Ginkgo biloba: Benefits, Dosage, Contraindications
Other name(s)
Silver Apricot
Family or group:
Plants
Active ingredients:
Flavonoids
Sterols
Terpenoids
Indications
Rating methodology
EFSA approval.
Vertigo ✪✪✪✪✪
Daily intake of ginkgo leaf extract at a dose of 120 to 160 mg orally appears to improve vertigo and balance disorders in individuals with vestibular disorders compared to placebo.
Posologie
Oral: leaf
120 - 160 mg
EGb 761, standardized extract, dry extract
Dementia ✪✪✪✪✪
Ginkgo Biloba leaf extract can 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, could provide modest improvements in cognitive symptoms and daily activities compared to a placebo. Moreover, ginkgo does not seem to prevent or slow the progression of dementia in elderly individuals, whether they exhibit initial cognitive impairments or not. Large clinical studies have not shown a reduction in the risk of developing dementia with regular ginkgo consumption. Compared to conventional treatments such as donepezil, ginkgo offers similar results in some preliminary studies, but current evidence is not sufficient to recommend it as an alternative. The EMA recognizes Ginkgo as a herbal medicine for improving cognitive impairment (related to aging) and quality of life in cases of mild dementia.
Posologie
Oral: 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 randomised 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 patients with cerebrovascular insufficiency in old age
Ginkgo biloba for cognitive impairment and dementia.
Efficacy and safety of herbal medicine on dementia and cognitive function: An umbrella review of systematic reviews and meta-analysis
Cognitive Decline ✪✪✪✪✪
Ginkgo appears to have positive effects on senile dementia and memory issues, often due to decreased vascularization of the brain. Several studies confirm the beneficial effects of Ginkgo on working memory and long-term memory, tasks based on attention, information processing speed, executive function, immediate and delayed recall, and recognition in healthy adults. Note that standardized extract EGb-761 at 240-360 mg per day appears effective and comparable in its effect 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 tablet on vascular cognitive impairment of none 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 ✪✪✪✪✪
Supplementation with ginkgo seems to reduce symptoms of intermittent claudication, although it appears to vary considerably from individual to individual. The WHO nevertheless recognizes its use 'to improve walking in intermittent claudication or after a phlebitis.
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 tension and other physical and psychological symptoms of premenstrual syndrome, with daily intake 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 over four weeks may modestly reduce anxiety symptoms compared to a 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 the progression of damage caused to the visual field of patients with normal tension glaucoma.
Posologie
Oral: leaf, buds
120 - 160 mg
12 - years
gemmotherapy, EGb 761, mother tincture, standardized extract, dry extract
Peripheral Artery Disease ✪✪✪✪✪
Considerably relieves pain and increases motor abilities in patients with lower limb artery disease.
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 randomised, double-blind, multicentric clinical trial
Demonstration of the efficacy of ginkgo biloba special extract EGb 761 on intermittent claudication - a placebo-controlled, double-blind multicenter trial.
Hemorheology and walking of peripheral arterial occlusive diseases patients 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 an antipsychotic treatment alone) and the side effects related to taking antipsychotics such as thirst, constipation, cardiovascular and nervous effects. It reduces tardive dyskinesia effects by at least 30% in schizophrenia patients treated with antipsychotics.
Posologie
Oral: leaf
121 - 300 mg
EGb 761, standardized extract, dry extract
Review and meta-analysis of usage 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 can 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 indicate that taking Ginkgo extract may enhance some cognitive functions such as working memory, and short- and long-term memory in healthy subjects; however, other studies show mixed results, without positive conclusions on cognitive functions and in particular memory. Some studies suggest the combination of Ginkgo with Panax Ginseng could enhance cognitive functions and memory especially in young and healthy subjects, more effectively than Ginkgo alone. Due to the small number of participants in studies and conflicting results, more evidence is required. Ginseng extract combined with Ginkgo biloba improves memory by about 7.5%. No definitive conclusions can be drawn, larger-scale studies will be necessary to conclude on the effectiveness of Ginkgo on memory and cognitive functions more broadly.
Posologie
Oral: leaf, 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 randomised, 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 standardised Ginkgo biloba extract complexed with phosphatidylserine.
