Interactions between Ginkgo and Vortioxetine
1 drug interaction and 11 additional warnings found for the following 2 drugs:
- ginkgo
- vortioxetine
Drug interactions
Moderate drug interactions
Moderate:
ginkgo vortioxetine
Applies to: ginkgo and vortioxetine
Generally avoid
Certain preparations of ginkgo biloba have been reported to induce seizures. There may be a theoretical risk of increased seizure potential when used with other agents that can lower the seizure threshold such as selective serotonin reuptake inhibitors (SSRI antidepressants or anorectics), monoamine oxidase inhibitors, neuroleptic agents, central nervous system stimulants, opioids, tricyclic antidepressants, other tricyclic compounds (e.g., cyclobenzaprine, phenothiazines), carbapenems, cholinergic agents, fluoroquinolones, interferons, chloroquine, mefloquine, lindane, and theophylline. Ginkgo products may contain varying amounts of 4'-O-methylpyridoxine (ginkgotoxin), a known neurotoxin found primarily in ginkgo biloba seeds but also detected in lesser amounts in the leaves. In vivo, 4'-O-methylpyridoxine competes with vitamin B6, which causes an indirect inhibition of glutamate decarboxylase and subsequent decrease in the formation of gamma-aminobutyric acid (GABA) in the brain. There have been published case reports of generalized convulsions and vomiting within several hours after ingestion of large amounts of ginkgo nuts/seeds, including in young children and healthy individuals with no known personal or family history of epilepsy. Many more cases, including fatalities, occurred in Japan in the 1930s to the 1960s during a food shortage when ginkgo nuts served as an important source of food. Some investigators have suggested that the amounts of ginkgotoxin in commercial extracts are too low to exert a detrimental effect. Nevertheless, a case report describes two elderly, previously well controlled epileptic patients who presented with recurrent seizures within two weeks of initiating treatment with a ginkgo extract. Both patients remained seizure-free several months after discontinuing the extract, with no alteration to their anticonvulsant medications.
Management
Patients should consult a healthcare provider before taking any herbal or alternative medicine. Because of inconsistencies in formulation and potency of commercial herbal preparations, there is no way to verify without laboratory testing if and in what quantity 4'-O-methylpyridoxine may be present in a given ginkgo preparation. Patients treated with agents that can lower the seizure threshold should preferably avoid the use of products containing ginkgo biloba.
References (8)
- Miller LG (1998) "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med, 158, p. 2200-11
- Gregory PJ (2001) "Seizure associated with Ginkgo biloba?." Ann Intern Med, 134, p. 344
- Miwa H, Iijima M, Tanaka S, Mizuno Y (2001) "Generalized convulsions after consuming a large amount of Gingko nuts." Epilepsia, 42, p. 280-1
- Kajiyama Y, Fujii K, Takeuchi H, Manabe Y (2002) "Ginkgo seed poisoning." Pediatrics, 109, p. 325-7
- Kupiec T, Raj V (2005) "Fatal seizures due to potential herb-drug interactions with Ginkgo biloba." J Anal Toxicol, 29, p. 755-8
- Harms SL, Garrard J, Schwinghammer P, Eberly LE, Chang Y, Leppik IE (2006) "Ginkgo biloba use in nursing home elderly with epilepsy or seizure disorder." Epilepsia, 47, p. 323-9
- Granger AS (2001) "Ginkgo biloba precipitating epileptic seizures." Age Ageing, 30, p. 523-5
- Spinella M (2001) "Herbal medicines and epilepsy: the potential for benefit and adverse effects." Epilepsy Behav, 2, p. 524-32
Food/lifestyle interactions
Moderate food/lifestyle interactions
Moderate:
vortioxetine Food/Lifestyle
Applies to: vortioxetine
Generally avoid
Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.
Management
Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.
References (4)
- Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
- Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
- (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
- (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka America Pharmaceutical, Inc.
