Natural Standard® Patient Monograph, Copyright © 2014 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Background

Ginkgo biloba has been used medicinally for thousands of years. Today, it is one of the top-selling herbs in the United States.

Ginkgo is used for the treatment of numerous conditions, many of which are under scientific investigation. Available evidence supports ginkgo for managing dementia, anxiety, schizophrenia, and cerebral insufficiency (insufficient blood flow to brain).

Evidence for other uses is either lacking or mixed. Further research is needed for all uses of ginkgo.

Although ginkgo is generally well tolerated, it should be used cautiously in people with clotting disorders or taking blood thinners, or prior to some surgical or dental procedures, due to reports of bleeding.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Adults (over 18 years old)

For age-associated memory impairment (AAMI), 240-600 milligrams of ginkgo extract (EGb 761® or ginkgobene®) has been taken by mouth for up to 42 weeks. Ginkgo in a dosage of 0.9-1.9 milliliters has been taken by mouth three times daily. Additionally, 120 milligrams of ginkgo extract has been taken by mouth twice daily for 6.1 years.

For altitude (mountain) sickness, 160 milligrams of ginkgo (EGb 761®) once daily or 120 milligrams of ginkgo twice daily has been taken by mouth for 4-5 days.

For autism, 100 milligrams of ginkgo EGb 761® has been taken by mouth daily for four weeks.

For blood pressure control, 120 milligrams of ginkgo extract has been taken by mouth for 6.1 years.

For cancer prevention, 120 milligrams of ginkgo extract (EGb 761®) has been taken by mouth twice daily for 6.1 years.

For cerebral insufficiency (insufficient blood flow to the brain), up to 160 milligrams of ginkgo has been taken by mouth daily for 12 weeks in up to three divided doses.

For cochleovestibular (ear) disorders, 160 milligrams of ginkgo (EGb 761®) supplements (Tanakan® or Tebokan®) has been taken by mouth as two tablets twice daily over six weeks.

For claudication (leg pain from clogged arteries), 80-320 milligrams of ginkgo extract (EGb 761®) or 6 milliliters of ginkgo liquid has been taken by mouth daily in single or divided doses for up to six months. The ginkgo product Tanakan® has been injected in the veins at a dose of 100 milligrams in 500 cubic centimeters of normal saline, twice daily for eight days. Additionally, 35 milligrams of ginkgo extract has been injected into the femoral vein.

For cocaine dependence, 120 milligrams of ginkgo has been taken by mouth daily for 10 weeks.

For cognitive performance, up to 600 milligrams of ginkgo has been taken by mouth as a tablet, flavone glycoside, ginkgolide, or leaf extract in single or divided doses for up to eight months (Blackmore's ginkgo Forte®, EGb 761®, Tebonin®, Tanakan®, Rökan®, Kaveri®).

For decreased libido and erectile dysfunction (impotence), up to 240 milligrams of ginkgo or ginkgo extract has been taken by mouth daily for up to 18 months.

For dementia, up to 600 milligrams daily of ginkgo in single or divided doses has been taken by mouth for up to six years (EGb 761®, Tebonin®, Tanakan®, Rökan®, Kaveri®). Additionally, 200 milligrams of EGb 761® has been injected in the blood for four days weekly. Geriaforce® at a daily dose of 2.85-5.7 milliliters has been injected in the blood for 24 weeks.

For depression and seasonal affective disorder (SAD), 240 milligrams of ginkgo has been taken by mouth for up to 10 weeks.

For diabetic nephropathy (kidney damage), 20 milliliters of ginkgo in 250 milliliters of normal saline has injected in the blood daily for four weeks.

For eye allergy, two eyedrops containing a combination of ginkgo and hyaluronic acid were used in each eye three times daily for one month.

For generalized anxiety disorder, 240-480 milligrams of ginkgo has been taken by mouth daily in up to three divided doses for 4-8 weeks.

For glaucoma (increased eye pressure), up to 300 milligrams of ginkgo, ginkgo extract or flavonoid glycosides has been taken by mouth daily in single or divided doses for up to four years.

For glucose tolerance, 120 milligrams of EGb 761® has been taken by mouth once daily for three months.

For Graves' disease (thyroid disorder), 120 milligrams of EGb 761® has been taken by mouth daily from three days before to 30 days after radioiodine therapy.