Acute cognitive effects of standardised 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 subjects. Additionally, preliminary clinical research suggests that taking a ginkgo leaf extract at 60-240 mg orally one to two times daily for up to 6 months may improve symptoms of AMD. More studies are needed to confirm the benefits of Ginkgo on vision
Posologie
Oral route: leaf
60 - 240 mg
6 - months
EGb 761, mother tincture, standardized extract, dry extract
Tinnitus ✪✪✪✪✪
Clinical studies have explored the effectiveness of Ginkgo biloba in treating sudden hearing loss often associated with tinnitus. Some meta-analyses suggest that adding ginkgo extract to conventional treatments, such as corticosteroids, could increase recovery rates and improve auditory sensitivity. However, these studies present limitations, including variable ginkgo dosages and heterogeneous methodologies. Moreover, it is difficult to determine the real impact of ginkgo due to high rates of spontaneous recovery observed in patients. In naturopathy, ginkgo is appreciated for its vasodilator and antioxidant properties, which could support inner ear health. Nonetheless, the current evidence is insufficiently robust to confirm its efficacy against tinnitus.
Posologie
Oral route: 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 route: leaf
120 mg
6 - months
EGb 761, mother tincture, standardized extract, dry extract
Pancreatic Cancer ✪✪✪✪✪
May be useful against pancreatic cancer in synergy with 5-fluorouracil.
Posologie
Oral route: leaf
EGb 761, standardized extract
Colon Cancer ✪✪✪✪✪
May be useful against metastatic colorectal cancer in synergy with 5-fluorouracil.
Posologie
Oral route: leaf
EGb 761, standardized extract
AMD ✪✪✪✪✪
Research to date does not allow confirmation whether people with AMD should take Ginkgo to prevent disease progression. However, clinical studies on small groups show some benefits for vision and especially for people with symptoms of AMD. More studies are needed to measure the effects of Ginkgo on AMD.
Posologie
Oral route: 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 leg heaviness and the sensation of cold hands and feet associated with minor circulatory problems.
Posologie
Oral route: leaf, buds
750 mg
gemmotherapy, standardized extract, dry extract
Properties
Antioxidant
Ginkgo enhances glutathione levels (an antioxidant that protects cells from free radicals). Flavonoids appear to prevent lipid peroxidation of cell membranes (an oxidation of unsaturated lipids) and protect neurons and retinal tissue from oxidative stress.
Usages associés
Microcirculatory Effect
Ginkgo leaf appears to improve blood flow to capillaries throughout the body, including the central nervous system, eyes, ears, extremities, and other tissues. Ginkgo leaf likely improves circulation by decreasing blood viscosity and affecting smooth vascular muscles. Ginkgo leaf seems to restore the balance between prostacyclin and thromboxane A2, which enhances vascular regulation. The exact mechanism by which ginkgo triggers vessel contraction and improves venous tone is unclear, but these effects may be due to inhibition of phosphodiesterase, leading to increased cAMP levels and catecholamine release. Overall, ginkgo leaf appears to enhance cerebral and peripheral microcirculation and reduce vascular permeability.
Usages associés
Cognitive Function
Ginkgo may inhibit toxicity and cell death induced by amyloid peptides (a small protein implicated in the pathophysiology of Alzheimer's disease). However, this effect has not been demonstrated in vivo. Ginkgo influences the secretion of certain neurotransmitters (such as adrenaline), seems 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 which are elevated in stress. Some studies show that a specific extract of Ginkgo (EGb761, Tanakan) decreases the secretion of adrenocorticotropic hormone (ACTH) and cortisol, which are increased during stress.
Usages associés
Cardiovascular
Ginkgo leaf seems to improve capillary blood flow including in the central nervous system, eyes, ears, extremities, by reducing blood viscosity and acting on smooth vascular muscle. Ginkgo leaf improves vascular spasms (through dilation) and contracts abnormally dilated vessels. The mechanism may be due to phosphodiesterase inhibition, leading to increased cAMP and catecholamine release. Some evidence suggests that Ginkgo extract may have a cardioprotective effect by promoting the 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 hypersensitivity, allergy, asthma, bronchitis, and certain peripheral vascular conditions.
Usages associés
Antiplatelet/Anticoagulant
Ginkgolides competitively inhibit the binding of platelet-activating factor (PAF) to the cell membrane receptor, which decreases platelet aggregation. Furthermore, ginkgo leaf extract can inhibit the formation of thromboxanes A2 and B2 (components involved in platelet aggregation).
Usages associés
Anticancer
In vitro, Ginkgo extract and constituents Quercetin and Ginkgolides A and B inhibit the proliferation of ovarian cancer cells. Ginkgolide B may regulate various proteins involved in proliferation and tumor suppression. Certain Ginkgo extracts can induce apoptosis and differentiation of gastric cancer cells.
