Can I Take Ginkgo With Apixaban (Eliquis) and Atorvastatin?
Ginkgo biloba is a common ingredient in eye health supplements, but it has a complicated history with blood thinners. This question looks at whether an optic nerve formula containing 120 mg of ginkgo leaf extract can be taken alongside apix
I currently take apixaban (5 mg twice daily) and atorvastatin (80 mg once daily). I would like to take Science Based Health Optic Nerve Formula with 120 mg ginkgo leaf extract, which was recommended to me by an OD. I read conflicting information about this. What is your opinion? Thanks!
Jul 26, 2026- Ginkgo may increase your bleeding risk when combined with apixaban because it can affect how platelets work and may raise apixaban levels in your body, so you should talk to your doctor or pharmacist before starting it. The interaction between ginkgo and atorvastatin is less concerning since research suggests ginkgo may lower atorvastatin levels by a small amount without affecting how well it works to lower cholesterol. The research on ginkgo's effects on bleeding is genuinely conflicting, with some studies showing it affects clotting and others finding no impairment, but most pharmacists recommend caution because the risk of serious bleeding is significant when you're already on a full-dose anticoagulant.
In the NDC directory: Apixaban NDC codes Atorvastatin Calcium NDC codes
Hello, and I'm really glad you brought this to us before starting the supplement!
You're right that the information out there is conflicting, and in my opinion, that's because the underlying research is too.
The interaction that matters most here is between ginkgo and apixaban (Eliquis). Ginkgo may add to your bleeding risk, and it may also nudge apixaban levels in your body, so this is classified as a moderate interaction (in our database at least) and one your prescribing doctor or pharmacist should weigh in on before you begin. The atorvastatin piece is much less concerning.
Why Ginkgo and Apixaban Raise a Bleeding Concern
Ginkgo contains a compound called ginkgolide B that is thought to interfere with platelet-activating factor, which can make platelets less sticky and mildly impair clotting on its own.
Several case reports have documented serious bleeding events in patients taking ginkgo, including bleeds in people also on warfarin, and a large medical records analysis found more bleeding events when ginkgo and warfarin were combined.
Stacking any degree of antiplatelet activity on top of an anticoagulant is exactly the kind of combination the Eliquis prescribing information warns about, since drugs and supplements that affect clotting add to its already meaningful bleeding risk.
There's a second, less obvious issue too.
Apixaban is moved through the body by a transporter protein called P-glycoprotein (P-gp), and repeated dosing of ginkgo has been shown in one small study to raise levels of another P-gp substrate drug.
In that study, ginkgo leaf extract taken for two weeks was able to "increase levels of the P-glycoprotein substrate, talinolol, by 36%" in healthy volunteers. Whether ginkgo does the same thing to apixaban hasn't been directly studied, but higher apixaban levels would mean a higher bleeding risk, so it adds to the caution here.
Why the Research Seems So Conflicting
Here's the honest picture. Some human studies show ginkgo affecting platelets, and researchers have noted that ginkgo possesses a blood-thinning potential that hasn't been well characterized.
On the other hand, a well-designed placebo-controlled trial of a standardized ginkgo extract found that among 29 coagulation and bleeding measures, none showed evidence of impaired clotting after a week of use, and a meta-analysis of standardized extracts reached a similar conclusion.
So the studies genuinely point in different directions, which is why you've read conflicting things. Most pharmacists land on caution here, because when the person involved is already on a full-dose anticoagulant, the downside of being wrong is a serious bleed.
Ginkgo's Effect on Atorvastatin
This one is much less worrisome.
Human data suggest ginkgo may modestly speed up atorvastatin's clearance, lowering overall exposure by roughly 10% to 14%, but importantly, this didn't appear to change the drug's cholesterol-lowering effect. It's still classified as a moderate interaction (in our database) worth knowing about, and it's something your doctor can keep in mind at your next cholesterol check, but it wouldn't be the deciding factor here.
Final Words
Thanks again for using HelloPharmacist. Ginkgo and apixaban carry a real, if debated, bleeding concern, so please don't start the Optic Nerve formula until the prescriber managing your apixaban has signed off.
If you have any follow-up questions after that conversation, we're always happy to help!
You may also find these related HelloPharmacist resources helpful:
References & sources
- Effect of the ingestion of Ginkgo biloba extract on platelet aggregation and urinary prostanoid excretion in healthy and Type 2 diabetic subjects. — PubMed
- 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. — PubMed
- Eliquis Structured Product Labeling — DailyMed
Dr. Brian Staiger, PharmD
Doctor of Pharmacy, board certified clinical pharmacist (BCPS), American Herbalist Guild, Medication Therapy Management certified
Brian Staiger, PharmD, BCPS, is a licensed pharmacist with more than 13 years of experience across retail pharmacy, clinical pharmacy, medication safety, pharmacy program development, and healthcare administration. He is the founder of HelloPharmacist.com, where he helps patients...
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