The short answer
The bleeding evidence for ginkgo with aspirin is mixed. An original case report raises concern, but two small trials of a standardized ginkgo extract found no added effect on platelet measures or bleeding time. Clinical bleeding data remain limited. Discuss the exact product with your clinician before combining them; these results do not establish that every preparation is safe.
What this answer covers
Oral Ginkgo biloba leaf extracts with oral aspirin. The case involved Ginkoba 50:1 extract; the trials tested EGb 761. Ginkgo seeds, powdered leaf, other extracts and different aspirin doses are not assumed to have equivalent effects.
- Supplement or preparation
- Ginkgo biloba
- Medication ingredient
- aspirin
What did the controlled trials show?
One trial studied 50 healthy young men taking aspirin 500 mg daily, with or without EGb 761 ginkgo extract for seven days. Adding ginkgo did not further prolong bleeding time. A separate four-week trial in older adults taking aspirin 325 mg daily also found no added platelet effect; bleeding and bruising reports were infrequent and similar.
Why is a bleeding warning still discussed?
A 70-year-old man developed bleeding inside the eye after adding Ginkoba extract to long-standing aspirin treatment. The bleeding stopped, and no recurrence was reported over three months after he stopped ginkgo while continuing aspirin. This is a warning signal, but one case without re-exposure cannot prove causation or give a general risk estimate.
Can the trial results apply to any ginkgo bottle?
No. The controlled studies used EGb 761, while the eye-bleeding case involved a different concentrated extract. The trials were also too small and short to rule out uncommon serious bleeding. A reassuring laboratory result with one product does not establish that an untested extract, seed preparation or different aspirin regimen behaves the same way.
Should I take ginkgo at another time of day?
The studies do not establish a protective spacing interval. European guidance names aspirin among medicines whose effects may be influenced and advises medical consultation for people using antiplatelet treatment. Show the clinician your ginkgo label and all other medicines. Do not change prescribed aspirin simply to make room for a supplement.
When should bleeding be assessed?
Seek prompt medical attention for vomiting blood, black or bloody stools, or faintness. New unusual bleeding also deserves review, even if you have used the same products for some time. The goal is to assess the whole medication and health picture rather than assume either that ginkgo caused the symptom or that a small trial ruled it out.
Evidence and practical considerations
Side effects & toxicity
The bleeding evidence for ginkgo with aspirin is mixed. An original case report raises concern, but two small trials of a standardized ginkgo extract found no added effect on platelet measures or bleeding time. Clinical bleeding data remain limited. Discuss the exact product with your clinician before combining them; these results do not establish that every preparation is safe.
- Exact scope
- Oral Ginkgo biloba leaf extracts with oral aspirin. The case involved Ginkoba 50:1 extract; the trials tested EGb 761. Ginkgo seeds, powdered leaf, other extracts and different aspirin doses are not assumed to have equivalent effects. with Aspirin, RxCUI 1191, IN, oral use. The inspected 81 mg enteric-coated tablet label names aspirin as its active ingredient and basis of strength; studies using oral 80, 325 or 500 mg are described individually. These strengths and release forms do not establish equivalent interaction magnitude. Other salicylates, salicylate salts and non-aspirin antiplatelet medicines are not treated as the exact drug.
- Medication form and route
- oral
- Timing or duration
- Limited to each source’s stated exposure; no untested duration or spacing interval is inferred.
What remains uncertain
- A single case with a different extract contrasts with two small, short standardized-extract trials. These data cannot quantify rare serious bleeding or settle all products and aspirin regimens.
Factors that may matter: ginkgo extract identity; aspirin dose; other antiplatelet or anticoagulant treatment; prior bleeding; duration of use.
Read the supporting source summaries
Source 1: regulatory OTC drug label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Users of oral aspirin 81 mg enteric-coated tablets.
Warns of severe stomach bleeding and identifies faintness, vomiting blood and bloody or black stools as reasons to seek medical attention. Directs patients to consult a doctor before use with prior ulcers or bleeding problems.
How this applies: Exact aspirin identity and baseline safety context; not direct proof for an individual botanical pair.
