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Ginger (Zingiber officinale Roscoe)



Interactions

Ginger/Drug Interactions:
  • Antiarthritic agentsAntiarthritic agents: Based on expert opinion, inhibition of prostaglandin and thromboxane formation by human platelets and the subsequent production of lipid peroxides have been proposed as possible mechanisms by which ginger might provide relief of rheumatoid arthritis symptoms (229). Theoretically, concurrent use may have additive effects.
  • AntibioticsAntibiotics: Based on animal evidence, ginger may increase the absorption and plasma half-life, and significantly decrease the elimination rate constant and clearance, of metronidazole (166). Based on in vitro evidence, ginger and some of its constituents may have antibacterial activity (147; 148; 149; 150; 151; 152; 153; 154; 155; 156; 157; 158; 159; 160; 161; 162; 163; 164; 165). Theoretically, concurrent use may have additive effects.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In theory, since ginger has been observed to inhibit thromboxane synthetase and because decreased platelet aggregation has been reported in clinical trials, concurrent use of ginger with agents that predispose patients to bleeding may enhance their effect and increase the risk of bleeding (230; 231; 130; 131). According to a human case report, international normalized ratio (INR) rose after initiating therapy with ginger and warfarin (189). It is not clear to what extent ginger was responsible for this rise in INR. Another case report indicated a possible anticoagulant interaction with concurrent use of ginger (219). Concurrent use of ginger has been associated with an increased risk of self-reported bleeding in patients taking warfarin (232). Theoretically, concurrent use may have additive effects.
  • Antidepressant agents, selective serotonin reuptake inhibitors (SSRIs)Antidepressant agents, selective serotonin reuptake inhibitors (SSRIs): Based on in vitro evidence, ginger may antagonize serotonin receptors (139) and theoretically may interfere with SSRIs.
  • Antidiabetic agentsAntidiabetic agents: Based on animal evidence, treatment of streptozotocin (STZ)-induced type I diabetic rats with Zingiber officinale produced a significant increase in insulin levels and a decrease in fasting glucose levels and also caused a decrease in serum cholesterol, serum triglyceride, and blood pressure (233; 234; 235; 236; 237; 238). Theoretically, due to its purported hypoglycemic effects, ginger may interfere with diabetes therapy, potentially requiring dosing adjustments (138).
  • AntiemeticsAntiemetics: Ginger has been shown to have antiemetic effects in clinical trials (184; 2; 3; 13; 239; 6; 15; 183; 185; 4; 7; 8; 10) and in animal study (240). Additive effects may occur when taken concomitantly with other antiemetics.
  • Antifungal agentsAntifungal agents: Based on in vitro evidence, ginger and some of its constituents exerted antifungal effects (241; 242; 243; 244; 28). Theoretically, concurrent use may have additive effects.
  • Anti-inflammatory agentsAnti-inflammatory agents: Ginger has been shown to suppress prostaglandin synthesis through the inhibition of cyclooxygenase-1 and cyclooxygenase-2, as well as suppress leukotriene biosynthesis by inhibiting 5-lipoxygenase (30; 229). Therefore, ginger may have additive effects when taken with anti-inflammatory agents. Based on animal evidence, Trikatu, an Ayurvedic formulation comprising a 1:1:1 ratio of dried fruits of Piper nigrum and Piper longum and dried rhizomes of Zingiber officinale, may decrease the bioavailability of diclofenac sodium (245). Based on animal evidence, ginger may also lower body temperature (246). Theoretically, concurrent use may have additive effects.
  • AntilipemicsAntilipemics: Oral ingestion of ginger extract has been shown to have hypocholesterolemic, hypolipidemic, and antiatherosclerotic effects in cholesterol-fed rabbits (133) and in rats (137). Inhibition of LDL oxidation and attenuated development of atherosclerosis has also been observed in apolipoprotein E-deficient mice (135). Theoretically, concurrent use may have additive effects.
  • Antineoplastic agentsAntineoplastic agents: Based on secondary sources, ginger may induce gastrointestinal bleeding when used with chemotherapy; however, the exact effects are unclear. Use of ginger with chemotherapy has been reported (247; 248); however, any interactions are unclear. Based on in vitro evidence, ginger and some of its constituents may have anticancer activity (249; 250; 251; 252; 42; 253; 254; 255; 256; 257; 258; 259; 260; 261; 147; 262; 263; 264; 265; 266; 267; 268; 269; 270; 271; 272; 273; 274; 275; 276). Theoretically, concurrent use may have additive effects. The constituents isolated from ginger species, including curcumin, 6-gingerol, and labdane-type diterpene compounds, were found to have positive effects on cell proliferation and the induction of apoptosis in the cultured human T lymphoma Jurkat cells (250). Ginger in food may interfere with cell-signaling pathways (249).
