Ginkgo Biloba and Rosuvastatin Interaction
There is no documented clinically significant interaction between Ginkgo biloba and rosuvastatin, making this combination generally safe for most patients. 1, 2
Pharmacological Basis
- Rosuvastatin is primarily metabolized via CYP2C9 and is a substrate for OATP1B1/1B3 transporters, with minimal involvement of CYP3A4, giving it fewer drug interactions compared to other statins 2
- Unlike some other statins that have numerous documented herb-drug interactions, rosuvastatin has not been specifically identified in guidelines as having clinically significant interactions with Ginkgo biloba 1, 2
- Ginkgo biloba's mechanism of action includes decreased red blood cell aggregation, decreased blood viscosity, and inhibition of platelet activating factor 1
Safety Considerations
- While Ginkgo biloba has potential antiplatelet effects that could theoretically increase bleeding risk, clinical evidence does not show a significant increase in hemorrhage risk when combined with antiplatelet medications (adjusted odds ratio: 1.5; 95% CI, 0.5-5.0) 3
- The bleeding risk with Ginkgo biloba is more strongly associated with advanced age (≥65 years) and male gender rather than drug interactions 3
- Some herbal products may cause spontaneous bleeding when used with anticoagulants, but specific interactions with rosuvastatin have not been documented in clinical guidelines 4
Monitoring Recommendations
- Although the combination appears safe, patients should be monitored for:
- Any unusual bruising or bleeding, particularly in elderly patients or those with other risk factors for bleeding 5
- Muscle-related symptoms (pain, weakness, tenderness), which are potential side effects of statin therapy that could theoretically be exacerbated 1
- Liver function tests, as both agents can independently affect hepatic function 1
Potential Benefits
- Some evidence suggests that Ginkgo biloba combined with statins may provide additional lipid-lowering benefits compared to statin monotherapy 6
- A meta-analysis of 8 RCTs showed that combining Ginkgo biloba with statins achieved greater reductions in triglycerides, total cholesterol, and LDL-C compared to statins alone 6
Special Considerations
- As a precaution, some sources recommend discontinuing Ginkgo biloba two weeks before elective surgery due to its mild antiplatelet effects 5
- Patients with known bleeding disorders should exercise additional caution when combining Ginkgo biloba with any medication 3
While this combination appears safe based on available evidence, patients should inform all healthcare providers about all medications and supplements they are taking, including herbal products like Ginkgo biloba 4.