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    Health Information

    Ginkgo

    Ginkgo

    Uses

    Common names:
    Maidenhair Tree
    Botanical names:
    Ginkgo biloba

    Parts Used & Where Grown

    Ginkgo biloba is the world?s oldest living species of tree. Individual trees live as long as 1,000 years. Ginkgo grows most predominantly in the southern and eastern United States, southern France, China, and Korea. The leaves of the tree are used in modern herbal medicine.

    What Are Star Ratings?

    Our proprietary ?Star-Rating? system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

    For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

    3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

    2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

    1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

    This supplement has been used in connection with the following health conditions:

    Used for Why
    3 Stars
    Age-Related Cognitive Decline
    120 to 160 daily
    Learn More

    Most1 , 2 , 3 , 4 , 5 , 6 , 7 but not all8 clinical trials, many of them double-blind, have found ginkgo supplementation to be a safe and effective treatment for ARCD.9

    3 Stars
    Glaucoma
    120 mg daily of a standardized herbal extract
    Learn More

    In a double-blind study, supplementation with a standardized extract of Ginkgo biloba in the amount of 40 mg three times a day for four weeks partially reversed visual field damage in people with one type of glaucoma (normal tension glaucoma).10

    3 Stars
    Intermittent Claudication
    120 to 160 mg daily
    Learn More

    Extensive studies have been done with Ginkgo biloba extracts (GBE) for treatment of intermittent claudication.11 , 12 Two double-blind trials found that 120 mg of GBE per day increased pain-free and total walking distance among people with intermittent claudication.13 , 14Similar results were seen in another double-blind trial using 160 mg of GBE per day.15 In yet another double-blind trial, two doses of ginkgo extract were compared for six months.16 The researchers studied 60 vs. 120 mg twice daily and found that, while both amounts resulted in significant improvements in pain-free walking distance, the improvements were more pronounced at the higher dose. One double-blind study found that ginkgo extract was not beneficial.17 However, that study lasted only three months, whereas the positive studies lasted six months. It may take longer than three months for ginkgo to have a beneficial effect in people with intermittent claudication.

    2 Stars
    Alzheimer?s Disease
    120 to 240 mg of a standardized herbal extract daily
    Learn More

    An extract made from the leaves of the Ginkgo biloba tree is an approved treatment for early-stage Alzheimer?s disease in Europe. While not a cure, Ginkgo biloba extract may improve memory and quality of life and slow progression in the early stages of the disease. In addition, several double-blind trials have shown that ginkgo is helpful for people in early stages of Alzheimer?s disease, as well as for those experiencing another form of dementia known as multi-infarct dementia.22 , 23 , 24 , 25 , 26 Ginkgo has been found to be nearly as effective against Alzheimer's disease as donepezil, a prescription drug used to treat the condition.27 One trial reported no effect of ginkgo supplementation in the treatment of Alzheimer?s disease, vascular dementia or age-associated memory impairment.28 However, the results of this trial have been criticized, since analysis of the results does not separate those patients with Alzheimer?s disease or vascular dementia from those with age-associated memory impairment. A comparison of placebo-controlled trials of ginkgo for Alzheimer?s disease concluded that the herb compared favorably with two prescription drugs, donepezil and tacrine, commonly used to treat the condition.29 Research studies have used 120 to 240 mg of ginkgo, standardized to contain 6% terpene lactones and 24% flavone glycosides per day, generally divided into two or three portions. Ginkgo may need to be taken for six to eight weeks before desired actions are noticed. Ginkgo was not effective for preventing Alzheimer's disease in elderly volunteers with normal cognitive function or in those with mild cognitive impairment.30

    2 Stars
    Depression
    240 mg daily
    Learn More

    Ginkgo biloba (240 mg per day) may alleviate depression in depressed elderly people not responding to antidepressant drugs.31 It is unknown if ginkgo could alleviate depression in other age groups. A small, preliminary trial has shown that ginkgo can reduce sexual problems caused by antidepressants like fluoxetine (Prozac), bupropion (Wellbutrin), venlafaxine (Effexor), and nefazodone (Serzone) in men and women.32 Double-blind trials are now needed to determine whether ginkgo is truly effective for this purpose.

