RT Journal
A1 Miller LG
T1 Herbal medicinals: Selected clinical considerations, focusing on known or potential drug-herb interactions
JF Archives of Internal Medicine
JO Archives of Internal Medicine
YR 1999
FD September 13
VO 159
IS 16
SP 1954
OP 1954
DO 
UL http://dx.doi.org/
AB 
Rosenblatt and Mindel1 reported spontaneous hyphema in a 70-year-old man 1 week after he began ingesting Ginkgo biloba (40 mg twice daily). The patient had taken aspirin (325 mg/d) for 3 years without incident; hence, the authors felt that a temporal relationship strongly implicated ginkgo. I agree. Rowin and Lewis2 have also reported spontaneous bilateral subdural hematomas associated with long-term G biloba use. They acknowledged that their patient had taken acetaminophen and had a very brief trial of ergotamine/caffeine tablets. However, given the lack of a temporal relationship and the fact that acetaminophen, ergotamine, and caffeine have not been shown to be associated with subdural hematomas, Rowin and Lewis implicated G biloba. Furthermore, the patient's bleeding time improved following discontinuation of G biloba. Again, I agree with their conclusions. Yet another report was recently published describing a 61-year-old man who developed subarachnoid hemorrhage after ingesting G biloba (40 mg 3 or 4 times daily).3 He was not taking any other medications.