Ginkgo biloba: benefits, dosage, contraindications
Other name(s)
Silver apricot
Family or group:
Plants
Active ingredients:
Flavonoids
Sterols
Terpenoids
Indications
Scoring methodology
EFSA approval.
Dizziness ✪✪✪✪✪
Daily oral intake of ginkgo leaf extract at 120 to 160 mg appears to improve dizziness and balance disorders in people with vestibular disorders compared with placebo.
Posologie
Oral: leaf
120 - 160 mg
EGb 761, standardized extract, dry extract
Dementia ✪✪✪✪✪
Ginkgo biloba leaf extract may stabilize or improve cognitive functions in patients with different types of dementia (Alzheimer's, vascular, or mixed). Some research suggests that taking high doses of a specific ginkgo extract, called EGb 761, at 240 mg per day for 24 weeks may provide a modest improvement in cognitive symptoms and activities of daily living compared with placebo. Furthermore, ginkgo does not appear to prevent or slow the progression of dementia in older adults, whether or not they have initial cognitive impairment. Large clinical trials have not demonstrated a reduction in the risk of developing dementia with regular ginkgo use. Compared to conventional treatments such as donepezil, ginkgo shows similar results in some preliminary studies, but current evidence is not sufficient to recommend it as an alternative. The EMA recognizes Ginkgo as an herbal medicinal product for improving age-related cognitive disorders and quality of life in cases of mild dementia.
Posologie
Oral use: leaf, buds
240 - 750 mg
24 - days
EGb 761, standardized extract, dry extract
The efficacy of Egb 761 in patients with senile dementia of the Alzheimer type, A double-blind, placebo-controlled study on different levels of investigation.
Ginkgo Biloba Extract Is Comparable With Donepezil in Improving Functional Recovery in Alzheimer's Disease: Results From a Multilevel Characterized Study Based on Clinical Features and Resting-State Functional Magnetic Resonance Imaging
European Union herbal monograph on Ginkgo biloba L., folium
The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease.
A double-blind placebo-controlled trial of Tanakan in the treatment of idiopathic cognitive impairment in the elderly.
Efficacy and tolerability of a once daily formulation of Ginkgo biloba extract EGb 761® in Alzheimer's disease and vascular dementia: results from a randomized controlled trial.
Effectiveness and safety of Ginkgo biloba preparations in the treatment of Alzheimer's disease: a systematic review and meta-analysis
Evidence for a therapeutic effect of Ginkgo biloba special extract: meta-analysis of 11 clinical studies in elderly patients with cerebrovascular insufficiency
Ginkgo biloba for cognitive impairment and dementia.
Efficacy and safety of herbal medicine for dementia and cognitive function: an umbrella review of systematic reviews and meta-analyses
Cognitive decline ✪✪✪✪✪
Ginkgo appears to have positive effects on senile dementia and memory problems, often due to reduced cerebral blood flow. Several studies confirm Ginkgo's beneficial effects on working memory and long-term memory, attention-based tasks, information processing speed, executive function, immediate and delayed recall, and recognition in healthy adults. Note that the standardized extract EGb-761 at 240–360 mg per day appears effective and its effect is comparable to 10 mg of donepezil.
Posologie
Oral: leaf, buds
240 - 360 mg
gemmotherapy, EGb 761, standardized extract, dry extract
Effect of Western medicine therapy assisted by Ginkgo biloba tablets on vascular cognitive impairment without dementia.
Specific memory effects of Ginkgo biloba extract EGb 761 in middle-aged healthy volunteers
Treatment of age-related memory complaints with Ginkgo biloba extract: a randomized double blind placebo-controlled study.
A double‐blind placebo‐controlled trial of tanakan in the treatment of idiopathic cognitive impairment in the elderly
European Union herbal monograph on Ginkgo biloba L., folium
Acute cognitive effects of standardised Ginkgo biloba extract complexed with phosphatidylserine.
Specific memory effects of Ginkgo biloba extract EGb 761 in middle-aged healthy volunteers.
Intermittent claudication ✪✪✪✪✪
Ginkgo supplementation appears to reduce the symptoms of intermittent claudication, although it seems to vary considerably from one individual to another. The WHO nevertheless recognizes its use to improve walking in intermittent claudication or after thrombophlebitis.
Posologie
Oral: leaf
750 mg
EGb 761
Demonstration of the efficacy of ginkgo biloba special extract EGb 761 on intermittent claudication--a placebo-controlled, double-blind multicenter trial.
A clinical trial of Gingkco Biloba Extract in patients with intermittent claudication.
Study of the antiischemic action of EGb 761 in the treatment of peripheral arterial occlusive disease by TcPo2 determination.