Disease interactions
10 potential interactions Applies to: 8 conditions, including Depression, Bipolar Disorder, Mania, Hyponatremia, and Dehydration.
Bipolar Disorder
Major:
vortioxetine
Vortioxetine has a major potential interaction with Bipolar Disorder.
Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.
Moderate:
vortioxetine
Vortioxetine has a moderate potential interaction with Bipolar Disorder.
Therapy with vortioxetine may cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.
Bleeding Disorder
Moderate:
vortioxetine
Vortioxetine has a moderate potential interaction with Bleeding Disorder.
Some antidepressants should be administered with caution in patients with an increased risk for hemorrhage. Patients should be advised to immediately report any signs and symptoms suggestive of bleeding complications, including ecchymosis, hematoma, epistaxis, and petechia.
Dehydration
Moderate:
vortioxetine
Vortioxetine has a moderate potential interaction with Dehydration.
Treatment with vortioxetine may cause hyponatremia, in many cases secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.
Depression
Major:
vortioxetine
Vortioxetine has a major potential interaction with Depression.
Antidepressants increased the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term trials; these trials did not show increased risk in patients older than 24 years and risk was reduced in patients 65 years and older. Adult and pediatric patients with major depressive disorder may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior, whether or not they are taking antidepressants; this risk may persist until significant remission occurs. Suicide is a known risk of depression and certain other psychiatric disorders; such disorders are the strongest predictors of suicide. Patients of all ages treated with antidepressants for any indication should be monitored appropriately and observed closely for clinical worsening, suicidality, and unusual changes in behavior, especially during the first few months of drug therapy, and at times of dose changes. Family members/caregivers should be advised to monitor for changes in behavior and to notify the health care provider. Changing the therapeutic regimen (including discontinuing the medication) should be considered in patients whose depression is persistently worse, or who are experiencing emergent suicidal thoughts or behaviors.
Moderate:
vortioxetine
Vortioxetine has a moderate potential interaction with Depression.
Therapy with vortioxetine may cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.
Glaucoma, Narrow Angle
Moderate:
vortioxetine
Vortioxetine has a moderate potential interaction with Glaucoma, Narrow Angle.
Some antidepressants exert mydriatic activity that can induce increased intraocular pressure and result in angle-closure (narrow-angle) glaucoma in a patient with anatomically narrow angles who does not have a patent iridectomy. Prior to initiating therapy with these agents, patients should be examined to determine whether they are susceptible to angle closure, and have a prophylactic procedure (e.g., iridectomy), if they are susceptible. The use of these drugs in patients with untreated anatomically narrow angles should be avoided.
Hyponatremia
Moderate:
vortioxetine
Vortioxetine has a moderate potential interaction with Hyponatremia.
Treatment with vortioxetine may cause hyponatremia, in many cases secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.
Mania
Moderate:
vortioxetine
Vortioxetine has a moderate potential interaction with Mania.
Therapy with vortioxetine may cause activation of mania and hypomania and should be used with caution in patients with personal or family history of mania, hypomania, bipolar disorder, and other mood disorders.
SIADH
Moderate:
vortioxetine
Vortioxetine has a moderate potential interaction with SIADH.
Treatment with vortioxetine may cause hyponatremia, in many cases secondary to development of the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Caution should be used when treating patients with hyponatremia or at greater risk of developing hyponatremia such as elderly patients, patients taking diuretics or those who are volume-depleted.
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ginkgo
A total of 304 drugs are known to interact with ginkgo.
- Ginkgo is in the drug class herbal products.
- Ginkgo is used to treat Herbal Supplementation.
vortioxetine
A total of 367 drugs are known to interact with vortioxetine.
- Vortioxetine is in the drug class miscellaneous antidepressants.
- Vortioxetine is used to treat Major Depressive Disorder.
Drug Interaction Classification
| Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
| Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
| 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. | |
| No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.