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Ativan and Ginkgo biloba

Determining the interaction of Ativan and Ginkgo biloba and the possibility of their joint administration.

Check result:

Ativan <> Ginkgo biloba

Relevance: 27.12.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Talk to your doctor before using ginkgo together with LORazepam. Some preparations of ginkgo biloba have caused seizures and may interfere with the anticonvulsant effects of LORazepam. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

GENERALLY AVOID: Certain preparations of ginkgo biloba have been reported to induce seizures and may antagonize the effects of anticonvulsants. 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 anticonvulsants should preferably avoid the use of products containing ginkgo biloba.

References

Miller LG "Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions." Arch Intern Med 158 (1998): 2200-11
Spinella M "Herbal medicines and epilepsy: the potential for benefit and adverse effects." Epilepsy Behav 2 (2001): 524-32
Gregory PJ "Seizure associated with Ginkgo biloba?." Ann Intern Med 134 (2001): 344
Miwa H, Iijima M, Tanaka S, Mizuno Y "Generalized convulsions after consuming a large amount of Gingko nuts." Epilepsia 42 (2001): 280-1
Granger AS "Ginkgo biloba precipitating epileptic seizures." Age Ageing 30 (2001): 523-5
Kupiec T, Raj V "Fatal seizures due to potential herb-drug interactions with Ginkgo biloba." J Anal Toxicol 29 (2005): 755-8
Kajiyama Y, Fujii K, Takeuchi H, Manabe Y "Ginkgo seed poisoning." Pediatrics 109 (2002): 325-7
Harms SL, Garrard J, Schwinghammer P, Eberly LE, Chang Y, Leppik IE "Ginkgo biloba use in nursing home elderly with epilepsy or seizure disorder." Epilepsia 47 (2006): 323-9

Ativan

Generic Name: lorazepam

Brand name: Ativan, Lorazepam Intensol

Synonyms: n.a.

What is Ativan?

Ginkgo biloba

Generic Name: ginkgo

Brand name: Ginkgo biloba, Gingko Biloba

Synonyms: n.a.

What is Ginkgo biloba?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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