Usages associés
Hypocholesterolemic
In vitro, Ginkgo extract reduces total cholesterol, inhibits HMG-CoA reductase activity (an enzyme involved in the production of cholesterol precursors), and decreases cholesterol influx into cultured hepatocytes.
Hypoglycemic
Ginkgo leaf extract seems to stimulate pancreatic beta-cells during a glucose load in healthy subjects. Ginkgo does not appear to affect insulin resistance or glucose elimination.
Safety dosage
Adult from 18 years: 120 mg - 240 mg
Ginkgo-based medications contain a normalized concentration of active ingredients: 22 to 27% flavonoids and 5 to 7% terpenolactones (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 decrease the absorption of alprazolam (xanax*), thus reducing its effectiveness. It does not seem to affect its hepatic metabolism.
Antiplatelet agents/Anticoagulant: moderate interaction
Ginkgo may increase bleeding risk if combined with an anticoagulant, due to its antiplatelet effect. It displaces platelet-activating factor PAF from its binding sites, thereby reducing aggregation and blood coagulation. Patients on anticoagulants should monitor their INR (International Normalized Ratio: part of markers monitoring certain blood factors involved in coagulation).
Anticonvulsants: moderate interaction
Ginkgo leaves may reduce the effectiveness of anticonvulsants, with the risk of a seizure occurring in well-balanced epileptic subjects.
Antidepressant: moderate interaction
Ginkgo may increase serotonin reuptake (a neurotransmitter in the central nervous system) by synapses. Thus, it may decrease the effectiveness of serotonergic antidepressants.
Antidiabetic: moderate interaction
The effect of ginkgo varies depending on insulin secretion level and the treatment taken by the patient. Indeed, if the patient is a type 2 diabetic with hyperinsulinemia and controlled by a diet, ginkgo seems to have no significant effect on insulin levels and blood sugar. If the patient is a type 2 diabetic with hyperinsulinemia and treated with hypoglycemic agents, ginkgo seems to decrease insulin levels and increase blood sugar. If the patient presents pancreatic exhaustion, ginkgo seems to stimulate pancreatic beta cells (insulin and peptide C producing cells) but without significant blood sugar variation. Type 2 diabetics are therefore advised to use ginkgo with caution.
Cholesterol-lowering: moderate interaction
Ginkgo seems to increase the clearance of atorvastatin (lipitor*) and simvastatin (zocor*), but this interaction does not affect cholesterol synthesis and absorption. Use with caution.
Cytochrome P450 substrates: moderate interaction
Ginkgo may inhibit cytochrome activity, but clinical studies remain contradictory (some show that ginkgo can induce activity in certain cytochrome subfamilies, others show 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 in HIV infection) whose metabolism depends on cytochrome P450 3A4, and may therefore increase viral load.
Ibuprofen: moderate interaction
The combination of Ginkgo and Ibuprofen may increase bleeding risk, although a meta-analysis did not show a significant antiplatelet effect with a dose of 80 to 480mg of Ginkgo extract for 32 weeks.
Omeprazole: weak interaction
Ginkgo may decrease the level of omeprazole through enzymatic induction (CYP 2C19).
Talinolol: strong interaction
A dose of 120mg orally of ginkgo leaf extract three times a day for 14 days may increase Talinolol levels. However, single doses of ginkgo do not seem to affect the pharmacokinetics of Talinolol.
Plantes ou autres actifs
Antiplatelet agents/Anticoagulant: weak interaction
The combination with Ginkgo may increase the risk of bleeding.
Precautions
Child from 6 to 14 years: use with caution
Potentially safe if used in appropriate doses. Some studies have shown 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 for children. They can cause seizures or even death.
Breastfeeding woman: avoid
Avoid use due to lack of reliable and sufficient data.
Type 2 Diabetes: use with caution
Ginkgo seems to affect insulin secretion and metabolism, so it can alter blood sugar in type 2 diabetic patients. This effect varies depending on insulin secretion level and treatment taken by the patient.
Clotting disorder: use with caution
Ginkgo decreases platelet aggregation, thereby increasing bleeding risk.
Person with condition: use with caution
Ginkgo can interfere with anticonvulsant medications.
Infertility: avoid
Some studies have shown Ginkgo extract may inhibit fertilization, but this effect has not been demonstrated in humans.
Contraindications
Pregnant woman: prohibited
Ginkgo taken orally during pregnancy can trigger labor, with the risk of premature delivery. It also increases the hemorrhagic risk during delivery due to its antiplatelet effect.
Surgical intervention: prohibited
Ginkgo can increase bleeding risk due to its antiplatelet effect. Ginkgo should be stopped 2 weeks prior to a scheduled surgical intervention.
