Allergic reactions are a significant concern with unprocessed ginkgo leaf (ginkgolic acid) but are much less likely to occur with the leaf extract. The malodorous ginkgo fruit cross-reacts with poison ivy (urushiol) and may cause an identical contact dermatitis.
Children eating large numbers (>50) of the uncooked ginkgo kernels have had seizures, and consequently there is some concern about using high doses of ginkgo in seizure patients. However, most patients tolerate gingko extract very well, with only occasional GI upset or headache being reported, and the product is considered safe for healthy nonpregnant adults.
Bleeding complications are an infrequent but serious concern, with subdural hematomas, subarachnoid hemorrhages, hyphema (bleeding of the iris), and surgical bleeding occasionally reported. Stopping ginkgo administration prior to surgery and the avoidance of its use with anticoagulant drugs and perhaps with aspirin is recommended. Use of ginkgo extract should be avoided in pregnant women and children, since at least one study showed in a ginkgo preparation small amounts of colchicine, a compound that can block cellular division and cause abortion; however, it is unclear whether this is a problem in all ginkgo preparations.
Ginkgo may reduce the effectiveness of thiazide diuretics for blood pressure control and at least theoretically should be avoided with MAOIs. There is also a suggestion that ginkgo may decrease male and female fertility, and it should be avoided in those trying to conceive.
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