For hearing loss, 120 milligrams of ginkgo has been taken by mouth twice daily. Additionally, 40 milligrams of ginkgo has been taken by mouth three times daily over two different courses of 90 days.

For heart disease, 120 milligrams of ginkgo extract (EGb 761®, Schwabe Pharmaceuticals, Karlsruhe, Germany) has been taken by mouth twice daily for 6.1 years. Additionally, 87.5 milligrams of ginkgo extract has been injected in the blood daily for two weeks.

For macular degeneration (eye disease), up to 480 milligrams of ginkgo or ginkgo extract has been taken in single or divided doses by mouth for up to six months (ginkgo extract LI 1370, EGb 761®).

For memory enhancement, 120-360 milligrams of ginkgo daily in single or divided doses has been taken by mouth for up to six weeks (Bioginkgo® , Ginkoba® , Blackmore's ginkgoforte extract, Li1370, EGb 761®, Ginkoba Gb extract).

For mental alertness (post-meal), 130-234 milligrams of ginkgo daily has been taken by mouth for 13 weeks.

For mood and cognition in postmenopausal women, 120 milligrams of ginkgo has been taken by mouth daily for seven days to six weeks.

For multiple sclerosis (MS), 240 or 360 milligrams of ginkgolide B has been taken by mouth daily.

For premenstrual syndrome (PMS), up to 320 milligrams of ginkgo or ginkgo extract has been taken by mouth in single or divided doses (Ginko T.D.™ EGb 761®).

For pulmonary interstitial fibrosis (lung scarring), 1 gram of ginkgo extract has been taken by mouth three times daily for three months.

For quality of life, 120 milligrams of EGb 761® extract has been taken by mouth daily for 4-10 months.

For Raynaud's (poor circulation), 120-360 milligrams of ginkgo extract (EGb 761®) has been taken by mouth in single or divided doses daily for up to 10 weeks.

For retinopathy (eye damage from type 2 diabetes), 80 milligrams (2 milliliters) of EGb 761® has been taken by mouth twice daily.

For schizophrenia, up to 360 milligrams of ginkgo or ginkgo extract (EGb 761®) has been taken by mouth in divided doses daily for up to 16 weeks, alone or in combination with antipsychotics.

For smell disorders, 80 milligrams of ginkgo has been taken by mouth three times daily for four weeks in addition to prednisolone and mometasone furoate.

For stroke, 40 milligrams of ginkgo has been taken by mouth four times daily for four weeks.

For stomach cancer, 0.5 grams of ginkgo has been taken by mouth three times daily.

For tinnitus (ringing of the ears), up to 240 milligrams of ginkgo or ginkgo extract has been taken by mouth in single or divided doses for up to 26 weeks (EGb 761®, Tanakan®, LI1370). Additionally, 200 milligrams of EGb 761® has been injected in the blood for 10 days, followed by 80 milligrams taken by mouth twice daily for 12 weeks.

For vertigo (dizziness), 160 milligrams of ginkgo (EGb 761®) has been taken by mouth daily for three months.

For vitiligo (lack of pigment in the skin), 120 milligrams of ginkgo extract or standardized ginkgo in two or three divided doses has been taken for up to six months.

Note: The intravenous ginkgo product Tebonin®, which was available in Germany, may have been removed from the German market due to significant adverse effects.

Note: Beneficial effects may take 4-6 weeks to appear. Ginkgo seeds are potentially toxic and should be avoided.

Children (under 18 years old)

For attention-deficit hyperactivity disorder (ADHD), 40-120 milligrams has been taken by mouth daily in single or divided doses for six weeks.

For dyslexia, 80 milligrams of EGb 761® has been taken by mouth daily for an average of 34.4 days.