Effect of Ginkgo biloba (EGb 761) on treadmill walking time among adults with peripheral artery disease: a randomized clinical trial.
6-Month double-blind randomised clinical trial of Ginkgo biloba extract versus placebo in two parallel groups in patients suffering from peripheral arterial insufficiency.
Premenstrual syndrome ✪✪✪✪✪
Significantly relieves breast tenderness and other physical and psychological symptoms of premenstrual syndrome when taken daily from the 16th day of the menstrual cycle.
Posologie
Oral: leaf
80 - 120 mg
EGb 761, mother tincture, standardized extract, dry extract
Anxiety ✪✪✪✪✪
Clinical studies on the intake of a specific Ginkgo biloba extract, called EGb 761, by patients with chronic anxiety syndrome for four weeks may modestly reduce anxiety symptoms compared with placebo. However, long-term efficacy is not clearly established, and current data remain limited.
Posologie
Oral: leaf
480 mg
4 - weeks
EGb 761, mother tincture, standardized extract, dry extract
Glaucoma ✪✪✪✪✪
Improves pre-existing damage and reduces progression of damage to the visual field in patients with normal-tension glaucoma.
Posologie
Oral: leaf, buds
120 - 160 mg
12 - years
gemmotherapy, EGb 761, mother tincture, standardized extract, dry extract
Peripheral arterial disease of the lower limbs ✪✪✪✪✪
Significantly relieves pain and improves motor function in patients with peripheral arterial disease of the lower limbs.
Posologie
Oral: leaf, buds
120 - 300 mg
gemmotherapy, EGb 761, standardized extract, dry extract
Comparison of two dosages of ginkgo biloba extract EGb 761 in patients with peripheral arterial occlusive disease Fontaine's stage IIb. A randomized, double-blind, multicenter clinical trial
Demonstration of the efficacy of the special ginkgo biloba extract EGb 761 on intermittent claudication - a placebo-controlled, double-blind multicenter trial.
Hemorheology and walking in patients with peripheral arterial occlusive disease during treatment with Ginkgo biloba extract.
Does Ginkgo biloba reduce the risk of cardiovascular events?
Schizophrenia ✪✪✪✪✪
In synergy with an antipsychotic, it can completely reduce the symptoms of schizophrenia (compared to antipsychotic treatment alone) and the side effects related to taking antipsychotics such as thirst, constipation, cardiovascular and nervous system effects. It reduces tardive dyskinesia by at least 30% in patients with schizophrenia treated with antipsychotics.
Posologie
Oral: leaf
121 - 300 mg
EGb 761, standardized extract, dry extract
Review and meta-analysis of the use of ginkgo as an adjunct therapy in chronic schizophrenia.
Efficacy and safety of extract of Ginkgo biloba as an adjunct therapy in chronic schizophrenia: A systematic review of randomized, double-blind, placebo-controlled studies with meta-analysis.
Alzheimer's disease ✪✪✪✪✪
Ginkgo biloba leaf extract may stabilize or improve cognitive functions in patients with different types of dementia (Alzheimer's, vascular, or mixed).
Posologie
Oral: leaf
240 mg
24 days
EGb 761, standardized extract, dry extract
The efficacy of Egb 761 in patients with senile dementia of the Alzheimer type, A double-blind, placebo-controlled study on different levels of investigation.
The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease.
A double-blind placebo-controlled trial of Tanakan in the treatment of idiopathic cognitive impairment in the elderly.
Efficacy and tolerability of a once daily formulation of Ginkgo biloba extract EGb 761® in Alzheimer's disease and vascular dementia: results from a randomised controlled trial.
Evidence for a therapeutic effect of Ginkgo biloba special extract. Meta-analysis of 11 clinical studies in patients with cerebrovascular insufficiency in old age
Memory ✪✪✪✪✪
Clinical studies show that taking Ginkgo extract may improve certain measures of cognitive function such as working memory, and short- and long-term memory in healthy subjects; however, other studies show mixed results, with no positive conclusion regarding cognitive functions and, in particular, memory. nnSome studies suggest that combining Ginkgo with Panax ginseng may strengthen cognitive functions and memory, especially in young healthy subjects, more effectively than Ginkgo alone. Because of the small number of participants in the studies and the conflicting results, more evidence is required. Ginseng extract combined with Ginkgo biloba extract improves memory by about 7.5%. nnNo definitive conclusion can be drawn; larger-scale studies will be necessary to conclude on Ginkgo's effectiveness on memory and cognitive functions more broadly.nn
Posologie
Oral route: leaves, buds
60 - 240 mg
12 weeks
gemmotherapy, EGb 761, mother tincture, standardized extract, dry extract
Synergies
Acute, dose-dependent cognitive effects of Ginkgo biloba, Panax ginseng and their combination in healthy young volunteers: differential interactions with cognitive demand.
