Ginkgo - Get the Facts on Herbal Supplements

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  • Based on laboratory research, ginkgo may add to the effects of herbs or supplements that affect levels of serotonin in the blood or brain, and could increase the risk of serotonin syndrome (a condition characterized by muscle stiffness, increased heart rate, hyperthermia, restlessness, and sweating).<a href="#hdng0">(More...)</a>



<a name="hdng0"></a>Based on laboratory research, ginkgo may add to the effects of herbs or supplements that affect levels of serotonin in the blood or brain, and could increase the risk of serotonin syndrome (a condition characterized by muscle stiffness, increased heart rate, hyperthermia, restlessness, and sweating). <a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> In early study ginkgo was shown to be effective in the treatment of patients with acute hemorrhoidal attacks. Further research is needed to confirm these results.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Based on early study, ginkgo may be effective in treating pulmonary interstitial fibrosis. Further research is needed to confirm these results.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Initial study of ginkgo in people having strokes found a lack of benefit. Further research is needed in this area.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Preliminary study of seasonal affective disorder (SAD) suggests that ginkgo is not effective in preventing the development of winter depression. Other research in elderly patients with depression shows possible minor benefits.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Based on human study, ginkgo may theoretically affect insulin and blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Use of ginkgo with drugs that may cause bleeding may further increase the risk of bleeding, based on multiple case reports of spontaneous bleeding in patients using ginkgo alone, with warfarin (Coumadin®), or with aspirin.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Bleeding has been associated with the use of ginkgo taken by mouth, and caution is advised in patients with bleeding disorders or taking drugs/herbs/supplements that may increase the risk of bleeding.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Use of ginkgo with herbs or supplements that may cause bleeding may increase the risk of bleeding, although some studies disagree.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

The risk of bleeding associated with ginkgo may be dangerous during pregnancy.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> There may be a risk of seizure when taking ginkgo, particularly in people with a history of seizure disorder.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Based on laboratory and human research, ginkgo may decrease blood pressure, although there is one report of ginkgo possibly raising blood pressure in a person taking a thiazide diuretic ("water pill").<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> A small amount of poorly designed research reports benefits of ginkgo for the treatment of vertigo.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> A small amount of poorly designed research reports benefits of ginkgo for the treatment of altitude (mountain) sickness.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