Evidence

These uses have been tested in humans or animals.  Safety and effectiveness have not always been proven.  Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Key to grades

A
Strong scientific evidence for this use
B
Good scientific evidence for this use
C
Unclear scientific evidence for this use
D
Fair scientific evidence against this use (it may not work)
F
Strong scientific evidence against this use (it likely does not work)

Grading rationale

Evidence gradeCondition to which grade level applies
B

Cerebral insufficiency (insufficient blood flow to the brain)

Cerebral insufficiency is characterized by poor concentration, confusion, decreased physical performance, fatigue, headache, dizziness, depression, and anxiety. Research of ginkgo for cerebral insufficiency has demonstrated efficacy in reducing symptoms. However, additional research is warranted in this area.
B

Dementia

Overall, the scientific literature suggests that ginkgo benefits people with dementia. Ginkgo may improve cognitive performance and protect against Alzheimer's. However, conclusions regarding ginkgo for dementia are often conflicting. Additional research is needed in this area.
B

Generalized anxiety disorder

From available research, ginkgo offers benefit to people with generalized anxiety disorder (GAD). Further research is needed to confirm dosing and who may benefit most from ginkgo.
B

Schizophrenia

Research suggests that in combination with antipsychotics, ginkgo may offer benefits for people with schizophrenia. Additional research is needed on this topic.
C

Altitude (mountain) sickness

Research on ginkgo for the treatment of altitude (mountain) sickness reports conflicting results. Additional research is needed before a firm conclusion can be made.
C

Asthma

Ginkgo extract or a ginkgo combination product may reduce asthma symptoms. Further research is required before a conclusion can be drawn.
C

Attention-deficit hyperactivity disorder (ADHD)

Limited research suggests that ginkgo is less effective than methylphenidate for symptoms of ADHD. Studies using combination therapies with ginkgo suggest benefits for ADHD symptoms. Further research on ginkgo alone is needed on this topic.
C

Autism

Ginkgo may reduce behaviors and symptoms of autism. Further well-designed research is needed before a conclusion can be made.
C

Blood pressure control

Conclusions on the effects of ginkgo on blood pressure control are lacking. Further research is needed is this area before a conclusion can be made.
C

Cancer prevention

Ginkgo lacked an effect on the cancer development in people taking ginkgo. Ginkgo also lacked protective effects on bladder cancer risk. Further research is needed on this topic.
C

Chemotherapy side effects reduction

There is inconclusive evidence regarding the efficacy of ginkgo to reduce the vascular adverse effects associated with some chemotherapy, such as 5-fluorouracil (5-FU). Further studies are required on this topic.
C

Chronic cochleovestibular disorders (ear disorder)

There is limited available evidence of the effect of ginkgo in chronic cochleovestibular disorders. Further trials are required before conclusions may be drawn.
C

Chronic venous insufficiency (damaged vein valves)

Ginkgo may widen and relax blood vessels. A combination product containing ginkgo may aid in treating people with lower limb chronic venous insufficiency. Further research is needed in this area.
C

Claudication (painful legs from clogged arteries)

Ginkgo may improve claudication symptoms. However, improvements in the absolute claudication distance were lacking in some studies. Additional evidence from high-quality trials is still needed before conclusions may be drawn.
C

Cocaine dependence

Ginkgo has also been found to increase chemicals from the brain. It is not clear whether ginkgo is helpful in treating cocaine dependence. Further research is needed in this area.
C

Cognitive performance

According to limited research, ginkgo may improve cognitive function in people with multiple sclerosis (MS) and vascular cognitive impairment no dementia (VCIND). However, other research found benefits were lacking. More well-designed studies are needed before a firm conclusion may be made.
C

Decreased libido and erectile dysfunction

It has been postulated that Ginkgo may be effective for treating erectile dysfunction. Ginkgo may help dilate blood vessels. However, additional research is needed in this area.
C

Depression and seasonal affective disorder

There is insufficient available evidence regarding the use of ginkgo for depression or seasonal affective disorder.
C

Diabetic nephropathy (kidney disease)

The effect of ginkgo has been studied on various endpoints in people with diabetic nephropathy. Benefits were observed in parameters of kidney function. Further research is required before conclusions may be drawn.
C

Diabetic neuropathy (nerve damage)

Ginkgo in combination with B vitamins lacked an effect on symptoms of diabetic neuropathy vs. B vitamins alone. Further research is needed.
C

Dyslexia

Ginkgo is traditionally used for improved memory or cognition. Preliminary results suggest that Ginkgo may be of benefit for dyslexia. More studies are required before conclusions may be drawn.
C

Exercise performance

Limited research reported a ginkgo combination formula enhanced endurance in healthy males.
C

Fibromyalgia (nervous system disorder)

CoQ10 and ginkgo improved quality of life and self-rating scores in people with fibromyalgia. Further research is needed on the effects of ginkgo alone for this use.
C

