Ginkgo

Ginkgo leaf products are used for minor symptomatic relief of claudication, although exercise and cilostazol may be more effective. Gingko increases the distance that affected people can walk without pain.Ginkgo leaf products are used for minor symptomatic relief of claudication, although exercise and cilostazol may be more effective. Gingko increases the distance that affected people can walk without pain.

Ginkgo has long been used in people with dementia. Gingko has also been used to alleviate memory loss, anxiety, tinnitus, age-related macular degeneration, and altitude sickness. Gingko may prevent damage to the kidneys caused by the immunosuppressant cyclosporine. Gingko has also been used for acute mountain sickness and as an adjunct to treat type 2 diabetes.Ginkgo has long been used in people with dementia. Gingko has also been used to alleviate memory loss, anxiety, tinnitus, age-related macular degeneration, and altitude sickness. Gingko may prevent damage to the kidneys caused by the immunosuppressant cyclosporine. Gingko has also been used for acute mountain sickness and as an adjunct to treat type 2 diabetes.

Ginkgo is thought to be a vasoactive agent. Although patients with intermittent claudication may be able to walk longer than placebo-treated patients, this benefit is quite minor, according to a 2013 Cochrane review. This review looked at 14 trials with a total of 739 participants, of which 11 trials (477 participants) compared Ginkgo is thought to be a vasoactive agent. Although patients with intermittent claudication may be able to walk longer than placebo-treated patients, this benefit is quite minor, according to a 2013 Cochrane review. This review looked at 14 trials with a total of 739 participants, of which 11 trials (477 participants) comparedGinkgo bilobaGinkgo biloba to placebo (1).

Early studies indicated that ginkgo temporarily stabilized mental and social function in people with mild-to-moderate dementia. However, subsequent larger clinical trials showed that ginkgo supplementation (EGb 761) did not delay the development and progression of dementia and Alzheimer disease in older adults (Early studies indicated that ginkgo temporarily stabilized mental and social function in people with mild-to-moderate dementia. However, subsequent larger clinical trials showed that ginkgo supplementation (EGb 761) did not delay the development and progression of dementia and Alzheimer disease in older adults (2–4). An overview of 12 systematic reviews (59 randomized controlled trials) of ginkgo with low to moderate evidence reported that, when used at daily doses higher than 200 mg and for ≥ 5 months to treat dementia, cognitive performance, activities of daily living, and clinical global impression improved (). An overview of 12 systematic reviews (59 randomized controlled trials) of ginkgo with low to moderate evidence reported that, when used at daily doses higher than 200 mg and for ≥ 5 months to treat dementia, cognitive performance, activities of daily living, and clinical global impression improved (5). In addition, a systematic review and meta-analysis of 18 randomized trials including 1642 patients with Alzheimer disease reported that ginkgo in combination with donepezil versus donepezil monotherapy may improve some cognition scores (eg, those on the Mini Mental Status Exam and the Montreal Cognitive Assessment), and activities of daily living (). In addition, a systematic review and meta-analysis of 18 randomized trials including 1642 patients with Alzheimer disease reported that ginkgo in combination with donepezil versus donepezil monotherapy may improve some cognition scores (eg, those on the Mini Mental Status Exam and the Montreal Cognitive Assessment), and activities of daily living (6). Further studies are warranted with regard to the clinical use of this supplement for dementia.

Earlier evidence suggested ginkgo may relieve tinnitus, but a Cochrane review of 4 studies (1543 patients) shows that it is not helpful when tinnitus is the primary ailment (Earlier evidence suggested ginkgo may relieve tinnitus, but a Cochrane review of 4 studies (1543 patients) shows that it is not helpful when tinnitus is the primary ailment (7). A systematic review and meta-analysis of ginkgo for acute mountain sickness prevention found a benefit trend, but data were insufficient to demonstrate a significant preventive effect (). A systematic review and meta-analysis of ginkgo for acute mountain sickness prevention found a benefit trend, but data were insufficient to demonstrate a significant preventive effect (8). Emerging evidence reports benefit of ginkgo in treatment of type 2 diabetes. When combined with metformin, ginkgo significantly decreased fasting glucose and hemoglobin A1C (). Emerging evidence reports benefit of ginkgo in treatment of type 2 diabetes. When combined with metformin, ginkgo significantly decreased fasting glucose and hemoglobin A1C (9).

