surg 2005;58:100-1. PubMed
  9. Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with Ginkgo biloba: a case report and systematic review of the literature. J Gen Intern Med 2005;20;657-61. DOI
  10. Meisel C, Johne A, Roots I. Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen. Atherosclerosis 2003;167:367. PubMed
  11. Bebbington A, Kulkarni R, Roberts P. Ginkgo biloba: Persistent bleeding after total hip arthroplasty caused by herbal self-medication. J Arthroplasty 2005;20:125-6. .
  12. Vale S. Subarachnoid haemorrhage associated with Ginkgo biloba. Lancet 1998;352:36. PubMed
  13. Aruna D, Naidu MU. Pharmacodynamic interaction studies of Ginkgo biloba with cilostazol and clopidogrel in healthy human subjects. Br J Clin Pharmacol 2007;63:333-8.
  14. Kim BH, Kim KP, Lim KS, et al. Influence of Ginkgo biloba extract on the pharmacodynamic effects and pharmacokinetic properties of ticlopidine: An open-label, randomized, two-period, two-treatment, two-sequence, single-dose crossover study in healthy Kor
  15. Kellermann AJ, Kloft C. Is there a risk of bleeding associated with standardized ginkgo biloba extract therapy? A systematic review and meta-analysis. Pharmacotherapy 2011;31:490-502.
  16. Bal Dit, Sollier C., Caplain, H., and Drouet, L. No alteration in platelet function or coagulation induced by EGb761 in a controlled study. Clin Lab Haematol. 2003;25(4):251-253. PubMed
  17. Kim, T. E., Kim, B. H., Kim, J., Kim, K. P., Yi, S., Shin, H. S., Lee, Y. O., Lee, K. H., Shin, S. G., Jang, I. J., and Yu, K. S. Comparison of the pharmacokinetics of ticlopidine between administration of a combined fixed-dose tablet formulation of ticl
  18. Pedroso, J. L., Henriques Aquino, C. C., Escorcio Bezerra, M. L., Baiense, R. F., Suarez, M. M., Dutra, L. A., Braga-Neto, P., and Povoas Barsottini, O. G. Ginkgo biloba and cerebral bleeding: a case report and critical review. Neurologist. 2011;17(2):89 PubMed
  19. Stoddard GJ, Archer M, Shane-McWhorter L, Bray BE, Redd DF, Proulx J, Zeng-Treitler Q. Ginkgo and Warfarin Interaction in a Large Veterans Administration Population. AMIA Annu Symp Proc. 2015 Nov 5;2015:1174-83.
  20. Hoerr R, Zimmermann A, Seitz F, Dienel A. Single and repeated doses of EGb 761® do not affect pharmacokinetics or pharmacodynamics of rivaroxaban in healthy subjects. Front Pharmacol. 2022 Apr 20;13:868843. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Ginkgo Also Interacts With Other Medications

Ginkgo has 1 major, 1,264 moderate known drug interactions in our database — the Alteplase, tPA one above is one of them. If you take anything else, check it against the full list below.

Major 1 Moderate 1,264 No known interaction 1,565 (incl. Alteplase, tPA)
Taking anything else?

Check Another of Your Medications Against Ginkgo

Covers the 2,830 medications we’ve checked against Ginkgo. Pick one to open its full report.

From our Q&A

Questions About Ginkgo or Alteplase, tPA

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Ginkgo or Alteplase, tPA, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Alteplase, tPA

This page covers Ginkgo only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Alteplase, tPA page lists 219 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Danshen (major), Piracetam (major), Aconite (moderate) and Allspice (moderate).

By severity: 3 major · 191 moderate · 25 minor.

From our pharmacist’s overview on the Alteplase, tPA page

“Nobody plans to receive alteplase (Activase, tPA). It arrives by IV in an emergency to dissolve the clot behind a stroke or heart attack, so the supplements already in your system at that moment matter, and this list deserves real weight.”

Reviewed by 2 · Jul 18, 2026

Open the Alteplase, tPA interaction page

One more smart check

Taking Ginkgo as Part of a Dietary Supplement Product? Check It for Interactions

We hold 4,399 real supplement products containing Ginkgo, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Ginkgo. Your product may carry other ingredients that interact with Alteplase, tPA too, on top of Ginkgo — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Ginkgo and Alteplase, tPA Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Ginkgo
Top 5%

#63 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Alteplase, tPA
Steady interest

#1,938 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Ginkgo

What is Ginkgo?

Ginkgo
  • Memory and cognitive support
  • Age-related mental decline
  • Circulation problems
  • Tinnitus (ringing in the ears)
  • Dizziness or vertigo

Ginkgo is one of the world's most popular herbal supplements, mostly taken to support memory and circulation. The evidence for these uses is mixed and generally weak, and it is not proven to prevent memory loss or dementia. It is usually well tolerated in healthy adults, but it can thin the blood, so talk to your pharmacist or doctor before using it.

Read the full Ginkgo monograph & all interactions
Keep checking

Other Drugs & Ginkgo

Browse every other medication we’ve checked against Ginkgo — both the ones with a known interaction and the ones without. Select any drug for the full detail.

1Major
1,264Moderate
0Minor
1,564No known interaction
1 Major 1,264 Moderate 1,564 No interaction
Major

1 interaction

Moderate

1,264 interactions

Showing 60 of 1,264 moderate interactions — see all 1,264 on the Ginkgo page.

No interaction 1,564 drugs checked — show the list

We also checked Ginkgo against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,564 medications checked with no known interaction — see the full Ginkgo list.

See the full Ginkgo interactions page
See every supplement checked against Alteplase, tPA, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Ginkgo monograph › Uses, safety, and every drug interaction in one place Alteplase, tPA supplement interactions › Every supplement checked against Alteplase, tPA, ranked by severity Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Ginkgo and Alteplase, tPA Together: Common Questions

Can you take Ginkgo with Alteplase, tPA?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Ginkgo and Alteplase, tPA interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Alteplase, tPA and Ginkgo?

Our pharmacists answer your medication & supplement questions — free.

Ask a pharmacist

This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.