Glaucoma (increased eye pressure)

Research suggests that ginkgo lacks an effect on glaucoma. Ginkgo may benefit other aspects of eye health, such as increasing blood flow and protecting against visual field damage. Further research is needed in this area.
C

Graves' disease (thyroid disorder)

Ginkgo's potential antioxidant properties may reduce toxicity associated with iodine-131 therapy. Further studies are required before firm conclusions may be made.
C

Hearing loss

In individuals with hearing loss, a higher dose of ginkgo was more effective than a lower ginkgo dose. Ginkgo may decrease the ear inflammation and improve hearing. Well-designed research is still needed in this area.
C

Heart disease

Ginkgo may have positive benefits on blood flow and relax blood vessels. However, ginkgo may lack benefit on other cardiovascular events. Further studies are required in this area.
C

Hemorrhoids

In early research, ginkgo was effective in the treatment of people with hemorrhoids. Components of ginkgo may also reduce pain and bleeding associated with hemorrhoids. Additional research is needed to confirm these results.
C

High blood sugar/glucose intolerance

Effects of Ginkgo on insulin and glucose responses were lacking in people with type 2 diabetes, prediabetes, or normal glucose tolerance. Further research is needed.
C

Macular degeneration (eye disease)

Preliminary research suggests that ginkgo may have antioxidant effects and improve eye blood flow. It remains unclear if macular degeneration is significantly affected by ginkgo. More research is needed in this area before a conclusion can be drawn.
C

Memory enhancement (in healthy people)

Evidence is mixed with respect to the use of Ginkgo for memory enhancement in healthy individuals. Additional research is needed in this area.
C

Mental performance (after eating)

The effect of Ginkgo on mental alertness after eating is unclear. Ginkgo may have positive benefits on some but not all endpoints. Further study is needed on this topic.
C

Migraine

Various trials have examined the effects of ginkgo as part of migraine treatment. Overall, these studies suggest an evidence of benefit in children and women. Further well-designed research is needed investigating the effects of Ginkgo itself.
C

Mood and cognition in post-menopausal women

In early research, ginkgo appeared to have modest beneficial effects on mood and cognition in postmenopausal women. However, use of the multi-ingredient product Gincosan® lacked significant effects. Further research using ginkgo alone is needed to confirm these results.
C

Multiple sclerosis

Ginkgo's anti-inflammatory and platelet-activating factor (PAF)-inhibiting properties may help treat multiple sclerosis (MS). However, well-designed trials showing benefits are lacking. Further research is needed in this area.
C

Ocular allergy (eye allergy)

Early research suggests that the addition of Ginkgo may improve allergy symptoms in the eye. Well-designed research is still needed for this topic.
C

Premenstrual syndrome (PMS)

There is insufficient evidence to draw conclusions ginkgo use for premenstrual syndrome (PMS). Well-designed studies are needed in this area.
C

Pulmonary interstitial fibrosis (scarred lung tissue)

In early research, ginkgo was found to be effective in treating pulmonary interstitial fibrosis. Further research is needed to confirm these results.
C

Quality of life

A few studies have suggested that Ginkgo may aid in quality of life. More research is needed before a conclusion may be made.
C

Retinopathy (eye damage from type 2 diabetes)

Early research suggests that ginkgo extract benefit to people with retinopathy. However, sufficient evidence is still lacking to draw a conclusion. Further studies are required in this area.
C

Skin aging

A gel base containing ginkgo was effective for skin moisturizing, skin smoothness and wrinkle reduction. More research is needed in this area.
C

Smell disorders

Ginkgo was found to lack additional benefit over glucocorticoids alone for loss is smell. Further research is needed before a conclusion can be made.
C

Stomach cancer

Limited evidence suggests ginkgo may reduce tumor volume. Further human studies are required before conclusions may be drawn.
C

Stroke recovery

Laboratory studies suggest that ginkgo may be helpful immediately following strokes, because of possible antioxidant or blood vessel effects. However, initial study of ginkgo in people having strokes found a lack of benefit. Further research is needed in this area.
C

Tinnitus (ringing in the ears)

There is conflicting research regarding the use of ginkgo for tinnitus. Additional well-designed research is needed in order to resolve this controversy.
C

Vertigo (dizziness)