In limited human study, ginkgo has been examined in addition to 5-fluorouracil (5-FU) in the treatment of pancreatic and colorectal cancer, to measure possible benefits on side effects. At this time, there is a lack of conclusive evidence in this area.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Adverse effects on the eyes have also been reported. Use of ginkgo is not recommended during pregnancy and breastfeeding due to lack of reliable scientific study in this area.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Preliminary clinical study has been conducted on the effect of ginkgo in chronic cochleovestibular disorders.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Laboratory studies suggest that ginkgo may be helpful immediately following strokes because of possible antioxidant or blood vessel effects.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Preliminary research suggests that ginkgo may improve eye blood flow, although it remains unclear if macular degeneration is significantly affected by ginkgo. More research is needed in this area before a conclusion can be drawn.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> There is preliminary research showing small improvements in memory and other brain functions in patients with AAMI, although some studies disagree. Overall, there is currently not enough clear evidence to recommend for or against ginkgo for this condition.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Age-associated memory impairment (AAMI) is a non-specific syndrome, which may be caused by early Alzheimer's disease or multi-infarct dementia (conditions for which ginkgo has been shown to have benefit).<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> The scientific literature overall does suggest that ginkgo benefits people with early stage Alzheimer's disease and multi-infarct dementia, and may be as helpful as acetylcholinesterase inhibitor drugs such as donepezil (Aricept®).<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Van Dongen M, van Rossum E, Kessels A, et al. Ginkgo for elderly people with dementia and age-associated memory impairment: a randomized clinical trial.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> There may be cross-sensitivity to ginkgo in people allergic to urusiols (mango rind, sumac, poison ivy, poison oak, cashews), and an allergic cross-reaction has been reported in a person allergic to poison ivy.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Theoretically, ginkgo may have additive effects when used with herbs or supplements that also decrease blood pressure.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Although it remains unclear if ginkgo has clinically significant effects on blood pressure, caution may be warranted when ginkgo is used with other agents that affect blood pressure.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Overall, controlled trials of ginkgo report few adverse effects and good tolerance, with rates of complications similar to placebo.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> There have been uncommon reports of dizziness, stomach upset, diarrhea, vomiting, muscle weakness, loss of muscle tone, restlessness, racing heart, rash, and irritation around the mouth with the use of ginkgo.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> There is conflicting research regarding the use of ginkgo for tinnitus. Additional well-designed research is needed in order to resolve this controversy.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Well-designed research comparing ginkgo to prescription drug therapies is needed.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Colchicine has been found in commercial preparations of ginkgo, and may increase blood concentrations in patients using colchicine.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> It is not clear if ginkgo may improve intraocular pressure and blood flow in patients with glaucoma.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Ginkgo may decrease damage to cells caused by radioiodine therapy in patients with Graves' disease.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Ginkgo has been found to decrease blood pressure in healthy volunteers, although some studies disagree.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Although not definitive, there is promising early evidence favoring the use of ginkgo for memory enhancement in healthy subjects, altitude (mountain) sickness, symptoms of premenstrual syndrome (PMS), and reduction of chemotherapy-induced end-organ vascular damage.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Although still controversial, a recent large trial has shifted the evidence against the use of ginkgo for tinnitus.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> There is not enough scientific evidence to recommend use of ginkgo in children.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Based on laboratory study, it has been suggested that ginkgo may provide benefit in multiple sclerosis (MS).<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Based on preliminary research, ginkgo may affect insulin and blood sugar levels.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Based on theory, high concentrations of ginkgo may reduce male and female fertility.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Initial study in women with premenstrual syndrome or breast discomfort suggests that ginkgo may relieve symptoms including emotional upset.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Early study suggests Ginkgo biloba extract may offer benefit to individuals with retinopathy.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Early study using oral Ginkgo biloba extract reports that ginkgo appears to arrest the progression of this disease. Better-designed studies are needed to confirm these results.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Kohler S, Funk P, Kieser M. Influence of a 7-day treatment with Ginkgo biloba special extract EGb 761 on bleeding time and coagulation: a randomized, placebo-controlled, double-blind study in healthy volunteers.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Mazza M, Capuano A, Bria P, et al. Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer's dementia in a randomized placebo-controlled double-blind study.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Issing W, Klein P, Weiser M. The homeopathic preparation Vertigoheel versus Ginkgo biloba in the treatment of vertigo in an elderly population: a double-blinded, randomized, controlled clinical trial.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Results from one clinical trial suggest that Ginkgo biloba may be effective in reducing the number of Raynaud's attacks in patients suffering from Raynaud's disease. In order to confirm these results, further clinical trials are required.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Wang J, Zhou S, Bronks R, et al. Supervised exercise training combined with ginkgo biloba treatment for patients with peripheral arterial disease.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Kampman K, Majewska MD, Tourian K, et al. A pilot trial of piracetam and ginkgo biloba for the treatment of cocaine dependence.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Lovera J, Bagert B, Smoot K, et al. Ginkgo biloba for the improvement of cognitive performance in multiple sclerosis: a randomized, placebo-controlled trial.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Wolf HR. Does Ginkgo biloba special extract EGb 761 provide additional effects on coagulation and bleeding when added to acetylsalicylic acid 500 mg daily? Drugs R D 2006;7(3):163-72.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Robertson SM, Davey RT, Voell J, et al. Effect of Ginkgo biloba extract on lopinavir, midazolam and fexofenadine pharmacokinetics in healthy subjects.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> The results of one study investigating the effect of Ginkgo biloba on post-prandial mental alertness are unclear.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Although most reports of seizures have been due to eating ginkgo seeds (not leaf extract which is found in most products), an animal study found that the anti-seizure properties of sodium valproate or carbamazepine were reduced by giving ginkgo. In theory, drugs such as donepezil (Aricept®) and tacrine (Cognex®) may have an additive effect when used at the same time as ginkgo, potentially increasing cholinergic effects (such as salivation and urination).<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Overall, ginkgo leaf extract (used in most commercial products) appears to be well tolerated in most healthy adults at recommended doses for up to six months. Minor symptoms including headache, nausea, and intestinal complaints have been reported.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Reports of bleeding range from nose bleeds to life-threatening bleeding in several case reports. In some of these reports, ginkgo has been used with other agents that may also cause bleeding.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Ginkgo has been used and studied for the treatment of sexual dysfunction in men and women.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Ginkgo may increase the actions of agents used for erectile dysfunction, including yohimbe.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Effects on monoamine oxidase (inhibition) by ginkgo are reported in animals but not confirmed in humans. In theory, ginkgo may add to the side effects of herbs or supplements that also inhibit monoamine oxidase, such as 5-HTP (5-Hydroxytryptophan).<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> The German ginkgo product Tebonin®, given through the veins (IV), was removed from the German market due to significant side effects.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

