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Drug Interactions between Celebrex and ginkgo

This report displays the potential drug interactions for the following 2 drugs:

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Moderate

celecoxib ginkgo

Applies to: Celebrex (celecoxib) and ginkgo

GENERALLY AVOID: Ginkgo may potentiate the risk of bleeding associated with anticoagulants, platelet inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and thrombolytic agents. Ginkgolide B, a component of ginkgo, inhibits platelet-activating factor by displacing it from its receptor-binding site, resulting in reduced platelet aggregation. There have been isolated reports of bleeding complications (e.g., spontaneous intracranial bleeding; spontaneous hyphema; peri- and postoperative bleeding) and prolonged bleeding times associated with the ingestion of ginkgo, some of which resolved following discontinuation of ginkgo use. Possible interactions with warfarin and aspirin have also been described in the medical literature. A patient stabilized on warfarin for five years developed intracerebral hemorrhage two months after starting ginkgo, and another who had been taking aspirin 325 mg/day for three years developed spontaneous bleeding of the iris into the anterior chamber of the eye one week after he began using ginkgo. In contrast, an investigative study found no significant effect of ginkgo pretreatment for 7 days on clotting status or the pharmacokinetics or pharmacodynamics of a single 25 mg dose of warfarin in 12 healthy volunteers. Another study consisting of 24 patients stabilized on warfarin for at least several months also found no significant effect of ginkgo on INR or warfarin dosage compared to placebo, and no major bleedings were observed in the study. However, it is important to recognize that pharmacologic effects of herbal products may be highly variable due to inconsistencies in formulation and potency of commercial preparations.

MANAGEMENT: Patients should consult a healthcare provider before taking any herbal or alternative medicine. In general, consumption of ginkgo should be avoided during use of coagulation-modifying agents and at least two weeks prior to surgery. In patients who have used this herb extensively prior to receiving anticoagulation, antiplatelet, NSAID or thrombolytic therapy, the potential for an interaction should be considered. Close clinical and laboratory observation for hematologic complications is recommended. Patients should be advised to promptly report any signs of bleeding to their physician, including pain, swelling, headache, dizziness, weakness, prolonged bleeding from cuts, increased menstrual flow, vaginal bleeding, nosebleeds, bleeding of gums from brushing, unusual bleeding or bruising, red or brown urine, or red or black stools.

References

  1. Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
  2. Rosenblatt M, Mindel J "Spontaneous hyphema associated with ingestion of Ginkgo biloba extract." N Engl J Med 336 (1997): 1108
  3. Rowin J, Lewis SL "Spontaneous bilateral subdural hematomas associated with chronic Gingko biloba ingestion." Neurology 46 (1996): 1775-6
  4. Chung KF, McCusker M, Page CP, Dent G, Guinot P, Barnes PJ "Effect of ginkgolide mixture (BN 52063) in antagonising skin and platelet responses to platelet acitivating factor in man." Lancet 1 (1987): 248-51
  5. Fugh-Berman A "Herb-drug interactions." Lancet 355 (2000): 134-8
  6. Heck AM, DeWitt BA, Lukes AL "Potential interactions between alternative therapies and warfarin." Am J Health Syst Pharm 57 (2000): 1221-7; quiz 1228-30
  7. Vaes LP, Chyka PA "Interactions of warfarin with garlic, ginger, or ginseng: nature of evidence." Ann Pharmacother 34 (2000): 1478-82
  8. Fessenden JM, Wittenborn W, Clarke L "Gingko biloba: A case report of herbal medicine and bleeding postoperatively from a laparoscopic cholecystectomy." Am Surg 67 (2001): 33-5
  9. Benjamin J, Muir T, Briggs K, Pentland B "A case of cerebral haemorrhage - can Ginkgo biloba be implicated?." Postgrad Med J 77 (2001): 112-3
  10. Izzo AA, Ernst E "Interactions between herbal medicines and prescribed drugs: a systematic review." Drugs 61 (2001): 2163-75
  11. Evans V "Herbs and the brain: friend or foe? The effects of ginkgo and garlic on warfarin use." J Neurosci Nurs 32 (2000): 229-32
  12. Cupp MJ "Herbal remedies: adverse effects and drug interactions." Am Fam Physician 59 (1999): 1239-45
  13. Matthews MK Jr "Association of Ginko biloba with intracerebral hemorrhage." Neurology 50 (1998): 1933-4
  14. Engelsen J, Nielsen JD, Winther K "Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in stable, long-term warfarin treated outpatients. A randomised, double blind, placebo-crossover trial." Thromb Haemost 87 (2002): 1075-6
  15. Fong KC, Kinnear PE "Retrobulbar haemorrhage associated with chronic Gingko biloba ingestion." Postgrad Med J 79 (2003): 531-2
  16. Sierpina VS, Wollschlaeger B, Blumenthal M "Ginkgo biloba." Am Fam Physician 68 (2003): 923-6
  17. Jiang X, Williams KM, Liauw WS, et al. "Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects." Br J Clin Pharmacol 59 (2005): 425-32
  18. Jayasekera N, Moghal A, Kashif F, Karalliedde L "Herbal medicines and postoperative haemorrhage." Anaesthesia 60 (2005): 725-6
  19. Wolf HR "Does Ginkgo biloba special extract EGb 761 provide additional effects on coagulation and bleeding when added to acetylsalicylic acid 500 mg daily?" Drugs R D 7 (2006): 163-72
View all 19 references

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Drug and food interactions

No alcohol/food interactions were found. However, this does not necessarily mean no interactions exist. Always consult your healthcare provider.

Therapeutic duplication warnings

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Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

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