There is inconclusive evidence regarding ginkgo for the treatment of vertigo. Additional research is needed to draw a conclusion.
C

Vitiligo (lack of skin pigmentation)

Limited research has investigated the efficacy of ginkgo for vitiligo. Further well-designed studies are required on this topic.
D

Age-associated memory impairment

Age-associated memory impairment (AAMI) is a nonspecific syndrome, which may be caused by early Alzheimer's disease or multi-infarct dementia. Overall evidence does not support benefits of Ginkgo for memory loss. Further studies are needed before a firm conclusion can be made.
D

Raynaud's disease (poor circulation)

Limited research suggests that ginkgo may be effective in reducing the number of attacks in people with Raynaud's disease (RD). However, other studies reported that significant changes were lacking. In order to make firm conclusions, further research is required.

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acidosis (high acid levels in blood), adaptogen, aging, alcoholism, allergies, antibacterial, antifungal, anti-inflammatory, antioxidant, antiparasitic, arthritis, benign breast diseases, bladder disorders, blood clots, brain damage, breast tenderness, bruising (hematoma), cancer treatment, cataracts, cellulitis (connective tissue inflammation), chilblains (inflammation from cold exposure), contraceptive (spermicidal), cyanosis (blue skin from low oxygen), degenerative diseases (prevention), dermatitis (skin inflammation), diabetes, digestion, dysentery (bloody diarrhea), eczema, edema, energy enhancer, expectorant, freckle-removing, genitourinary disorders, headache, hepatitis B, high cholesterol, hypoxia (lack of oxygen), immunomodulator, inflammatory bowel disease, insomnia, labor induction, menstrual pain, mood, neuroprotection, pain, postphlebitis syndrome (blood clot complication), respiratory tract illnesses, scabies (topical), seizures, sepsis (serious infection), skin sores (topical), stress, vaginal dryness, vascular damage, vision problems, wound healing.

Interactions

Interactions with Drugs

Ginkgo may lower blood sugar levels. Caution is advised when using medications that may also lower blood sugar. People taking drugs for diabetes by mouth or insulin should be monitored closely by a qualified healthcare professional, including a pharmacist. Medication adjustments may be necessary.

Ginkgo may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).

Ginkgo may interfere with the way the body processes certain drugs using the liver's "cytochrome P450" enzyme system. As a result, the levels of these drugs may be altered in the blood, and may cause increased effects or potentially serious adverse reactions. People using any medications should check the package insert, and speak with a qualified healthcare professional, including a pharmacist, about possible interactions.

Tyramine/tryptophan containing foods may cause dangerously high blood pressure when taken at the same time as agents that have properties similar to monoamine oxidase inhibitor drugs (MAOIs). These include protein foods that have been aged/preserved. Specific examples of foods are anchovies, avocados, bananas, bean curd, beer (alcohol-free/reduced), caffeine (large amounts), caviar, champagne, cheeses (particularly aged, processed, or strong varieties), chocolate, dry sausage/salami/bologna, fava beans, figs, herring (pickled), liver (particularly chicken), meat tenderizers, papaya, protein extracts/powder, raisins, shrimp paste, sour cream, soy sauce, wine (particularly chianti), yeast extracts, and yogurt.

Ginkgo may cause altered blood pressure. Caution is advised in people taking drugs that lower blood pressure.

Ginkgo may also interact with agents eliminated by the kidney; agents for Alzheimer's, asthma, or cancer; agents for psychosis, seizures, tinnitus (ringing of ears) or vertigo (dizziness); agents for pain relief; agents for the brain, eyes, heart, or lungs; agents that increase urination such as thiazide; agents that may lower seizure threshold; agents that widen blood vessels; agents that reduce androgen or estrogen activity; antianxiety agents; anticholinergics (blocks acetylcholine); antidepressants such as monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs); antihistamines; anti-inflammatories; cholesterol lowering agents; cilostazol; clozapine; cognitive agents; colchicine; efavirenz; exercise performance enhancement agents; hemorrhoid agents; hormonal agents; ibuprofen; impotence agents; iodine; lithium; nifedipine; olanzapine; prednisone; risperidone; rofecoxib; sexual performance agents; ticlopidine; trazodone.