Neuropsychological changes after 30-day Ginkgo biloba administration in healthy participants.
The dose-dependent cognitive effects of acute administration of Ginkgo biloba to healthy young volunteers.
Gincosan (a combination of Ginkgo biloba and Panax ginseng): the effects on mood and cognition of 6 and 12 weeks' treatment in post-menopausal women.
The memory enhancing effects of a Ginkgo biloba/Panax ginseng combination in healthy middle-aged volunteers.
Specific memory effects of Ginkgo biloba extract EGb 761 in middle-aged healthy volunteers
The psychopharmacological effects of Ginkgo biloba extract in normal healthy volunteers.
Modulation of cognition and mood following administration of single doses of Ginkgo biloba, ginseng, and a ginkgo/ginseng combination to healthy young adults.
Specific memory effects of Ginkgo biloba extract EGb 761 in middle-aged healthy volunteers.
The effects of acute doses of standardized Ginkgo biloba extract on memory and psychomotor performance in volunteers.
Treatment of age-related memory complaints with Ginkgo biloba extract: a randomized double blind placebo-controlled study.
Ginkgo biloba special extract LI 1370 improves dual-task walking in patients with MCI: a randomized, double-blind, placebo-controlled exploratory study.
Phase II study of Ginkgo biloba in irradiated brain tumor patients: effect on cognitive function, quality of life, and mood.
An examination of the efficacy of Ginkgo biloba extract EGb761 on the neuropsychologic functioning of cognitively intact older adults.
Safety and effectiveness of a traditional ginkgo fresh plant extract - results from a clinical trial.
An examination of the efficacy of Ginkgo biloba extract EGb761 on the neuropsychologic functioning of cognitively intact older adults.
Acute cognitive effects of standardized Ginkgo biloba extract complexed with phosphatidylserine.
Acute cognitive effects of standardized Ginkgo biloba extract complexed with phosphatidylserine.
A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761 in a sample of cognitively intact older adults: neuropsychological findings.
Specific memory effects of Ginkgo biloba extract EGb 761 in middle-aged healthy volunteers.
A randomized placebo-controlled trial of Ginkgo biloba for the prevention of cognitive decline.
Eye health ✪✪✪✪✪
An increase in ocular blood flow has been observed in cases of normal-tension glaucoma as well as in healthy controls. Moreover, preliminary clinical research suggests that taking a ginkgo leaf extract at 60 - 240 mg orally once or twice daily for a period of up to 6 months may improve the symptoms of age-related macular degeneration (AMD). More studies are needed to confirm the benefits of Ginkgo on vision
Posologie
Oral: leaf
60 - 240 mg
6 - months
EGb 761, mother tincture, standardized extract, dry extract
Tinnitus ✪✪✪✪✪
Clinical studies have explored the efficacy of Ginkgo biloba in the treatment of sudden hearing loss, often associated with tinnitus. Some meta-analyses suggest that adding ginkgo extract to conventional treatments, such as corticosteroids, may increase recovery rates and improve hearing sensitivity. However, these studies have limitations, including variable ginkgo dosages and heterogeneous methodologies. Furthermore, it is difficult to determine the true impact of ginkgo because of the high rates of spontaneous recovery observed in patients. In naturopathy, ginkgo is valued for its vasodilatory and antioxidant properties, which could support inner ear health. Nevertheless, current evidence is not strong enough to confirm its effectiveness against tinnitus.
Posologie
Oral: leaf, buds
240 mg
gemmotherapy, standardized extract, dry extract
Efficacy and safety of Ginkgo biloba extract as an adjuvant in the treatment of Chinese patients with sudden hearing loss: a meta-analysis
Diabetic retinopathy ✪✪✪✪✪
Significantly improves color vision measurement in patients with early diabetic retinopathy.
Posologie
Oral: leaf
120 mg
6 months
EGb 761, mother tincture, standardized extract, dry extract
Pancreatic cancer ✪✪✪✪✪
Could be useful against pancreatic cancer in synergy with 5-fluorouracil.
Posologie
Oral: leaf
EGb 761, standardized extract
Colon cancer ✪✪✪✪✪
Could be useful against metastatic colorectal cancer in synergy with 5-fluorouracil.