Does not identify a measured interaction with garlic, ginkgo or feverfew. Intrinsic aspirin bleeding risk is not proof of an added botanical effect, and an 81 mg coated product is not the same regimen as every cited study.
Source 2: primary randomized crossover trial
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 50 healthy men aged 20-44 years, randomized to two treatment sequences.
Aspirin prolonged bleeding time, but adding EGb 761 did not further prolong it: mean post-treatment values 6.2 versus 6.3 minutes; ratio 1.01, 90% CI 0.86-1.19. Other measured coagulation and platelet effects were similar.
How this applies: Direct contrary evidence for this standardized extract and aspirin regimen, without proving safety of every ginkgo product or long-term bleeding outcomes.
Abstract only, seven-day exposure, healthy young men and surrogate tests. Authors extended reassurance to elderly people in their conclusion, but this population was not studied; no such extrapolation is adopted.
Source 3: primary randomized placebo-controlled trial
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Older adults, mean age 69 years, with peripheral artery disease or cardiovascular risk factors. Platelet-function analysis included 26 placebo and 29 ginkgo participants; aggregation analysis included 21 and 23 respectively.
No clinically or statistically significant added effect on the tested platelet measures. Bleeding/bruising reports were infrequent and similar; no adverse bleeding events were observed.
How this applies: Direct aspirin co-use data that must accompany case-based cautions; does not establish a personal safe dose.
Abstract only, small samples differing by assay and four-week follow-up. The study was not large enough to exclude rare serious bleeding; no inference that all ginkgo preparations are equivalent.
Source 4: primary clinical case correspondence
nejm.org · Source check Sep 10, 2026
Population: A 70-year-old man taking aspirin after coronary bypass surgery.
Recurrent blurred vision and visible iris bleeding were reported. Bleeding stopped spontaneously; after ginkgo withdrawal with aspirin continued, no recurrence was reported over three months.
How this applies: An exact aspirin co-exposure signal, not a causal proof or an incidence estimate for all leaf extracts.
Single case, no rechallenge, no randomized comparator and no measured interaction mechanism. The preparation differs from EGb 761 trials. Direct PDF download returned a failure body; full-text access is based on complete indexed original-publisher text, not that failed file.
Source 5: official regulatory herbal monograph
ema.europa.eu · Source check Sep 10, 2026
Population: Adults using the defined ginkgo leaf dry extract; separate provisions cover powdered leaf.
Calls for medical consultation with bleeding tendency or antiplatelet treatment and notes that effects may be influenced when combined with aspirin. Bleeding reports are acknowledged without an event frequency.
How this applies: Supports clinician review for the named aspirin combination while keeping trial and case evidence separate. The current EMA page lists a later consultation, not a replacement adopted monograph.
Regulatory precaution, not an additional trial. The source differentiates dry extract from powdered leaf; not all retail products match. Its pre-surgery instruction does not establish a routine hours-apart aspirin schedule.
Research assessment: · Open full citations ↗
Timing & monitoring
No validated hours-apart schedule or universal avoidance requirement is established for this exact combination. Review the particular supplement and the reason for aspirin with a clinician.
- Exact scope
- Oral Ginkgo biloba leaf extracts with oral aspirin. The case involved Ginkoba 50:1 extract; the trials tested EGb 761. Ginkgo seeds, powdered leaf, other extracts and different aspirin doses are not assumed to have equivalent effects. with Aspirin, RxCUI 1191, IN, oral use. The inspected 81 mg enteric-coated tablet label names aspirin as its active ingredient and basis of strength; studies using oral 80, 325 or 500 mg are described individually. These strengths and release forms do not establish equivalent interaction magnitude. Other salicylates, salicylate salts and non-aspirin antiplatelet medicines are not treated as the exact drug.
- Medication form and route
- oral
- Timing or duration
- Limited to each source’s stated exposure; no untested duration or spacing interval is inferred.
What remains uncertain
- A single case with a different extract contrasts with two small, short standardized-extract trials. These data cannot quantify rare serious bleeding or settle all products and aspirin regimens.
Factors that may matter: ginkgo extract identity; aspirin dose; other antiplatelet or anticoagulant treatment; prior bleeding; duration of use.