Interactions with Herbs and Dietary Supplements

Ginkgo may lower blood sugar levels. Caution is advised when using herbs or supplements that may also lower blood sugar. Blood glucose levels may require monitoring, and doses may need adjustment.

Ginkgo may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.

Ginkgo may interfere with the way the body processes certain herbs or supplements using the liver's "cytochrome P450" enzyme system. As a result, the levels of other herbs or supplements may become altered in the blood. It may also alter the effects that other herbs or supplements possibly have on the P450 system.

Tyramine/tryptophan containing foods may cause dangerously high blood pressure when taken at the same time as agents that have properties similar to monoamine oxidase inhibitor drugs (MAOIs). These include protein foods that have been aged/preserved. Specific examples of foods are anchovies, avocados, bananas, bean curd, beer (alcohol-free/reduced), caffeine (large amounts), caviar, champagne, cheeses (particularly aged, processed, or strong varieties), chocolate, dry sausage/salami/bologna, fava beans, figs, herring (pickled), liver (particularly chicken), meat tenderizers, papaya, protein extracts/powder, raisins, shrimp paste, sour cream, soy sauce, wine (particularly chianti), yeast extracts, and yogurt.

Ginkgo may cause low blood pressure. Caution is advised in people taking herbs or supplements that lower blood pressure.

Ginkgo may also interact with androgen blocking herbs and supplements; antianxiety herbs and supplements; anticholinergics (blocks acetylcholine); antidepressants such as monoamine oxidase inhibitors (MAOIs) or selective serotonin reuptake inhibitors (SSRIs); antihistamines; anti-inflammatories; antioxidants; athletic performance enhancers; cholesterol lowering herbs and supplements; cognitive herbs and supplements; ginger; hemorrhoid herbs and supplements; herbs and supplements eliminated by the kidney; herbs and supplements for Alzheimer's, arthritis, asthma, or cancer; herbs and supplements for psychosis, seizures, tinnitus (ringing of ears), or vertigo (dizziness); herbs and supplements for sexual arousal; herbs and supplements for the brain, eyes, heart, and lungs; herbs and supplements that widen blood vessels; hormonal herbs and supplements or hormone replacement therapy; impotence herbs and supplements; iodine; herbs and supplements that increase urination; pain relief herbs and supplements; seizure threshold-lowering herbs and supplements; St. John's wort; yohimbe bark extract; yohimbine.

Methodology

This information is based on a systematic review of scientific literature, and was peer-reviewed and edited by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Related terms

6-Hydroxykynurenic acid, adiantifolia, AKL1, arbre aux quarante écus (French), ArginMax®, bai guo ye, baiguo, bilobalide, BioGinkgo®, Blackmores Ginkgo Brahmi (Bacopa monniera), BN-52063, duck foot tree, EGb, EGb 761®, Elefantenohr (German), eun-haeng (Korean), Fächerblattbaum (German), flavone glycosides, flavonoid glycosides, fossil tree, GBE, GBE 24, GBX, Geriaforce® tincture, ginan, ginaton, Gincosan®, Ginexin Remind®, gingko, Gingopret®, Ginkai®, ginkgo balm, Ginkgo biloba Blätter (German), Ginkgo biloba exocarp polysaccharides (GBEP), Ginkgo bilba extract, Ginkgo biloba L. extracts, Ginkgo biloba Linné (form. Salisburia adiantifolia Sm.), ginkgo flavone glycosides, Ginkgo folium, Ginkgo Go®, ginkgo leaf extract, Ginkgo Phytosome®, Ginkgo Powder®, Ginko T.D.™, Ginkgoaceae (family), Ginkgobene®, Ginkgoblätter (German), ginkgogink, Ginkgold®, ginkgolic acids, ginkgolides, ginkgopower, Ginkopur®, ginkyo, gin-nan (Japanese), GK 501, glucaric acid, glucose, Herbal vX®, icho (Japanese), isorhamnetin, ityo, Japanbaum (German), Japanese silver apricot, kaempferol, Kaveri®, kew tree, kung sun shu, LI 1370, maidenhair tree, noyer du Japon (French), organic acids, Oriental plum tree, pei kuo, pei-wen, proanthocyanidins, Pterophyllus, Pterophyllus salisburiensis, quercetin, rhamnose, Rö Kan®, Rökan, Rokan, salisburia, Salisburia adiantifolia, Salisburia macrophylla, Seredin, Seredrin®, silver apricot, sophium, Tanakan®, tanakene, tebofortan, Tebonin®, tempeltrae, temple balm, terpenelactones, terpenoids, tramisal, valverde, vasan, vital, ya chio, yin-guo, yin-hsing (Chinese).