Consumers should be aware that substances such as rutin and quercetin may be used to adulterate lower- quality ginkgo to make it appear satisfactory to consumers and regulatory authorities. Consumers should be aware that substances such as rutin and quercetin may be used to adulterate lower- quality ginkgo to make it appear satisfactory to consumers and regulatory authorities.

Nausea, dyspepsia, headache, dizziness, and heart palpitations may occur. It should not be used by pregnant women because it may lead to early labor or excessive bleeding during childbirth. Gingko also should be stopped at least 2 weeks before surgery because of the potential for excessive bleeding.

Ginkgo may interact with aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and warfarin; it also may reduce the efficacy of antiseizure medications. Because of possible interaction with monoamine oxidase inhibitors, ginkgo may precipitate serotonin syndrome in patients on other antidepressant medications (Ginkgo may interact with aspirin, other nonsteroidal anti-inflammatory drugs (NSAIDs), and warfarin; it also may reduce the efficacy of antiseizure medications. Because of possible interaction with monoamine oxidase inhibitors, ginkgo may precipitate serotonin syndrome in patients on other antidepressant medications (10). (See also table Some Possible Dietary Supplement–Medication Interactions.)

1. 1. Nicolaï SP, Kruidenier LM, Bendermacher BL, et al. Gingko biloba for intermittent claudication. Cochrane Database Syst Rev. 6: CD006888, 2013. doi: 10.1002/14651858.CD006888.pub3

2. 2. Vellas B, Coley N, Ousset PJ, et al; GuidAge Study Group. Long-term use of standardised Gingko biloba extract for the prevention of Alzheimer's disease (GuidAge): a randomised placebo-controlled trial. Lancet Neurol. 11(10):851-859, 2012. doi: 10.1016/S1474-4422(12)70206-5

3. 3. Snitz BE, O'Meara ES, Carlson MC, et al; Ginkgo Evaluation of Memory (GEM) Study Investigators. Gingko biloba for preventing cognitive decline in older adults: a randomized trial. JAMA. 302(24):2663-2670, 2009. doi: 10.1001/jama.2009.1913

4. 4. DeKosky ST, Williamson JD, Fitzpatrick AL, et al; Ginkgo Evaluation of Memory (GEM) Study Investigators. Gingko biloba for prevention of dementia: a randomized controlled trial. JAMA. 300(19):2253-2262, 2008. doi: 10.1001/jama.2008.683

5. 5. Yuan Q, Wang CW, Shi J, et al. Effects of gingko biloba on dementia: an overview of systematic reviews. J Ethnopharmacol. 195:1-9, 2017. doi: 10.1016/j.jep.2016.12.005

6. 6. Li D, Ma J, Wei B, Gao S, Lang Y, Wan X. Effectiveness and safety of ginkgo biloba preparations in the treatment of Alzheimer's disease: A systematic review and meta-analysis. . Effectiveness and safety of ginkgo biloba preparations in the treatment of Alzheimer's disease: A systematic review and meta-analysis.Front Aging Neurosci. 2023 Mar 7;15:1124710. doi: 10.3389/fnagi.2023.1124710.

7. 7. Hilton MP, Zimmermann EF, Hunt WT. Gingko biloba for tinnitus. Cochrane Database Syst Rev. (3):CD003852, 2013. doi: 10.1002/14651858.CD003852.pub3

8. 8. Tsai TY, Wang SH, Lee YK, et al: .Gingko biloba extract for prevention of acute mountain sickness: a systematic review and meta-analysis of randomised controlled trials. BMJ Open. 8(8):e022005, 2018. doi: 10.1136/bmjopen-2018-022005

9. 9. Aziz TA, Hussain SA, Mahwi TO, et al. The efficacy and safety of Gingko biloba extract as an adjuvant in type 2 diabetes mellitus patients ineffectively managed with metformin: a double-blind, randomized, placebo-controlled trial. Drug Des Devel Ther. 12:735-742, 2018. doi: 10.2147/DDDT.S157113

10. 10. Diamond BJ, Bailey MR. Ginkgo biloba: indications, mechanisms, and safety. . Ginkgo biloba: indications, mechanisms, and safety.Psychiatr Clin North Am. 2013 Mar;36(1):73-83. doi: 10.1016/j.psc.2012.12.006

The following English-language resource may be useful. Please note that The Manual is not responsible for the content of this resource.

1. National Institutes of Health (NIH), National Center for Complementary and Integrative Health: Gingko