Drug & supplement interaction

Ginkgo + Sofosbuvir, Velpatasvir

Sofosbuvir, Velpatasvir brand name: Epclusa.

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

Sofosbuvir, Velpatasvir falls into 3 drug categories that Ginkgo can interact with; the most serious is rated moderate. Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions3
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Ginkgo and Sofosbuvir, Velpatasvir

These two interact in 3 distinct ways. Each one is explained separately below.

Why Are There 3 Interactions?

Ginkgo interacts with whole categories of medication. Sofosbuvir, Velpatasvir falls into 3 of those categories, so it can interact with Ginkgo in 3 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

1 of 3

Why this applies to Sofosbuvir, Velpatasvir

Sofosbuvir, Velpatasvir falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Ginkgo interacts with.

Theoretically, ginkgo might decrease levels of drugs metabolized by CYP3A4.
There is conflicting evidence about whether ginkgo induces or inhibits CYP3A4. Ginkgo does not appear to affect hepatic CYP3A4. However, it is not known if ginkgo affects intestinal CYP3A4. Preliminary clinical research suggests that taking ginkgo does not significantly affect levels of donepezil, lopinavir, or ritonavir, which are all CYP3A4 substrates. Other clinical research also suggests ginkgo does not significantly affect CYP3A4 activity. However, there are two case reports of decreased efavirenz concentrations and increased viral load in patients taking ginkgo. It is suspected that terpenoids from the ginkgo extract reduced drug levels by inducing cytochrome P450 3A4 (CYP3A4).
Severity Moderate Likelihood Possible Evidence B

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 gist with Epclusa (sofosbuvir and velpatasvir) and ginkgo. On paper, ginkgo might speed up an enzyme called CYP3A4 in the gut, which could lower the level of velpatasvir in your blood. If that happened, the worry isn't extra side effects, it's the opposite: your hepatitis C treatment could work a little less well, and the goal here is to fully clear the virus.

That said, the evidence is thin and conflicting. Studies haven't clearly shown ginkgo to be a strong enzyme booster, and most CYP3A4 drugs tested weren't really affected. Still, because finishing a full course of Epclusa matters so much for a cure, I'd play it safe and run ginkgo past your pharmacist or doctor before combining them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Gurley BJ, Gardner SF, Hubbard MA. Clinical assessment of potential cytochrome P450-mediated herb-drug interactions. AAPS Ann Mtg & Expo Indianapolis, IN: 2000; Oct 29 - Nov 2:presentation #3460.
  2. Galluzzi S, Zanetti O, Binetti G, et al. Coma in a patient with Alzheimer's disease taking low dose trazodone and Ginkgo biloba. J Neurol Neurosurg Psychiatry 2000;68:679-80. DOI
  3. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000;7:273-82. PubMed
  4. Gurley BJ, Gardner SF, Hubbard MA, et al. Cytochrome P450 phenotypic ratios for predicting herb-drug interactions in humans. Clin Pharmacol Ther 2002;72:276-87.. PubMed
  5. Yale SH, Glurich I. Analysis of the inhibitory potential of Ginkgo biloba, Echinacea purpurea, and Serenoa repens on the metabolic activity of cytochrome P450 3A4, 2D6, and 2C9. J Altern Complement Med 2005;11:433-9.
  6. Yasui-Furukori N, Furukori H, Kaneda A, et al. The effects of Ginkgo biloba extracts on the pharmacokinetics and pharmacodynamics of donepezil. J Clin Pharmacol 2004;44:538-42.
  7. Markowitz JS, Donovan JL, Lindsay DeVane C, et al. Multiple-dose administration of Ginkgo biloba did not affect cytochrome P-450 2D6 or 3A4 activity in normal volunteers. J Clin Psychopharmacol 2003;23:576-81. PubMed
  8. Wiegman DJ, Brinkman K, Franssen EJ. Interaction of Ginkgo biloba with efavirenz. AIDS 2009;23:1184-5. PubMed
  9. Naccarato M, Yoong D, Gough K. A potential drug-herbal interaction between Ginkgo biloba and efavirenz. J Int Assoc Physicians AIDS Care (Chic). 2012;11(2):98-100. doi: 10.1177/1545109711435364. Epub 2012 Feb 9.
  10. Robertson, S. M., Davey, R. T., Voell, J., Formentini, E., Alfaro, R. M., and Penzak, S. R. Effect of Ginkgo biloba extract on lopinavir, midazolam and fexofenadine pharmacokinetics in healthy subjects. Curr Med Res Opin 2008;24(2):591-599. PubMed
  11. Penzak, S. R., Busse, K. H., Robertson, S. M., Formentini, E., Alfaro, R. M., and Davey, R. T., Jr. Limitations of using a single postdose midazolam concentration to predict CYP3A-mediated drug interactions. J Clin Pharmacol 2008;48(6):671-680. PubMed
  12. Jalloh MA, Gregory PJ, Hein D, et al. Dietary supplement interactions with antiretrovirals: a systematic review. Int J STD AIDS. 2017 Jan;28(1):4-15. PubMed
  13. Bai J, Zhang C. Metabolic interaction between biflavonoids in Ginkgo biloba leaves and tacrolimus. Biopharm Drug Dispos 2023;44(2):157-164.
Moderate

P-GLYCOPROTEIN SUBSTRATES

2 of 3

Sofosbuvir, Velpatasvir also falls under P-GLYCOPROTEIN SUBSTRATES.