Combination products: Rhodiola-Ginkgo Capsule (RGC), ArginMax® (extracts of Ginkgo, ginseng, damiana, L-arginine, multivitamins, and minerals), Herbal vX® (Muira puama and Ginkgo), Gincosan® (Ginkgo biloba and Panax ginseng).

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

Avoid in people with a known allergy or sensitivity to Ginkgo biloba, its parts, or members of the Ginkgoaceae family. There is possible cross-sensitivity in people allergic to urushiols (mango rind, sumac, poison ivy, poison oak, cashews).

Side Effects and Warnings

Ginkgo appears to be safe when taken by healthy adults by mouth in suggested doses for up to six months. The most concerning potential complication is bleeding, which has been life threatening in a small number of reports.

Ginkgo may cause higher or lower blood pressure. Caution is advised in people taking drugs or herbs and supplements that alter blood pressure.

Drowsiness or sedation may occur. Use caution if driving or operating heavy machinery.

Ginkgo may lower blood sugar levels. Caution is advised in people with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Blood glucose levels may need to be monitored by a qualified healthcare professional, including a pharmacist, and medication adjustments may be necessary.

Use cautiously in people with a history of or at risk of stomach or intestine disorders, musculoskeletal disorders, nervous system disorders, psychiatric disorders, seizures, or skin disorders. Use cautiously in people at risk of Stevens-Johnson syndrome. Use cautiously in children, women trying to conceive, and pregnant or breastfeeding women.

Use cautiously in people taking agents for heart disease or seizures, anticholinergic agents, antidepressants, CYP450-metabolized agents, or St. John's wort. Use cautiously in people undergoing electroconvulsive therapy (ECT).

Ginkgo may increase the risk of bleeding. Avoid in people with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary.

Avoid ingesting ginkgo seeds or pulp, due to potential adverse effects. Avoid 2-3 weeks prior to some surgical and dental procedures. Avoid in people with heart disease. Avoid ginkgo injected in the blood. Avoid consuming or handling with known allergy or hypersensitivity to Ginkgo biloba, its constituents, members of the Ginkgoaceae family, or urushiols (mango rind, sumac, poison ivy, poison oak, cashews), due to cross-reactivity potential.

Ginkgo may also cause altered insulin levels, anal sphincter spasms, behavioral changes, bleeding after surgery, bleeding of the eye, blood in urine, blurred vision, bruising, cardiac arrest, coma, constipation, death, diarrhea, distortion of taste, dizziness, dry mouth, edema, fertility reduction, gastrointestinal pain or irritation, headache, heart palpitations, hemorrhage, hypomania, increased appetite, increased bleeding, inflammation of the anus and rectum, internal bleeding in the skull or brain, irregular heartbeat, ischemia (reduced blood supply), loss of consciousness, mild gastrointestinal discomfort, mouth or lip inflammation, muscle tone loss, muscle weakness, nausea, negative interactions with St. John's Wort (muscle stiffness, rapid heartbeats, fever, restlessness, and sweating), nervousness, neurologic adverse affects, palpitations, priapism (prolonged erection), psychiatric adverse effects, rash, rectal burning, restlessness, sadness, sedation, seizures, serotonin syndrome via additive effects with MAOIs, skin reactions such as inflammation, numbness, rash or stinging, sleepiness, Stevens-Johnson syndrome, stroke, upset stomach, vomiting, weight loss, widened blood vessels, withdrawal syndrome and dependency.

Pregnancy and Breastfeeding

Ginkgo should be used with caution during pregnancy, due to the potential for increased bleeding risk. Ginkgo should be avoided during breastfeeding, due to a lack of sufficient data.

