Ginkgo Biloba

Aka: Ginkgo Biloba, Ginkgo

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II. Indications (Purported benefits)

  1. Dementia (longstanding use in Chinese traditional medicine)
    1. Alzheimer's Disease
    2. Multiple-Infarct Dementia
  2. Used in Germany for:
    1. Intermittent Claudication
    2. Vertigo
    3. Tinnitus

III. Mechanism

  1. Flavonoids and Terpenoids are antioxidants
  2. Ginkgolide B (terpenoid)
    1. Inhibits Platelet activating factor
    2. Interferes with Platelet aggregation and blood clot

IV. Pharmacokinetics

  1. Readily absorbed
  2. Peak concentration in 2-3 hours after ingestion
  3. Excreted by Kidney, Liver
  4. Half life: 5 hours

V. Precautions

  1. Stop Ginkgo 14 days before elective surgery (due to Platelet Dysfunction and bleeding risk)
  2. Do NOT ingest fresh gingko seeds
    1. Contain Ginkgotoxin which may induce Seizures (or death in larger quantities)

VI. Dosing

  1. Standardized extract: 120 to 160 mg divided twice daily to three times daily
    1. Typical dose is 240 mg/day
  2. Standardized extract components
    1. Flavone glycosides: 24%
    2. Terpene lactones: 6%

VII. Adverse Effects

  1. Mild Gastrointestinal symptoms (Vomiting, Diarrhea)
  2. Headache
  3. Serious bleeding complications (e.g. Subdural Hematoma)
    1. Ginkgo Biloba may induce Platelet Dysfunction
    2. Associated with Ginkgo combined with Aspirin or Warfarin use
    3. Exacerbated by Garlic, Feverfew, Ginseng (see below)
  4. Seizures
    1. Reports of Seizures in those with Epilepsy and previously controlled on prophylaxis

VIII. Safety

  1. Avoid in pregnancy (due to antiplatelet activity and hormonal effects)
  2. Avoid in Lactation (unknown safety)

IX. Drug Interactions

  1. Multiple potential CYP450 interactions (1A2, 2C9, 3A4)
  2. Avoid use with Anticoagulants
    1. Aspirin
    2. Warfarin (Coumadin)
    3. Ticlopidine (Ticlid)
    4. Clopidogrel (Plavix)
    5. Dipyridamole (Persantine)
  3. Avoid use with Herbals with Anticoagulant activity
    1. Feverfew
    2. Garlic
    3. Ginseng
    4. Dong Quai
    5. Red Clover

X. Efficacy: Cognitive effects

  1. Preliminary studies suggest possible benefit
    1. Benefits likely to offer only modest effect
  2. Dementia Study, n=309, 120 mg qd for 1 year, RDBCT
    1. Ginkgo patients scored higher on cognitive tests
    2. Caregivers rated Ginkgo patients higher score
    3. Clinicians ratings found no difference
    4. Patients completing study: <50%
    5. Le Bars (1997) JAMA 278:1327 [PubMed]
  3. Van Dongen study found no benefit
    1. No benefit in Dementia
    2. No benefit in memory Impairment
    3. Van Dongen (2000) Am Geriatr Soc 48:1183-94 [PubMed]
  4. NIH DBPCT with n=2000 over 6 years is ongoing
    1. Sierpina (2003) Am Fam Physician 68(5):923-6 [PubMed]

XI. Efficacy: Non-cognitive uses

  1. Peripheral Vascular Disease
    1. Study showed longer walking distance and less pain
    2. Peters (1998) Vasa 27:106-10 [PubMed]
  2. Tinnitus
    1. Modest effect on reduction or Tinnitus resolution
    2. Ernst (1999) Clin Otolaryngol 24:164-7 [PubMed]

XII. References

  1. (2025) Presc Lett 32(5): 30
  2. Shaughnessy (1997) Fam Practice Recert 19(10):53-6
  3. Ang-Lee (2001) JAMA 286:208-16 [PubMed]
  4. Cupp (1999) Am Fam Physician 59(5):1239-44 [PubMed]
  5. Sierpina (2003) Am Fam Physician 68(5):923-6 [PubMed]
  6. Zink (1998) Am Fam Physician 58(5):1133-40 [PubMed]

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