Drug Interactions between Exaprin and ginkgo

MONITOR: The combined use of low-dose or high-dose aspirin with other nonsteroidal anti-inflammatory drugs (NSAIDs) may increase the potential for serious gastrointestinal (GI) toxicity, including inflammation, bleeding, ulceration, and perforation. Aspirin at anti-inflammatory dosages or higher may also decrease the plasma concentrations of many NSAIDs. The decreases have ranged from none or small (piroxicam, meloxicam, naproxen, tolmetin) to substantial (flurbiprofen, ibuprofen). However, the therapeutic response does not appear to be affected. Investigators theorize that aspirin may displace NSAIDs from plasma protein binding sites, resulting in increased concentration of unbound, or free, drug available for clearance. The increase in NSAID free fraction, and possibly some contributory anti-inflammatory effect from aspirin, may account for the lack of overall effect on therapeutic response.

MANAGEMENT: Caution is advised if aspirin, particularly at anti-inflammatory dosages, is used with other NSAIDs. Concomitant administration of NSAIDs is considered contraindicated or not recommended with aspirin at analgesic/anti-inflammatory dosages by many NSAID manufacturers. During concomitant therapy, patients should be advised to take the medications with food and to immediately report signs and symptoms of GI ulceration and bleeding such as abdominal pain, bloating, sudden dizziness or lightheadedness, nausea, vomiting, hematemesis, anorexia, and melena.

Switch to consumer interaction data

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.

Switch to consumer interaction data

One study has reported that coadministration of caffeine and aspirin lead to a 25% increase in the rate of appearance and 17% increase in maximum concentration of salicylate in the plasma. A significantly higher area under the plasma concentration time curve of salicylate was also reported when both drugs were administered together. The exact mechanism of this interaction has not been specified. Physicians and patients should be aware that coadministration of aspirin and caffeine may lead to higher salicylate levels faster.

Switch to consumer interaction data