  • Antiobesity drugsAntiobesity drugs: Based on animal evidence, oral administration of zingerone reduced body weight and adipose tissue weight in ovariectomized rats (277; 278). Theoretically, ginger may have additive effects when taken with antiobesity agents. Ginger has been suggested as a possible weight loss aid (279; 280), although further evidence is needed to confirm these preliminary findings.
  • AntiprotazoalsAntiprotazoals: Based on in vitro evidence, ginger extracts demonstrated a reduction in worm numbers (281; 282; 283). Theoretically, concurrent use may have additive effects.
  • Antitussive agentsAntitussive agents: Constituents in ginger have exhibited antitussive effects (284). Theoretically, concurrent use may have additive effects.
  • Antiviral agentsAntiviral agents: Based on in vitro evidence, ginger exerted antiviral activity via inhibition of hepatitis C virus protease and human cytomegalovirus protease (285). Theoretically, concurrent use may have additive effects.
  • BenzodiazepinesBenzodiazepines: Based on animal evidence, a mixture of ginger and Ginkgo biloba extracts demonstrated anxiolytic effects in rats (143; 144; 145; 146). In theory, ginger may increase the amount of drowsiness caused by some drugs.
  • Cardiovascular drugsCardiovascular drugs: Ginger may interfere with medications that change the contraction of the heart, including beta-blockers and digoxin. Arrhythmias are theoretically possible at high doses, based on in vitro and in vivo study showing components of ginger to activate Ca2+-ATPase and to have dose-dependent positive inotropic effects (134). Based on animal evidence, ginger juice may increase the acute toxicity of quinidine (286). Anecdotally, some experts report hemodynamic effects of large doses, including hypertension or hypotension, although scientific data are lacking in this area. In vitro research indicates that gingerols and the related shogaols exhibit cardiodepressant activity at low doses and cardiotonic properties at higher doses (136).
  • CNS depressantsCNS depressants: Based on animal evidence, a mixture of ginger and Ginkgo biloba extracts demonstrated anxiolytic effects in rats (143; 144; 145; 146). In theory, since large doses of ginger have been reported to depress the central nervous system (CNS), it may cause additive sedation when used with CNS-depressant drugs.
  • CNS stimulantsCNS stimulants: Inhalation of ginger essential oil has been shown to reduce immobility in mice (287). Theoretically, concurrent use may have additive effects.
  • CyclosporineCyclosporine: Based on animal evidence, ginger may decrease the oral bioavailability of cyclosporine (168).
  • Cytochrome P450-metabolized agentsCytochrome P450-metabolized agents: The Chinese herbal medicine sho-saiko-to, which contains ginger and six other herbs (bupleurum, pinellia tuber, scutellaria root, jujube fruit, ginseng, and licorice root), has been associated in healthy humans with reduced activity of cytochrome P450 1A2, P450 3A, and xanthine oxidase (in 26 healthy subjects) (288). Based on secondary sources, ginger may interact with such agents (289); however, the contribution of ginger to this effect is not clear.
  • Erectile dysfunction agentsErectile dysfunction agents: Based on in vitro evidence, Zingiber officinalis may exert short-lived and dose-dependent rabbit corpus cavernosum relaxations (290).
  • EstrogensEstrogens: Ginger may exert high estrogenic potency based on in vitro evidence (142).
  • Gastrointestinal agentsGastrointestinal agents: Based on secondary sources, the ginger rhizome (underground stem) may increase stomach acid production. Therefore, it may interfere with antacids, sucralfate (Carafate®), H2 antagonists, or proton pump inhibitors. In contrast, other in vitro and animal study has revealed gastroprotective properties (291; 292). Also, (6)-shogaol has inhibited intestinal motility in intravenous preparations and facilitated gastrointestinal motility in oral preparations. Ginger extract, zingiberene, and (6)-gingerol have been observed to afford cytoprotection against chemically-induced ulceration in rats (291; 292), and ginger extract has been reported to inhibit the growth of Helicobacter pylori in vitro (55). However, clinical study indicated a significant increase in the exfoliation of gastric surface epithelial cells following the consumption of 6g or more of ginger (293).
