Drug & supplement interaction

Ginkgo + Sofosbuvir, Velpatasvir, Voxilaprevir

Sofosbuvir, Velpatasvir, Voxilaprevir brand name: Vosevi.

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

Sofosbuvir, Velpatasvir, Voxilaprevir falls into 4 drug categories that Ginkgo can interact with; the most serious is rated moderate. Theoretically, ginkgo might increase levels of drugs metabolized by CYP1A2.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions4
EvidenceB
What do Severity, Likelihood & Evidence mean?
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Interaction report

Ginkgo and Sofosbuvir, Velpatasvir, Voxilaprevir

These two interact in 4 distinct ways. Each one is explained separately below.

Why Are There 4 Interactions?

Ginkgo interacts with whole categories of medication. Sofosbuvir, Velpatasvir, Voxilaprevir falls into 4 of those categories, so it can interact with Ginkgo in 4 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

1 of 4

Why this applies to Sofosbuvir, Velpatasvir, Voxilaprevir

Sofosbuvir, Velpatasvir, Voxilaprevir falls under CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES — the group Ginkgo interacts with.

Theoretically, ginkgo might increase levels of drugs metabolized by CYP1A2.
Laboratory research suggests that ginkgo leaf extract can mildly inhibit CYP1A2 enzymes. However, clinical research suggests ginkgo might not affect CYP1A2. Until more is known, use ginkgo cautiously in patients taking drugs metabolized by these enzymes.
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 short version on combining ginkgo with Vosevi (sofosbuvir, velpatasvir, voxilaprevir). The concern on file is that ginkgo might mildly slow down a liver enzyme called CYP1A2, which in theory could let levels of certain medications creep up. The honest truth, though, is that this is a weak, mostly theoretical worry. Lab studies hint at it, but actual human studies suggest ginkgo probably doesn't change CYP1A2 much at all.

On top of that, Vosevi isn't a prodrug and doesn't rely heavily on CYP1A2 for its activity, so a meaningful interaction here is unlikely. Still, since Vosevi is an important antiviral and ginkgo can also thin the blood a little, I'd run any new supplement past your pharmacist or doctor first.

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
Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

2 of 4

Sofosbuvir, Velpatasvir, Voxilaprevir also falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES.

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 concern with Vosevi (sofosbuvir, velpatasvir, and voxilaprevir). Parts of this combo pill, especially velpatasvir and voxilaprevir, are handled by an enzyme called CYP3A4. The worry is that ginkgo might speed up that enzyme in a small number of people, which could lower the level of your hepatitis C medicine in your blood. If that happens, the drug may not knock the virus down as well, and treatment failure is the real risk here.

I want to be honest though: the evidence is shaky and mostly theoretical. Most studies show ginkgo does not meaningfully change CYP3A4, with only a couple of case reports suggesting otherwise. Since clearing hepatitis C matters so much, I'd play it safe and run ginkgo by your pharmacist or doctor before combining the two.

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

3 of 4

Sofosbuvir, Velpatasvir, Voxilaprevir 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 situation with Vosevi (sofosbuvir, velpatasvir, voxilaprevir) and ginkgo. All three of these hepatitis C medicines are moved around your body by a transporter called P-glycoprotein. Ginkgo can mildly slow that transporter down, and in theory that could let a bit more of the drug build up. In one small study, regular ginkgo (not a single dose) raised levels of another P-gp drug by about a third.

For Vosevi, higher levels could mean more of its usual side effects, like headache, tiredness, or nausea. This is a theoretical, moderate concern, not something proven with this exact combo. Still, since clearing your hepatitis C matters, I'd check with your pharmacist or doctor before adding ginkgo rather than guessing.

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)

4 of 4
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

If you're taking Vosevi for hepatitis C, here's the gist. Ginkgo may block a 'pump' in your gut called P-glycoprotein that normally helps move the sofosbuvir part of this combo out of your system. With that pump slowed down, a little more of the drug could get absorbed, which in theory means slightly higher levels in your blood.

I want to be honest about the evidence, though: this comes only from a rat study, not from people, and the changes were small. So this is more of a theoretical caution than a proven problem. Sofosbuvir-based treatments are generally well tolerated, with things like tiredness, headache, or nausea being most common. Still, since clearing the virus matters so much, I'd run any ginkgo use past 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, Voxilaprevir 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, Voxilaprevir)
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, Voxilaprevir

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, Voxilaprevir, 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, Voxilaprevir

This page covers Ginkgo only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Sofosbuvir, Velpatasvir, Voxilaprevir page lists 173 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 · 130 moderate · 40 minor.

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

“Vosevi (sofosbuvir, velpatasvir, and voxilaprevir) cures hepatitis C over a single short course, and that is exactly why I would be genuinely careful with supplements while taking it. Anything that drags its blood levels down can cost you the cure itself.”

Reviewed by 2 · Jul 18, 2026

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

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

29 days ago today
Medication Sofosbuvir, Velpatasvir, Voxilaprevir
Top half

#1,152 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, Velpatasvir, and Voxilaprevir

What Is Sofosbuvir, Velpatasvir, and Voxilaprevir Used For?

Brand name: Vosevi

Vosevi is used to treat chronic hepatitis C virus (HCV) infection in adults without cirrhosis (liver scarring) or with compensated cirrhosis (mild liver scarring, Child-Pugh A). It is specifically for people who have already tried an HCV treatment that did not fully work.

Vosevi is approved for adults with HCV genotypes 1, 2, 3, 4, 5, or 6 who were previously treated with a regimen containing an NS5A inhibitor. It is also approved for adults with genotype 1a or 3 who were previously treated with sofosbuvir without an NS5A inhibitor. Note: Vosevi has not been shown to offer additional benefit over sofosbuvir/velpatasvir for adults with genotype 1b, 2, 4, 5, or 6 who received sofosbuvir without an NS5A inhibitor.

See full Sofosbuvir, Velpatasvir, and Voxilaprevir 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, Voxilaprevir, 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, Voxilaprevir supplement interactions › Every supplement checked against Sofosbuvir, Velpatasvir, Voxilaprevir, ranked by severity Sofosbuvir, Velpatasvir, and Voxilaprevir 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, Voxilaprevir Together: Common Questions

Can you take Ginkgo with Sofosbuvir, Velpatasvir, Voxilaprevir?
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 4 interactions listed for Ginkgo and Sofosbuvir, Velpatasvir, Voxilaprevir?
Sofosbuvir, Velpatasvir, Voxilaprevir 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, Voxilaprevir 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

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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.