Posologie
Oral: leaf
EGb 761, standardized extract
AMD ✪✪✪✪✪
Research to date does not allow confirmation whether people with age-related macular degeneration (AMD) should take Ginkgo to prevent disease progression. However, clinical studies on small groups show some benefits for vision, particularly in people with AMD symptoms. More studies are needed to measure the effects of Ginkgo on AMD.
Posologie
Oral: leaf
60 - 240 mg
6 - months
standardized extract, dry extract
Peripheral circulatory disorders ✪✪✪✪✪
The EMA recognizes the traditional use of Ginkgo for the relief of heavy legs and the sensation of cold hands and feet associated with minor circulatory problems.
Posologie
Oral: leaf, buds
750 mg
gemmotherapy, standardized extract, dry extract
Properties
Antioxidant
Ginkgo increases glutathione levels (an antioxidant that protects cells from free radicals). Flavonoids appear to prevent lipid peroxidation of cell membranes (oxidation of unsaturated lipids), and protect neurons and retinal tissue from oxidative stress.
Usages associés
Microcirculatory effect
The ginkgo leaf appears to improve blood flow to capillaries throughout the body, including the central nervous system, the eyes, the ears, the extremities and other tissues. The ginkgo leaf likely improves circulation by decreasing blood viscosity and by affecting vascular smooth muscle. The ginkgo leaf appears to restore the balance between prostacyclin and thromboxane A2, which improves vasoregulation. It is not exactly known how ginkgo causes vessel contraction and improves venous tone, but these effects may be due to phosphodiesterase inhibition, which leads to increased cAMP levels and the release of catecholamines. Overall, the ginkgo leaf appears to increase the microcirculation of cerebral and peripheral blood flow, and reduce vascular permeability.
Usages associés
Cognitive function
Ginkgo may inhibit amyloid peptide-induced toxicity and cell death (a small protein implicated in the pathophysiology of Alzheimer's disease). But this effect has not been demonstrated in vivo. Ginkgo influences the secretion of certain neurotransmitters (such as adrenaline), appears to inhibit catechol-O-methyltransferase (COMT) (an enzyme that degrades catecholamines) and increases alpha-adrenergic receptors. Ginkgolides A and B play an anti-stress role by reducing glucocorticoids that are increased during stress. Some studies show that a specific Ginkgo extract (EGb761, Tanakan) decreases the secretion of adrenocorticotropic hormone (ACTH) and cortisol, which are increased during stress.
Usages associés
Cardiovascular
The Ginkgo leaf appears to improve capillary blood flow including in the central nervous system, the eyes, the ears, and the extremities, doing so by reducing blood viscosity and acting on vascular smooth muscle. The Ginkgo leaf improves vascular spasms (by dilation) and constricts abnormally dilated vessels. The mechanism may be due to inhibition of phosphodiesterase, leading to an increase in cAMP and the release of catecholamines. Some evidence shows that Ginkgo extract may have a cardioprotective effect by promoting production of vascular endothelial growth factor (VEGF).
Usages associés
Anti-inflammatory
Ginkgo reduces levels of interleukins 6 and 8 and TNF-alpha (polypeptide molecules involved in inflammation). This anti-inflammatory effect is beneficial in cases of hypersensitivity, allergy, asthma, bronchitis and in certain peripheral vascular conditions.
Usages associés
Antiplatelet agents/Anticoagulant
Ginkgolides competitively inhibit the binding of platelet-activating factor (PAF) to the cell membrane receptor, which decreases platelet aggregation. In addition, Ginkgo leaf extract may inhibit the formation of thromboxanes A2 and B2 (components involved in platelet aggregation).
Usages associés
Anticancer
In vitro, Ginkgo extract and the constituents quercetin and ginkgolides A and B inhibit the proliferation of ovarian cancer cells. Ginkgolide B may regulate various proteins involved in tumor proliferation and suppression. Some Ginkgo extracts may induce apoptosis and differentiation of gastric cancer cells.
Usages associés
Cholesterol-lowering
In vitro, Ginkgo extract decreases total cholesterol, inhibits the activity of HMG-CoA reductase (the enzyme involved in the production of cholesterol precursors), and reduces cholesterol influx into cultured hepatocytes.
Hypoglycemic
Ginkgo leaf extract appears to stimulate pancreatic beta cells during a glucose challenge in healthy subjects. Ginkgo does not appear to affect insulin resistance or glucose elimination.
Safe dosage
Adults 18 years and older: 120 mg - 240 mg
Ginkgo-based medicines have a standardized concentration of active compounds: 22 to 27% flavonoids and 5 to 7% terpene lactones (ginkgolides and bilobalide). They are usually administered at a dose of 120 to 240 mg of standardized extracts per day.