  • ImmunosuppressantsImmunosuppressants: In vitro evidence indicates that ginger may have immunomodulatory effects (140; 141).
  • MetronidazoleMetronidazole: Based on animal evidence, ginger may increase the absorption and plasma half-life, and significantly decrease the elimination rate constant and clearance, of metronidazole (166).
  • NifedipineNifedipine: Based on human evidence, antiplatelet aggregation was increased when nifedipine and ginger were used. Nifedipine and ginger had a synergistic effect on the inhibition of platelet aggregation (167).
  • Nonsteroidal anti-inflammatory agents (NSAIDs)Nonsteroidal anti-inflammatory agents (NSAIDs) : Based on a review, ginger has been shown to share pharmacological properties with nonsteroidal anti-inflammatory drugs (NSAIDs) because it suppresses prostaglandin synthesis through the inhibition of cyclooxygenase-1 and cyclooxygenase-2 (30). Therefore, ginger may have additive effects when taken with COX inhibitors.
  • P-glycoprotein-regulated agentsP-glycoprotein-regulated agents: Based on in vitro evidence, (6)-gingerol has been reported to have inhibitory effects on P-glycoprotein (294).

Ginger/Herb/Supplement Interactions:
  • Antiarthritic herbs and supplementsAntiarthritic herbs and supplements: Based on expert opinion, inhibition of prostaglandin and thromboxane formation by human platelets and the subsequent production of lipid peroxides, have been proposed as possible mechanisms by which ginger might provide relief of rheumatoid arthritis symptoms (229). Theoretically, concurrent use may have additive effects.
  • AntibacterialsAntibacterials: Based on animal evidence, ginger may increase the absorption and plasma half-life, and significantly decrease the elimination rate constant and clearance, of metronidazole (166). Based on in vitro evidence, ginger and some of its constituents may have antibacterial activity (147; 148; 149; 150; 151; 152; 153; 154; 155; 156; 157; 158; 159; 160; 161; 162; 163; 164; 165). Theoretically, concurrent use may have additive effects with herbs and supplements that have similar effects.
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In theory, inhibition of thromboxane synthetase and decreased platelet aggregation has been reported in clinical trials (230; 231; 130; 131). Concurrent use of ginger with agents that predispose patients to bleeding may enhance their effect and increase the risk of bleeding. According to a case report, a patient using chronic warfarin had an increase in the international normalized ratio (INR) after initiating therapy with ginger (189). It is not clear to what extent ginger was responsible for this rise in INR. Another case report indicated a possible anticoagulant interaction with concurrent use of ginger (219). Concurrent use of ginger has been associated with an increased risk of self-reported bleeding in patients taking warfarin (232). Theoretically, concurrent use may have additive effects with herbs and supplements that have similar effects.
  • AntidepressantsAntidepressants: Based on in vitro evidence, ginger may antagonize serotonin receptors (139) and theoretically may interfere with herbs or supplements with SSRI effects.
  • AntiemeticsAntiemetics: Ginger has been shown to have antiemetic effects in clinical trials (184; 2; 3; 13; 239; 6; 15; 183; 185; 4; 7; 8; 10) and in animal study (240). Additive effects may occur when taken concomitantly with other antiemetics.
  • AntifungalsAntifungals: Based on in vitro evidence, ginger and some of its constituents exerted antifungal effects (241; 242; 243; 244; 28). Theoretically, concurrent use may have additive effects.
  • Anti-inflammatory herbs and supplementsAnti-inflammatory herbs and supplements: Based on a review, ginger has been shown to suppress prostaglandin synthesis through the inhibition of cyclooxygenase-1 and cyclooxygenase-2, as well as leukotriene biosynthesis by inhibiting 5-lipoxygenase (30; 229). Based on animal evidence, ginger may lower body temperature (246). Therefore, ginger may have additive effects when taken with anti-inflammatory agents.
  • AntilipemicsAntilipemics: Oral ingestion of ginger extract has been shown to have hypocholesterolemic, hypolipidemic, and antiatherosclerotic effects in cholesterol-fed rabbits (133) and in rats (137). Inhibition of LDL oxidation and attenuated development of atherosclerosis has also been observed in apolipoprotein E-deficient mice (135). Theoretically, concurrent use may have additive effects.