There is a case report of "coma" in an elderly Alzheimer's patient taking trazodone and ginkgo, although it is not clear that ginkgo was the cause.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> High blood pressure was reported in a patient taking a thiazide diuretic ("water pill") plus ginkgo.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Theoretically, ginkgo may add to the effects of medications that also lower blood pressure, although raised blood pressure has been reported in a patient taking a thiazide diuretic ("water pill") with ginkgo. It has been suggested that Ginkgo biloba leaf extract (GBE) and nifedipine should not be ingested at the same time.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Numerous studies suggest that Ginkgo biloba taken by mouth causes small improvements in claudication symptoms (leg pain with exercise or at rest due to clogged arteries). Ginkgo may not be as helpful for this condition as exercise therapy or prescription drugs.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Contamination with the drug colchicine has been found in commercial preparations of Ginkgo biloba.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Ginkgo biloba exocarp polysaccharides (GBEP) capsule preparation has been studied for upper digestive tract malignant tumors of middle and late stage with positive results.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a> Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Carlson JJ, Farquhar JW, DiNucci E, et al. Safety and efficacy of a ginkgo biloba-containing dietary supplement on cognitive function, quality of life, and platelet function in healthy, cognitively intact older adults.<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank" [1]</a>

Some smaller studies for memory enhancement have had promising results, but a trial sponsored by the National Institute on Aging of more than 200 healthy adults over age 60 found that ginkgo taken for 6 weeks did not improve memory.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a> Solomon PR, Adams F, Silver A, et al. Ginkgo for memory enhancement: a randomized controlled trial.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a>

There are some data to suggest that ginkgo can increase bleeding risk, so people who take anticoagulant drugs, have bleeding disorders, or have scheduled surgery or dental procedures should use caution and talk to a health care provider if using ginkgo.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a> Today, people use ginkgo leaf extracts hoping to improve memory; to treat or help prevent Alzheimer's disease and other types of dementia; to decrease intermittent claudication (leg pain caused by narrowing arteries); and to treat sexual dysfunction, multiple sclerosis, tinnitus, and other health conditions.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a>

Ginkgo leaf extract has been used to treat a variety of ailments and conditions, including asthma, bronchitis, fatigue, and tinnitus (ringing or roaring sounds in the ears).<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a> Extracts are usually taken from the ginkgo leaf and are used to make tablets, capsules, or teas.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a>

Side effects of ginkgo may include headache, nausea, gastrointestinal upset, diarrhea, dizziness, or allergic skin reactions.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a> NCCAM is conducting a large clinical trial of ginkgo with more than 3,000 volunteers.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a> NCCAM is also looking at potential interactions between ginkgo and prescription drugs.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a>

Ginkgo seeds have been used in traditional Chinese medicine for thousands of years, and cooked seeds are occasionally eaten.<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank" [2]</a>

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1. <a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank">MedlinePlus Herbs and Supplements: Ginkgo (Ginkgo biloba L.)</a>
<a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html" TARGET="_blank">http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-ginkgo.html</a>

2. <a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank">Ginkgo [NCCAM Herbs at a Glance]</a>
<a href="http://nccam.nih.gov/health/ginkgo/" TARGET="_blank">http://nccam.nih.gov/health/ginkgo/</a>

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