    2 Stars
    Erectile Dysfunction
    60 to 240 mg daily
    Learn More

    Ginkgo biloba may help some men with ED by increasing blood flow to the penis. One double-blind trial found improvement in men taking 240 mg per day of a standardized Ginkgo biloba extract (GBE) for nine months.33 A preliminary trial, involving 30 men who were experiencing ED as a result of medication use (selective serotonin reuptake inhibitors and other medications), found that approximately 200 mg per day of GBE had a positive effect on sexual function in 76% of the men.34

    2 Stars
    Macular Degeneration
    120 to 240 mg daily of a standardized herbal extract
    Learn More

    Ginkgo (Ginkgo biloba) may help treat early-stage macular degeneration, according to small, preliminary clinical trials.35 Many healthcare professionals recommend 120 to 240 mg of standardized extract (24% ginkgo flavone glycosides and 6% terpene lactones) in capsules or tablets per day.

    2 Stars
    Tardive Dyskinesia
    240 mg per day 
    Learn More
    In a double-blind trial, treatment with Ginkgo biloba extract EGb 761 (240 mg per day) for 12 weeks significantly improved symptoms of tardive dyskinesia by about 30% in schizophrenic patients.36 Ginkgo is believed to work by functioning as an antioxidant.
    2 Stars
    Vertigo
    120 to 160 mg a day of a standardized herbal extract
    Learn More

    In a preliminary clinical trial, a standardized extract of Ginkgo biloba (GBE) significantly reduced symptoms of vertigo in a group of elderly people with mild cognitive impairment.37 Participants were given 40 mg three times per day for one year. GBE has also been reported to significantly reduce vertigo of unknown cause in preliminary38 and double-blind39 trials. The amounts given were 120 mg and 160 mg per day, respectively, for three months.

    2 Stars
    Vitiligo
    120 mg daily of a standardized extract
    Learn More

    In a double-blind study of 52 people with slowly spreading vitiligo, supplementation with Ginkgo biloba extract (standardized to contain 24% ginkgoflavonglycosides), in the amount of 40 mg three times per day for up to six months, resulted in marked to complete repigmentation in 40% of cases, compared with only 9% among those receiving a placebo.40 Ginkgo was also found to be effective in a preliminary trial.41

    1 Star
    Asthma
    Refer to label instructions
    Learn More

    Ginkgo biloba extracts have been considered a potential therapy for asthma. This is because the extracts block the action of platelet-activating factor (PAF), a compound the body produces that in part causes asthma symptoms. A trial using isolated ginkgolides from ginkgo (not the whole extract) found they reduced asthma symptoms.42 A controlled trial used a highly concentrated tincture of ginkgo leaf and found this preparation helped decrease asthma symptoms.43 For asthma, 120 to 240 mg of standardized ginkgo or 3 to 4 ml of regular tincture three times daily can be used.

    1 Star
    Atherosclerosis
    Refer to label instructions
    Learn More

    Ginkgo may reduce the risk of atherosclerosis by interfering with a chemical the body sometimes makes in excess, called platelet activating factor (PAF).44 PAF stimulates platelets to stick together too much; ginkgo stops this from happening. Ginkgo also increases blood circulation to the brain, arms, and legs.45

    Garlic and ginkgo also decrease excessive blood coagulation. Both have been shown in double-blind46 and other controlled47 trials to decrease the overactive coagulation of blood that may contribute to atherosclerosis.

    Numerous medicinal plants and plant compounds have demonstrated an ability to protect LDL cholesterol from being damaged by free radicals . Garlic,48 ginkgo,49 and guggul50 are of particular note in this regard. Garlic and ginkgo have been most convincingly shown to protect LDL cholesterol in humans.

    1 Star
    Memory Enhancement
    Refer to label instructions
    Learn More
    The terpene lactones found in ginkgo extracts, known as ginkgolides and bilobalide, typically make up approximately 6% of the extract. They are associated with increasing circulation to the brain and other parts of the body and may exert a protective action on nerve cells.51 ginkgo regulates the tone and elasticity of blood vessels,52 making circulation more efficient.53 Ginkgo is also well-known for its effect on memory and thinking (cognitive function). It may enhance cognitive performance in healthy older adults,8 in people with age-related cognitive decline, and in people with Alzheimer?s disease.
    1 Star
    Ménière?s Disease
    Refer to label instructions
    Learn More

    Although Ginkgo biloba extract (GBE) has not been studied specifically for its effects in MD, in preliminary studies it has been reported to reduce symptoms of tinnitus , vertigo , and hearing loss due to unspecified inner ear disorders.54 Controlled research using GBE is needed to determine whether it is a treatment option specifically for MD.