Theoretically, taking ginkgo with P-glycoprotein substrates might increase the levels and adverse effects of these substrates.
A small clinical study in healthy volunteers shows that using ginkgo leaf extract 120 mg orally three times daily for 14 days can increase levels of the P-glycoprotein substrate, talinolol, by 36% in healthy male individuals. However, single doses of ginkgo do not have the same effect.
Severity Moderate Likelihood Possible Evidence B

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 gist with Epclusa (sofosbuvir/velpatasvir): both of these antiviral pieces get moved around the body by a transporter called P-glycoprotein. Ginkgo may slightly slow that transporter down, so in theory more of the drug could stay in your system. The most likely result would be a touch more of the usual side effects, things like headache, tiredness, or nausea.

Honestly, this is on the gentle end. The evidence comes from a small study using a different medication, and single doses of ginkgo didn't cause any change. Still, since you want this hepatitis C treatment to work cleanly, I'd run it by your pharmacist or doctor before adding ginkgo, rather than starting or stopping anything on your own.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Fan, L., Tao, G. Y., Wang, G., Chen, Y., Zhang, W., He, Y. J., Li, Q., Lei, H. P., Jiang, F., Hu, D. L., Huang, Y. F., and Zhou, H. H. Effects of Ginkgo biloba extract ingestion on the pharmacokinetics of talinolol in healthy Chinese volunteers. Ann Phar PubMed
Moderate

SOFOSBUVIR (Sovaldi)

3 of 3
Theoretically, ginkgo might increase the levels and clinical effects of sofosbuvir.
Animal research in rats shows that giving a ginkgo extract 25 mg/kg orally daily for 14 days increases the area under the concentration time curve (AUC) after a single sofosbuvir dose of 40 mg/kg by 11%, increases the half-life by 60%, and increases the plasma concentration at 4 hours by 38%. This interaction appears to be related to the inhibition of intestinal P-glycoprotein by ginkgo.
Severity Moderate Likelihood Possible Evidence D

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 gist with Epclusa (sofosbuvir/velpatasvir) and ginkgo. Sofosbuvir relies on a little cellular pump in your gut called P-glycoprotein to control how much gets absorbed. In rat studies, ginkgo slowed that pump down, which let a bit more sofosbuvir into the bloodstream (roughly a 10 to 40 percent bump and a longer time hanging around). In theory, that could mean slightly higher drug levels and a touch more chance of side effects like headache, tiredness, or nausea.

I want to be honest, though: this is based only on animal data, so we really don't know if it matters in people. It's not a reason to panic. Since finishing a full hepatitis C course exactly as prescribed is so important, just run your ginkgo use by your pharmacist or doctor first.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Wasef AK, Wahdan SA, Saeed NM, El-Demerdash E. Effects of aged garlic and ginkgo biloba extracts on the pharmacokinetics of sofosbuvir in rats. Biopharm Drug Dispos. 2022;43(4):152-62. 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 Sofosbuvir, Velpatasvir one above is among them. If you take anything else, check it against the full list below.

Major 1 Moderate 1,264 No known interaction 1,565 (incl. Sofosbuvir, Velpatasvir)
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 Sofosbuvir, Velpatasvir

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 Sofosbuvir, Velpatasvir, 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 Sofosbuvir, Velpatasvir

This page covers Ginkgo only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Sofosbuvir, Velpatasvir page lists 147 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), St. John's Wort (major), Acacia Rigidula (moderate) and Adrafinil (moderate).

By severity: 3 major · 108 moderate · 36 minor.

From our pharmacist’s overview on the Sofosbuvir, Velpatasvir page

“Epclusa (the sofosbuvir and velpatasvir combination) is a finite course meant to cure hepatitis C, so I treat its supplement interactions with genuine seriousness, since anything that lowers the drug's level can undermine the cure itself. St.”

Reviewed by 2 · Jul 18, 2026

Open the Sofosbuvir, Velpatasvir 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 Sofosbuvir, Velpatasvir 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 Sofosbuvir, Velpatasvir 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%

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

29 days ago today
Medication Sofosbuvir, Velpatasvir
Steady interest

#2,522 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
Medication

About Sofosbuvir and Velpatasvir

What Is Sofosbuvir and Velpatasvir Used For?

Brand name: Epclusa

Sofosbuvir and velpatasvir treats chronic hepatitis C virus (HCV) infection caused by genotypes 1, 2, 3, 4, 5, or 6 — covering all the major strains. It is approved for adults and children 3 years of age and older, whether or not they have cirrhosis (liver scarring).

It is used on its own in patients without cirrhosis or with compensated cirrhosis (where the liver is scarred but still functioning). In patients with decompensated cirrhosis (more advanced liver disease where the liver is no longer coping), it is used in combination with another medicine called ribavirin. Epclusa is a brand that is also available as oral pellets for younger children.

See full Sofosbuvir and Velpatasvir drug information
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 Sofosbuvir, Velpatasvir, 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 Sofosbuvir, Velpatasvir supplement interactions › Every supplement checked against Sofosbuvir, Velpatasvir, ranked by severity Sofosbuvir and Velpatasvir drug information › The full plain-English guide to this medication 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 Sofosbuvir, Velpatasvir Together: Common Questions

Can you take Ginkgo with Sofosbuvir, Velpatasvir?
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.
Why are there 3 interactions listed for Ginkgo and Sofosbuvir, Velpatasvir?
Sofosbuvir, Velpatasvir belongs to more than one drug category, and Ginkgo interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Ginkgo and Sofosbuvir, Velpatasvir 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 Sofosbuvir, Velpatasvir and Ginkgo?

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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.