Selected references

  1. Bettermann, K., Arnold, A. M., Williamson, J., Rapp, S., Sink, K., Toole, J. F., Carlson, M. C., Yasar, S., Dekosky, S., and Burke, G. L. Statins, risk of dementia, and cognitive function: secondary analysis of the ginkgo evaluation of memory study. J Stroke Cerebrovasc.Dis 2012;21(6):436-444.
  2. Bredie, S. J. and Jong, M. C. No significant effect of ginkgo biloba special extract EGb 761 in the treatment of primary Raynaud phenomenon: a randomized controlled trial. J Cardiovasc.Pharmacol 2012;59(3):215-221.
  3. Dardano, A., Ballardin, M., Caraccio, N., Boni, G., Traino, C., Mariani, G., Ferdeghini, M., Barale, R., and Monzani, F. The effect of Ginkgo biloba extract on genotoxic damage in patients with differentiated thyroid carcinoma receiving thyroid remnant ablation with iodine-131. Thyroid 2012;22(3):318-324.
  4. Han, S. S., Nam, E. C., Won, J. Y., Lee, K. U., Chun, W., Choi, H. K., and Levine, R. A. Clonazepam quiets tinnitus: a randomised crossover study with Ginkgo biloba. J Neurol.Neurosurg.Psychiatry 2012;83(8):821-827.
  5. Herrschaft, H., Nacu, A., Likhachev, S., Sholomov, I., Hoerr, R., and Schlaefke, S. Ginkgo biloba extract EGb 761(R) in dementia with neuropsychiatric features: a randomised, placebo-controlled trial to confirm the efficacy and safety of a daily dose of 240 mg. J Psychiatr.Res 2012;46(6):716-723.
  6. Ihl, R., Tribanek, M., and Bachinskaya, N. Efficacy and tolerability of a once daily formulation of Ginkgo biloba extract EGb 761(R) in Alzheimer's disease and vascular dementia: results from a randomised controlled trial. Pharmacopsychiatry 2012;45(2):41-46.
  7. Jalili, J., Askeroglu, U., Alleyne, B., and Guyuron, B. Herbal products that may contribute to hypertension. Plast.Reconstr.Surg. 2013;131(1):168-173.
  8. Laws, K. R., Sweetnam, H., and Kondel, T. K. Is Ginkgo biloba a cognitive enhancer in healthy individuals? A meta-analysis. Hum.Psychopharmacol. 2012;27(6):527-533.
  9. Lee, J., Sohn, S. W., and Kee, C. Effect of Ginkgo biloba Extract on Visual Field Progression in Normal Tension Glaucoma. J Glaucoma. 5-16-2012;
  10. Lovera, J. F., Kim, E., Heriza, E., Fitzpatrick, M., Hunziker, J., Turner, A. P., Adams, J., Stover, T., Sangeorzan, A., Sloan, A., Howieson, D., Wild, K., Haselkorn, J., and Bourdette, D. Ginkgo biloba does not improve cognitive function in MS: a randomized placebo-controlled trial. Neurology 9-18-2012;79(12):1278-1284.
  11. Roland, P. D. and Nergard, C. S. [Ginkgo biloba--effect, adverse events and drug interaction]. Tidsskr.Nor Laegeforen. 4-30-2012;132(8):956-959.
  12. Vellas, B., Coley, N., Ousset, P. J., Berrut, G., Dartigues, J. F., Dubois, B., Grandjean, H., Pasquier, F., Piette, F., Robert, P., Touchon, J., Garnier, P., Mathiex-Fortunet, H., and Andrieu, S. Long-term use of standardised Ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): a randomised placebo-controlled trial. Lancet Neurol. 2012;11(10):851-859.
  13. Yasar, S., Lin, F. M., Fried, L. P., Kawas, C. H., Sink, K. M., DeKosky, S. T., and Carlson, M. C. Diuretic use is associated with better learning and memory in older adults in the Ginkgo Evaluation of Memory Study. Alzheimers.Dement. 2012;8(3):188-195.
  14. Zadoyan, G., Rokitta, D., Klement, S., Dienel, A., Hoerr, R., Gramatte, T., and Fuhr, U. Effect of Ginkgo biloba special extract EGb 761(R) on human cytochrome P450 activity: a cocktail interaction study in healthy volunteers. Eur J Clin Pharmacol 2012;68(5):553-560.
  15. Zhang, S. J. and Xue, Z. Y. Effect of Western medicine therapy assisted by Ginkgo biloba tablet on vascular cognitive impairment of none dementia. Asian Pac.J Trop.Med 2012;5(8):661-664.

This evidence-based monograph was prepared by The Natural Standard Research Collaboration

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