    1 Star
    Migraine Headache
    Refer to label instructions
    Learn More

    Ginkgo biloba extract may also help because it inhibits the action of a substance known as platelet-activating factor,55 which may contribute to migraines. No clinical trials have examined its effectiveness in treating migraines, however.

    1 Star
    Multiple Sclerosis
    Refer to label instructions
    Learn More

    Inflammation of nerve tissue is partly responsible for the breakdown of myelin in people with MS. When intravenous injections of a constituent of Ginkgo biloba , known as ginkgolide B, were given to people with MS for five days, 80% of them reportedly improved.56 This specialized treatment is experimental, and it is not known whether oral use of ginkgo extracts would have a similar effect.

    1 Star
    Premenstrual Syndrome
    Refer to label instructions
    Learn More

    A double-blind trial has shown that standardized Ginkgo biloba extract, when taken daily from day 16 of one menstrual cycle to day 5 of the next menstrual cycle, alleviates congestive and psychological symptoms of PMS better than placebo.57 The trial used 80 mg of a ginkgo extract two times per day.

    1 Star
    Raynaud?s Disease
    Refer to label instructions
    Learn More

    Ginkgo biloba has been reported to improve the circulation in small blood vessels.58 For that reason, some doctors recommend ginkgo for people with Raynaud?s disease. One preliminary trial found that 160 mg of standardized ginkgo extract per day reduced pain in people with Raynaud?s disease.59 Larger clinical trials are needed to confirm ginkgo?s effectiveness for this condition. Ginkgo is often used as a standardized extract (containing 24% ginkgo flavone glycosides and 6% terpene lactones). Doctors who recommend use of ginkgo often suggest that people take 120?160 mg per day.

    1 Star
    Retinopathy
    Refer to label instructions
    Learn More

    The use of 160 mg per day of a standardized extract of Ginkgo biloba for six months has been reported in a small double-blind trial60 to improve impaired visual function in people with mild diabetic retinopathy.

    1 Star
    Tinnitus
    Refer to label instructions
    Learn More

    Ginkgo biloba has been used to treat tinnitus, with mixed results.61 The largest placebo-controlled trial to date failed to find any effect of 150 mg per day of ginkgo extract in people with tinnitus.62 Two smaller, controlled trials have found that standardized ginkgo extract (120 mg per day, containing 24% flavone glycosides and 6% terpene lactones), was effective at relieving the symptoms of tinnitus.63 , 64 One trial failed to find ginkgo beneficial, but used less than 30 mg of ginkgo extract per day, an amount unlikely to have any therapeutic effect.65

    1 Star
    Type 1 Diabetes
    Refer to label instructions
    Learn More
    Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic nerve damage (neuropathy), though research is at best very preliminary in this area.66
    1 Star
    Type 2 Diabetes
    Refer to label instructions
    Learn More
    Ginkgo biloba extract may prove useful for prevention and treatment of early-stage diabetic neuropathy, though research is at best very preliminary in this area.67

    Traditional Use (May Not Be Supported by Scientific Studies)

    Medicinal use of ginkgo can be traced back almost 5,000 years in Chinese herbal medicine. The nuts of the tree were most commonly recommended and used to treat respiratory tract ailments. The use of the leaves is a modern development originating in Europe.

