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.

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).

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.

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.

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.

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