The Belgian authorities advise to add a warning to food supplements with preparations of ginger in case of concomitant use of anticoagulants.
Zingiber officinale is mentioned on the ‘List 3’ (Plants to be notified if in a pre-dosed form) of the Royal Decree on Botanicals [1]; with the following restrictions/conditions:
“Only the use of the following plant parts is permitted: rhizome. The recommended daily dose should not lead to an intake higher than the amount equivalent to 1.5 g of dried rhizome for adolescents and adults and the amount equivalent to 0.75 g of dried rhizome for children between 6 and 12 years of age. The recommended daily intake should not exceed 1 g of dried rhizome for pregnant women (extracts are not permitted). The use for children under 6 years of age is not permitted.”
The Belgian Department of Health asked the Advisory Commission for Plant Preparations to issue an advice about the safe use of ginger (Zingiber officinale Rosc.) and its preparations, together with anticoagulant medicines.[2]
The Commission executed a literature study and found in vitro data demonstrating that ginger preparations can interact with platelet aggregation, inhibit coagulation and significantly prolong prothrombin time in a dose-dependent manner. Several cases reports were attributed to the concomitant use of ginger and different types of anticoagulants. The effect of ginger on platelet aggregation was revised in a systematic literature review. The review concluded that while in vitro data, as well as some clinical studies and epidemiological evidence suggest that ginger inhibits platelet aggregation, the evidence is equivocal with multiple limitations, particularly within the clinical data, which prevents firm recommendations being made. Limitations include the lack of standardization of ginger preparations used, significant variations in dosage and time frame studied, and the high level of bias in the study designs used. Therefore, further research is needed to clearly define the safety, or otherwise, of ginger in patient population at increased risk of bleeding.
The Advisory Commission on Plant Preparations concludes that because of the precautionary principle, ginger preparations can be used in food supplements only if the following warning is added: “Consult your doctor or pharmacist in case of concomitant use of anticoagulants.”.
[1] Royal Decree of 31 August 2021 concerning the manufacture of and trade in foodstuffs composed of or containing plants or plant preparations, see https://www.health.belgium.be/Node/24555
[2] Advice of Advisory Commission on Plant Preparations on the use of ginger, see https://www.health.belgium.be/nl/zingiber-officinale-anticoagulantia-2023
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