    How It Works

    Common names:
    Maidenhair Tree
    Botanical names:
    Ginkgo biloba

    How It Works

    The medical benefits of Ginkgo biloba extract are attributed primarily to two groups of active constituents: the ginkgo flavone glycosides and the terpene lactones. Ginkgo flavone glycosides, which typically make up approximately 24% of the extract, are primarily responsible for ginkgo?s antioxidant activity and may mildly inhibit platelet aggregation (stickiness). These two actions may help ginkgo prevent circulatory diseases, such as atherosclerosis , and support the brain and central nervous system.68 In addition to the cardiovascular system, ginkgo?s antioxidant action may also extend to the brain and retina of the eye.69 Preliminary trials have suggested potential benefit for people with macular degeneration 70 and diabetic retinopathy .71 The terpene lactones found in ginkgo extracts, known as ginkgolides and bilobalide, typically make up approximately 6% of the extract. They are associated with increasing circulation to the brain and other parts of the body and may exert a protective action on nerve cells.72 ginkgo regulates the tone and elasticity of blood vessels,73 making circulation more efficient.74

    Ginkgo is also well-known for its effect on memory and thinking (cognitive function). It may enhance cognitive performance in healthy older adults,75 in people with age-related cognitive decline , and in people with Alzheimer?s disease .

    How to Use It

    Most clinical trials have used between 120 and 240 mg of ginkgo (standardized to contain 6% terpene lactones and 24% flavone glycosides) per day, generally divided into two or three portions.76 The higher amount (240 mg per day) has been used in some people with mild-to-moderate Alzheimer?s disease , age-related cognitive decline , intermittent claudication , and resistant depression . Ginkgo may need to be taken for eight to twelve weeks before desired actions such as cognitive improvement are noticed. Although nonstandardized Ginkgo biloba leaf and tinctures are available, there is no well-established amount or use for these forms.

    Interactions

    Common names:
    Maidenhair Tree
    Botanical names:
    Ginkgo biloba

    Interactions with Supplements, Foods, & Other Compounds

    At the time of writing, there were no well-known supplement or food interactions with this supplement.

    Interactions with Medicines

    Certain medicines interact with this supplement.

    Types of interactions: Beneficial Adverse Check

    Replenish Depleted Nutrients

    • none

    Reduce Side Effects

    • Citalopram

      Ginkgo biloba extract may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline . An open-label study with elderly, depressed persons found that 200?240 mg of ginkgo per day was effective in alleviating sexual side effects in both men and women taking SSRIs.77 One case study reported that 180 to 240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.78

    • Cyclosporine

      Ginkgo was reported to protect liver cells from damage caused by cyclosporine in a test tube experiment.80 A Ginkgo biloba extract partially reversed cyclosporine-induced reduced kidney function in a study of isolated rat kidneys.81 Human trials have not studied the actions of ginkgo to prevent or reduce the side effects of cyclosporine.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Fluoxetine

      Ginkgo biloba extract (GBE) may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline . An open-label study with elderly, depressed persons found that 200?240 mg of GBE daily was effective in alleviating sexual side effects in both men and women taking SSRIs.82 One case study reported that 180?240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.83

    • Fluvoxamine

      Ginkgo biloba extract may reduce the side effects experienced by some persons taking SSRIs such as fluoxetine or sertraline . An open-label study with elderly, depressed persons found that 200 to 240 mg of ginkgo daily was effective in alleviating sexual side effects in both men and women taking SSRIs.84

      One case study reported that 180?240 mg of GBE daily reduced genital anesthesia and sexual side effects secondary to fluoxetine use in a 37-year-old woman.85

    • Haloperidol

      In a double-blind trial, supplementation of schizophrenic patients with Ginkgo biloba extract, in the amount of 250 mg per 2.2 pounds of body weight per day for 12 weeks, enhanced the effectiveness of haloperidol and also reduced the side effects of the drug.86

    • Paroxetine

      In three men and two women treated with fluoxetine or sertraline (SSRI drugs closely related to paroxetine) for depression who experienced sexual dysfunction, addition of Ginkgo biloba extract (GBE) in the amount of 240 mg per day effectively reversed the sexual dysfunction.87 This makes sense because ginkgo has been reported to help men with some forms of erectile dysfunction .88

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Sertraline

      In three men and two women treated with fluoxetine or sertraline (SSRI drugs closely related to paroxetine) for depression who experienced sexual dysfunction, addition of Ginkgo biloba extract (GBE) in the amount of 240 mg per day effectively reversed the sexual dysfunction.89 This makes sense because ginkgo has been reported to help men with some forms of erectile dysfunction .90

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

    Support Medicine

    • Clozapine
      In one study, treatment with 120 mg per day of Ginkgo biloba extract for 12 weeks enhanced the beneficial effect of clozapine on certain symptoms of schizophrenia in patients who had not responded adequately to clozapine by itself79.