  • AntineoplasticsAntineoplastics: Based on secondary sources, ginger may induce gastrointestinal bleeding when used with chemotherapy; however, the exact effects are unclear. Use of ginger with chemotherapy has been reported (247; 248); however, any interactions are unclear. Based on in vitro evidence, ginger and some of its constituents may show anticancer activity (249; 250; 251; 252; 42; 253; 254; 255; 256; 257; 258; 259; 260; 261; 147; 262; 263; 264; 265; 266; 267; 268; 269; 270; 271; 272; 273; 274; 275; 276). Theoretically, concurrent use may have additive effects. The constituents isolated from ginger species, including curcumin, 6-gingerol, and labdane-type diterpene compounds, were found to have positive effects on cell proliferation and the induction of apoptosis in the cultured human T lymphoma Jurkat cells (250). Ginger in food may interfere with cell-signaling pathways (249).
  • Antiobesity herbs and supplementsAntiobesity herbs and supplements: Based on animal evidence, oral administration of zingerone reduced body weight and adipose tissue weight in ovariectomized rats (277; 278). Ginger has been suggested as a possible weight loss aid (279; 280), although further evidence is needed to confirm these preliminary findings. Theoretically, concurrent use may have additive effects.
  • AntioxidantsAntioxidants: In vitro, ginger and its constituents have been shown to exhibit antioxidant effects (199; 295; 296; 297; 298; 299; 147; 300; 301; 302; 303; 304) through free radical scavenging abilities (305; 306; 307; 308; 263; 309; 310; 265; 311; 312; 313; 314; 315; 316; 317). Theoretically, concurrent use may have additive effects.
  • AntiparasiticsAntiparasitics: Based on in vitro evidence, ginger extracts demonstrated a reduction in worm numbers as well as antifungal activity (281; 282; 283). Theoretically, concurrent use may have additive effects.
  • AntitussivesAntitussives: Constituents in ginger have exhibited antitussive effects (284). Theoretically, concurrent use may have additive effects.
  • AntiviralsAntivirals: Based on in vitro evidence, ginger exerted antiviral activity via inhibition of hepatitis C virus protease and human cytomegalovirus protease (285). Theoretically, concurrent use may have additive effects.
  • CalciumCalcium: Ginger or ginger extracts may stimulate calcium uptake in both skeletal and cardiac muscle. In vitro study of gingerol involving canine cardiac tissue and rabbit skeletal muscle demonstrated gingerol to activate the Ca2+-ATPase pump in a dose-dependent manner (318). In theory, ginger coupled with high serum levels of calcium may cause hyperexcitability of cardiac muscle.
  • Cardiovascular herbs and supplementsCardiovascular herbs and supplements: Ginger may also interfere with medications that change the contraction of the heart. Arrhythmias are theoretically possible at high doses, based on in vitro and in vivo study showing components of ginger to activate Ca2+-ATPase and to have dose-dependent positive inotropic effects (134). Based on animal evidence, ginger juice may increase the acute toxicity of some cardiovascular agents (286). Anecdotally, some experts report hemodynamic effects of large doses, including hypertension or hypotension, although scientific data are lacking in this area. In vitro research indicates that gingerols and the related shogaols exhibit cardiodepressant activity at low doses and cardiotonic properties at higher doses (136).
  • Cytochrome P450-metabolized herbs and supplementsCytochrome P450-metabolized herbs and supplements: The Chinese herbal medicine sho-saiko-to contains ginger and six other herbs (bupleurum, pinellia tuber, scutellaria root, jujube fruit, ginseng, and licorice root) and has been associated in healthy humans with reduced activity of cytochrome P450 1A2, P450 3A, and xanthine oxidase (in 26 healthy subjects) (288). The contribution of ginger alone to this effect is unclear.
  • Erectile dysfunction herbs and supplementsErectile dysfunction herbs and supplements: Based on in vitro evidence, Z. officinalis may exert short-lived and dose-dependent rabbit corpus cavernosum relaxations (290).
  • GarlicGarlic: In theory, since ginger has been observed to inhibit thromboxane synthetase, the concurrent use of ginger with agents that predispose patients to bleeding, such as garlic or ginkgo, may enhance their effect and increase the risk of bleeding (230; 231; 130; 131). In animal study, a combination of garlic and ginger was found to be more effective in reducing blood glucose and serum lipids (319).