Read the supporting source summaries
Source 1: regulatory OTC drug label
dailymed.nlm.nih.gov · Source check Sep 10, 2026
Population: Users of oral aspirin 81 mg enteric-coated tablets.
Warns of severe stomach bleeding and identifies faintness, vomiting blood and bloody or black stools as reasons to seek medical attention. Directs patients to consult a doctor before use with prior ulcers or bleeding problems.
How this applies: Exact aspirin identity and baseline safety context; not direct proof for an individual botanical pair.
Does not identify a measured interaction with garlic, ginkgo or feverfew. Intrinsic aspirin bleeding risk is not proof of an added botanical effect, and an 81 mg coated product is not the same regimen as every cited study.
Source 2: primary randomized crossover trial
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: 50 healthy men aged 20-44 years, randomized to two treatment sequences.
Aspirin prolonged bleeding time, but adding EGb 761 did not further prolong it: mean post-treatment values 6.2 versus 6.3 minutes; ratio 1.01, 90% CI 0.86-1.19. Other measured coagulation and platelet effects were similar.
How this applies: Direct contrary evidence for this standardized extract and aspirin regimen, without proving safety of every ginkgo product or long-term bleeding outcomes.
Abstract only, seven-day exposure, healthy young men and surrogate tests. Authors extended reassurance to elderly people in their conclusion, but this population was not studied; no such extrapolation is adopted.
Source 3: primary randomized placebo-controlled trial
pubmed.ncbi.nlm.nih.gov · Source check Sep 10, 2026
Population: Older adults, mean age 69 years, with peripheral artery disease or cardiovascular risk factors. Platelet-function analysis included 26 placebo and 29 ginkgo participants; aggregation analysis included 21 and 23 respectively.
No clinically or statistically significant added effect on the tested platelet measures. Bleeding/bruising reports were infrequent and similar; no adverse bleeding events were observed.
How this applies: Direct aspirin co-use data that must accompany case-based cautions; does not establish a personal safe dose.
Abstract only, small samples differing by assay and four-week follow-up. The study was not large enough to exclude rare serious bleeding; no inference that all ginkgo preparations are equivalent.
Source 4: primary clinical case correspondence
nejm.org · Source check Sep 10, 2026
Population: A 70-year-old man taking aspirin after coronary bypass surgery.
Recurrent blurred vision and visible iris bleeding were reported. Bleeding stopped spontaneously; after ginkgo withdrawal with aspirin continued, no recurrence was reported over three months.
How this applies: An exact aspirin co-exposure signal, not a causal proof or an incidence estimate for all leaf extracts.
Single case, no rechallenge, no randomized comparator and no measured interaction mechanism. The preparation differs from EGb 761 trials. Direct PDF download returned a failure body; full-text access is based on complete indexed original-publisher text, not that failed file.
Source 5: official regulatory herbal monograph
ema.europa.eu · Source check Sep 10, 2026
Population: Adults using the defined ginkgo leaf dry extract; separate provisions cover powdered leaf.
Calls for medical consultation with bleeding tendency or antiplatelet treatment and notes that effects may be influenced when combined with aspirin. Bleeding reports are acknowledged without an event frequency.
How this applies: Supports clinician review for the named aspirin combination while keeping trial and case evidence separate. The current EMA page lists a later consultation, not a replacement adopted monograph.
Regulatory precaution, not an additional trial. The source differentiates dry extract from powdered leaf; not all retail products match. Its pre-surgery instruction does not establish a routine hours-apart aspirin schedule.
Research assessment: · Open full citations ↗
Review and change history
- Publication status
- Published research summary
- Clinical review
- Not yet recorded
| Date | Update |
|---|---|
| Article prepared | |
| Original sources checked and a new article prepared, preserving direct co-use evidence, contrary findings and formulation limits. No independent clinical review is recorded. | |
| Research summary published |
Article revision: 054e493372a8f9e2
This guide brings together the evidence records used by our interaction checker. Each finding retains its own preparation limits, research date, and source summaries.
Full citations require verification. Reading this answer and the source summaries does not.
Taking other supplements or medications?
Use the checker to explore your other combinations. Ask a pharmacist to review the exact products, amounts and medical conditions in your complete list.
Open the interaction checkerInformation, not medical advice. Do not change prescribed treatment based on this guide.