    Reduces Effectiveness

    • none

    Potential Negative Interaction

    • Aspirin

      There have been two case reports suggesting a possible interaction between ginkgo Ginkgo biloba and an anticoagulant drug or aspirin leading to increased bleeding.91 , 92 In the first, a 78-year-old woman taking warfarin developed bleeding within the brain following the concomitant use of ginkgo (the amount used is not given in the case report). In the second, a 70-year-old man developed slow bleeding behind the iris of the eye (spontaneous hyphema) following use of ginkgo (80 mg per day) together with aspirin (325 mg per day). While this interaction is unproven, anyone taking anticoagulant medications or aspirin should inform their physician before using ginkgo.

    • Bendroflumethiazide

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.93 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Chlorothiazide

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.94 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Chlorthalidone

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.95 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Glimepiride

      In a preliminary trial, administration of Ginkgo biloba extract (120 mg per day) for three months to patients with type 2 diabetes who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet.96 Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.

    • Glipizide

      In a preliminary trial, administration of Ginkgo biloba who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet.97 Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.

    • Glyburide

      In a preliminary trial, administration of Ginkgo biloba extract (120 mg per day) for three months to patients with type 2 diabetes who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet.98 Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.

    • Heparin

      Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding.99 Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem.100 , 101 People taking heparin should consult with a physician knowledgeable about botanical medicines if they are considering taking ginkgo.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Hydrochlorothiazide

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.102 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Hydroflumethiazide

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.103 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Ibuprofen
      It has been argued that ginkgo has a blood-thinning effect and might therefore further increase the risk of bleeing when taken in combination with drugs (including ibuprofen) that thin the blood. However, the bulk of the evidence suggests that ginkgo does not, in fact, have a blood-thinning effect104.
      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Indapamide

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.105 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Metformin

      In a preliminary trial, administration of Ginkgo biloba extract (120 mg per day) for three months to patients with type 2 diabetes who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet.106 Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.

    • Methyclothiazide

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.107 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Metolazone

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.108 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Polythiazide

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.109 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Repaglinide

      In a preliminary trial, administration of Ginkgo biloba extract (120 mg per day) for three months to patients with type 2 diabetes who were taking oral anti-diabetes medication resulted in a significant worsening of glucose tolerance. Ginkgo did not impair glucose tolerance in individuals whose diabetes was controlled by diet.110 Individuals taking oral anti-diabetes medication should consult a doctor before taking Ginkgo biloba.

    • Ticlopidine

      Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding.111 In a rat study, a high intake of ginkgo increased the action of ticlopidine in a way that could prove dangerous if the same effect occurred in people.112 Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem.113 , 114 People taking ticlopidine should use ginkgo extracts only under the supervision of a doctor.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Trazodone

      There is one case report of an elderly patient with Alzheimer?s disease going into a coma while concurrently using trazodone and ginkgo.115 Until more is known, ginkgo should not be combined with trazodone except under supervision of a doctor.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Trichlormethiazide

      One case was reported in which ginkgo use was associated with high blood pressure in a person treated with a thiazide diuretic.116 Ginkgo was not proven to be the cause of this reaction.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
    • Warfarin

      Ginkgo extracts may reduce the ability of platelets to stick together, possibly increasing the tendency toward bleeding.117 Standardized extracts of ginkgo have been associated with two cases of spontaneous bleeding, although the ginkgo extracts were not definitively shown to be the cause of the problem.118 , 119 There are two case reports of people taking warfarin in whom bleeding occurred after the addition of ginkgo.120 , 121 People taking warfarin should consult with a physician knowledgeable about botanical medicines if they are considering taking ginkgo.

      The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

    Explanation Required

    • none

    The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers? package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

    Side Effects

    Common names:
    Maidenhair Tree
    Botanical names:
    Ginkgo biloba

    Side Effects

    Excessive bleeding has been reported in a few individuals taking ginkgo,122 , 123 although a cause/effect relationship was not proven. A review of 18 randomized controlled trials with a total of 1,985 adults concluded that it is unlikely that taking ginkgo increases the risk of bleeding.124 In addition, two elderly individuals with well-controlled epilepsy developed recurrent seizures within two weeks after starting ginkgo.125 Mild headaches lasting for a day or two and mild upset stomach have been reported in a small number of people using ginkgo.