Interactions
Médicaments
Alprazolam: moderate interaction
Ginkgo appears to reduce the absorption of alprazolam (Xanax*), thereby decreasing its effectiveness. It does not appear to affect its hepatic metabolism.
Antiplatelet agents/Anticoagulants: moderate interaction
Ginkgo may increase bleeding risk if combined with an anticoagulant, due to its platelet anti-aggregant effect. It displaces the platelet-activating factor (PAF) from its binding sites, thereby reducing aggregation and blood clotting. Patients on anticoagulants should monitor their INR (International Normalized Ratio: one of the markers used to monitor certain blood factors involved in clotting).
Anticonvulsants: moderate interaction
Ginkgo leaves may decrease the effectiveness of anticonvulsants and could trigger a convulsive seizure in otherwise well-controlled epileptic patients.
Antidepressant: moderate interaction
Ginkgo may increase the reuptake of serotonin (a neurotransmitter in the central nervous system) at synapses. Therefore, it may reduce the effectiveness of serotonergic antidepressants.
Antidiabetic: moderate interaction
The effect of ginkgo varies depending on the level of insulin secretion and the treatment taken by the patient. Indeed, if the patient is a type 2 diabetic with hyperinsulinemia and controlled by diet, ginkgo appears to have no significant effect on insulin levels and blood glucose. If the patient is a type 2 diabetic with hyperinsulinemia and treated with hypoglycemic agents, ginkgo appears to decrease insulin levels and increase blood glucose. If the patient has pancreatic beta-cell exhaustion, ginkgo appears to stimulate the pancreatic beta cells (insulin- and C‑peptide–producing cells) but without a significant change in blood glucose. Therefore, it is recommended that type 2 diabetics use ginkgo with caution.
Cholesterol-lowering: moderate interaction
Ginkgo appears to increase the clearance of atorvastatin (Lipitor*) and simvastatin (Zocor*), but this interaction does not affect cholesterol synthesis or absorption. Use with caution.
Cytochrome P450 substrates: moderate interaction
Ginkgo may inhibit cytochrome activity, but clinical studies remain contradictory (some show that ginkgo may induce the activity of certain cytochrome subfamilies, others show it has no effect). Due to insufficient clinical data, ginkgo should be used with caution in combination with cytochrome P450 substrates.
Non-nucleoside reverse transcriptase inhibitor: moderate interaction
Ginkgo may decrease the concentration of certain non-nucleoside reverse transcriptase inhibitors (NNRTIs) (an antiretroviral used to treat HIV infection) whose metabolism depends on cytochrome P450 3A4, and therefore it may increase viral load.
Ibuprofen: moderate interaction
The combination of Ginkgo and ibuprofen may increase bleeding risk, although a meta-analysis did not demonstrate a significant antiplatelet effect at doses of 80 to 480 mg of Ginkgo extract over 32 weeks.
Omeprazole: minor interaction
Ginkgo may decrease omeprazole levels by enzymatic induction (CYP2C19).
Talinolol: strong interaction
A 120 mg oral dose of Ginkgo leaf extract three times daily for 14 days may increase talinolol levels. But single doses of Ginkgo do not appear to affect talinolol pharmacokinetics.
Plantes ou autres actifs
Antiplatelet agents/Anticoagulant: minor interaction
Concomitant use of Ginkgo may increase bleeding risk.
Precautions
Children aged 6 to 14 years: use with caution
Possibly safe when used at appropriate doses. Some studies have shown that it can be used safely in children aged 6 to 14 years at a dose of 80 to 120 mg per day for 6 weeks. Fresh seeds are dangerous in children. They can cause seizures and even death.
Breastfeeding: avoid
Avoid use due to lack of reliable and sufficient data.
Type 2 diabetes: use with caution
Ginkgo appears to affect insulin secretion and metabolism, so it can alter blood glucose in patients with type 2 diabetes. This effect varies depending on the level of insulin secretion and the treatment the patient is receiving.
Coagulation disorder: use with caution
Ginkgo reduces platelet aggregation and therefore increases bleeding risk.
Person with condition: use with caution
Ginkgo may interfere with anticonvulsant medications.
Infertility: avoid
Some studies have shown that Ginkgo extract may inhibit fertilization, but this effect has not been demonstrated in humans.
Contraindications
Pregnancy: contraindicated
Oral Ginkgo taken during pregnancy may trigger labor, risking preterm birth. It also increases bleeding risk during delivery due to its platelet anti-aggregant effect.
Surgery: contraindicated
Ginkgo may increase bleeding risk through its platelet anti-aggregant effect. Ginkgo should be stopped 2 weeks before a planned surgical procedure.