  • Gastrointestinal herbs and supplementsGastrointestinal herbs and supplements: Based on secondary sources, ginger rhizome (underground stem) may increase stomach acid production. In contrast, other in vitro and animal study has revealed gastroprotective properties (291; 292). Ginger extract, zingiberene, and (6)-gingerol have been observed to afford cytoprotection against chemically induced ulceration in rats (291; 292), and ginger extract has been reported to inhibit the growth of Helicobacter pylori in vitro (55). However, clinical study indicated a significant increase in the exfoliation of gastric surface epithelial cells following the consumption of 6g or more of ginger (293).
  • GinkgoGinkgo: In theory, since ginger has been observed to inhibit thromboxane synthetase, the concurrent use of ginger with agents that predispose patients to bleeding, such as garlic or ginkgo, may enhance their effect and increase the risk of bleeding (230; 231; 130; 131).
  • Herbs or supplements used in hematology and blood disordersHerbs or supplements used in hematology and blood disorders: In theory, since ginger has been observed to inhibit thromboxane synthetase, concurrent use of ginger with agents that predispose patients to bleeding, such as garlic or ginkgo, may enhance their effect and increase the risk of bleeding (230; 231; 130; 131). According to a case report, a patient using chronic warfarin had an increase in the international normalized ratio (INR) after initiating therapy with ginger (189). It is not clear to what extent ginger was responsible for this rise in INR.
  • HypertensivesHypertensives: Anecdotally, some experts report hemodynamic effects of large doses, including hypertension or hypotension, although scientific data are lacking in this area. Theoretically, concurrent use may have additive effects.
  • HypoglycemicsHypoglycemics: Theoretically, due to its purported hypoglycemic effects, ginger may lower blood glucose levels when taken concomitantly with hypoglycemic or antihyperglycemic herbs or supplements (138).
  • HypotensivesHypotensives: In animal study, an aqueous extract of ginger induced a dose-dependent fall in arterial blood pressure (320).
  • ImmunostimulantsImmunostimulants: The authors of a systematic review concluded that in vitro evidence indicates that ginger has immunomodulatory effects and is an effective antimicrobial and antiviral agent (199). Theoretically, concurrent use may have additive effects.
  • ImmunosuppressantsImmunosuppressants: The authors of one systematic review concluded that in vitro evidence indicates that ginger has immunomodulatory effects and is an effective antimicrobial and antiviral agent (199).
  • P-glycoprotein-regulated agentsP-glycoprotein-regulated agents: Based on in vitro evidence, (6)-gingerol has been reported to have inhibitory effects on P-glycoprotein (294).
  • PhytoestrogensPhytoestrogens: Ginger may exert high estrogenic potency based on in vitro evidence (142).
  • Sedative herbs and supplementsSedative herbs and supplements: Based on animal evidence, a mixture of ginger and Ginkgo biloba extracts demonstrated anxiolytic effects in rats (143; 144; 145; 146). In theory, ginger may increase the amount of drowsiness caused by some herbs or supplements.
  • StimulantsStimulants: Inhalation of ginger essential oil has been shown to reduce immobility in mice (287). Theoretically, concurrent use may have additive effects.

Ginger/Lab Interactions:
  • Blood pressureBlood pressure: An aqueous extract of ginger induced a dose-dependent (3-10mg/kg) fall in the arterial blood pressure (BP) of anesthetized rats, which was partially blocked by atropine (1mg/kg) (320).
  • Blood glucoseBlood glucose: Theoretically, due to its purported hypoglycemic effects, ginger may lower blood glucose levels when taken concomitantly with hypoglycemic or antihyperglycemic herbs or supplements (138).
  • Coagulation panelCoagulation panel: There is a European case report of a 75 year-old woman taking chronic warfarin whose international normalized ratio (INR) rose after initiating therapy with ginger and was complicated by epistaxis (189). Her INR normalized after discontinuation of ginger and treatment with vitamin K. It is not clear to what extent ginger was responsible for this rise in INR. In one clinical trial, ginger did not affect the pharmacokinetics or pharmacodynamics of warfarin in healthy subjects (321). However, studies in patients taking anticoagulants are needed to assess the clinical significance of these interactions.
  • LipidsLipids: Oral ingestion of ginger extract has been shown to have hypocholesterolemic, hypolipidemic, and antiatherosclerotic effects in cholesterol-fed rabbits (133) and in rats (137). Inhibition of LDL oxidation and attenuated development of atherosclerosis has also been observed in apolipoprotein E-deficient mice (135).

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.