    Ginkgo leaves are known to contain a group of potentially toxic constituents known as alkylphenols. To reduce the potential for adverse effects, the German Commission E Monograph requires that ginkgo products for human consumption contain less than 5 parts per million of alkylphenols.126

    One small clinical trial found that ginkgo supplementation for three months increased secretion of insulin by the pancreas, but did not affect blood glucose levels, in healthy young adults.127 These results suggest that the participants may have developed an insensitivity to insulin, a potential concern because insulin insensitivity may be a precursor to type 2 diabetes . However, this trial does not prove that ginkgo causes insulin insensitivity, nor does it prove that long-term ginkgo supplementation increases the risk for any disease. In addition, the results of this trial are not consistent with other research on ginkgo. Larger and more rigorously designed clinical trials of ginkgo supplementation have found no significant adverse effects after as many as 12 months of supplementation.128

    People should seek an accurate medical diagnosis prior to self-prescribing ginkgo. This is especially important for the elderly, whose circulatory conditions can involve serious disease, and for people scheduled for surgery, as ginkgo may affect bleeding time.

    References

    1. Allain H, Raoul P, Lieury A, et al. Effects of two doses of ginkgo biloba extract (EGb 761) on the dual-coding test in elderly subjects. Clin Ther 1993;15(3):549?58.

    2. Rai GS, Shovlin C, Wesnes KA. A double-blind, placebo-controlled study of Ginkgo biloba extract (?tanakan?) in elderly patients with mild to moderate memory impairment. Curr Med Res Opin 1991;12(6):350?5.

    3. Brautigam MRH, Blommaert FA, Verleye G, et al. Treatment of age-related memory complaints with Ginkgo biloba extract: a randomized double-blind placebo-controlled study. Phytomedicine 1998;5:425?34.

    4. Wesnes K, Simmons D, Rook M. A double-blind, placebo-controlled trial of Tanakan in the treatment of idiopathic impairment in the elderly. Human Psychopharmacol 1987;2:159?69.

    5. Israel L, Dell?Accio E, Martin G, Hugonot R. Ginkgo biloba extract and memory training programs?comparative assessment on elderly outpatients. Psychologie Médicale 1987;19:1431?9.

    6. Gräbel E. The influence of Ginkgo biloba extract (EGb 761) on mental performance: A double-blind study under computerized measurement conditions in patients with cerebral insufficiency. Fortschr Med 1992;110:73?6.

    7. Winther K, Randlov C, Rein E, Mehlsen J. Effects of Ginkgo biloba extract on cognitive function and blood pressure in elderly subjects. Curr Ther Res 1998;59:881?8.

    8. Van Dongen M, van Rossum E, Kessels AGH, et al. The efficacy of ginkgo for elderly people with dementia and age-associated memory impairment: New results of a randomized clinical trial. J Am Geriatr Soc 2000;48:1183?94.

    9. Ihl R, Bachinskaya N, Korczyn AD, et al. Efficacy and safety of a once-daily formulation of Ginkgo biloba extract EGb 761 in dementia with neuropsychiatric features: a randomized controlled trial. Int J Geriatr Psychiatry 2011;26:1186?94.

    10. Quaranta L, Bettelli S, Uva MG, et al. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology 2003;110:359?62.

    11. Schneider B. Ginkgo biloba extract in peripheral arterial disease. Meta-analysis of controlled clinical trials. Arzneimittelforschung 1992;42:428?36 [in German].

    12. Peters H, Kieser M, Hölscher U. Demonstration of the efficacy of Ginkgo biloba special extract EGb 761® on intermittent claudication?a placebo-controlled, double-blind multicenter trial. VASA 1998;27:106?10.

    13. Bauer U. Six-month double-blind randomised clinical trial of Ginkgo biloba extract versus placebo in two parallel groups in patients suffering from peripheral arterial insufficiency. Arzneimittelforsschung 1984;34:716?20 [in German].

    14. Blume J, Kieser M, Hölscher U. Placebo-controlled, double-blind study on the efficacy of Ginkgo biloba special extract EGb 761 in maximum-level trained patients with intermittent claudication. Vasa 1996;25:265?74.

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