Be aware that the U.S Food and Drug Administration does not strictly regulate
herbs and dietary supplements. There is no guarantee of strength, purity
or safety of products containing or claiming to contain ginkgo. Decisions
to use herbs or supplements should be carefully considered. Individuals using
prescription drugs should discuss taking herbs or supplements with a pharmacist
or health care professional before starting.
Scientists have studied ginkgo for the following health problems:
Peripheral vascular disease, claudication
Intermittent claudication is a painful condition caused by clogged arteries
in the legs. When people walk, not enough blood gets to muscles, and this
can cause cramps or pain. Multiple studies suggest that taking ginkgo by
mouth may reduce pain and increase the distance that patients with intermittent
claudication can walk without pain. However, conflicting data also exist.
Some studies have found that taking ginkgo may slow the progress of Alzheimer's
disease or dementia associated with multiple strokes. Many of these studies
have had flaws with their design. More studies are needed to determine which
patients may benefit the most from ginkgo and what dose of ginkgo provides
the best effects.
Cerebral insufficiency is a term often used in Europe to describe people
with decreased blood flow to the brain caused by clogged arteries. Early
evidence suggests that ginkgo may improve short-term memory and concentration
and reduce dizziness, headaches and mood disturbances in people with cerebral
Several studies suggest that taking ginkgo by mouth may improve recovery
from strokes that result from decreased blood flow to certain areas of the
brain. Different studies, however, have produced results that do not agree
with each other. Better studies are needed to provide more definitive answers
in the future.
Tinnitus (ringing in the ears)
Multiple small, poor-quality studies report reduced ringing in the ears after
treatment with ginkgo in people with chronic tinnitus. However, recent
well-designed studies found no improvements with ginkgo. It remains unclear
if ginkgo is helpful for this condition.
Upper digestive tract malignant tumors
Ginkgo biloba exocarp polysaccharides (GBEP) capsule preparation has been
studied for upper digestive tract malignant tumors of middle and late stage
with positive results. However, further research is needed before a
recommendation can be made.
Acute mountain sickness
Ginkgo biloba has been studied for acute mountain sickness and has not shown
definitive benefit over a prescription drug.
Mood and cognition in postmenopausal women
Based on early study of chronic administration, Gincosan appeared to have
no beneficial effects on mood, anxiety, or sleepiness in postmenopausal women.
Early study results show that ginkgo may help vertigo. Further research is
needed to confirm these results.
Acute hemorrhoidal attacks
In early study, gingko was shown to be effective in the treatment of patients
with acute hemorrhoidal attacks. Further research is needed to confirm these
Sexual dysfunction due to antidepressant drugs
Based on early study, ginkgo does not seem to help sexual dysfunction due
to antidepressant drugs.
Ginkgo has been studied in humans for many other conditions, including acute
cochlear deafness, acute hemorrhoidal attack, acute mountain sickness,
age-related memory impairment, allergic contact dermatitis, arteritis, asphyxia,
asthenic disorders, asthma, circulatory encephalopathy, color vision, coronary
heart disease, cognitive performance, depression, decreased sex drive, dizziness,
erectile dysfunction, fibromyalgia, glaucoma, macular degeneration, multiple
sclerosis, pancreatic cancer, premenstrual syndrome, sexual function, sudden
hearing loss, unilateral idiopathic sudden sensorineural hearing loss, vaginal
dryness, vascular vestibular disorders, and vertiginous syndrome. In addition,
it has been studied in humans to determine if it reduces the side effects
associated with chemotherapy. However, there is not enough evidence to make
a recommendation for using ginkgo for any of these purposes.
Early research suggests that ginkgo may improve memory, but studies have
been small with flaws in their designs, and results have disagreed with each
Ginkgo has been suggested for many other uses, based on tradition or on
scientific theories. However, these uses have not been thoroughly studied
in humans, and there is limited scientific evidence about safety or
effectiveness. Some of these suggested uses are for conditions that are
potentially very serious and even life-threatening. You should consult with
a health care professional before taking ginkgo for any unproven use.
|Acute cerebral infarction
Age-related macular disease
Antidepressant-induced sexual dysfunction
Congestive heart failure
Coronary heart disease
Diabetic peripheral neuropathy
Enhancement of female sexual function
|Enhancement of learning
Enhancement of memory
Irregular heart beats
Mild cognitive impairment
Normal tension glaucoma
Primary chronic venous insufficiency
Respiratory (lung) illnesses
Seasonal affective disorder
Vestibular organ peripheral lesion syndrome
People with allergies to plants in the Ginkgoaceae family or to urushiols
(mango rind, sumac, poison ivy, poison oak) may be more likely to have allergic
reactions to ginkgo. One case of a severe, blistering, peeling rash
(Stevens-Johnson syndrome) associated with a product that contained ginkgo
has been reported. Ginkgo fruit or pulp may cause allergies if applied to
the skin. Ginkgo injections have caused severe reactions and are not recommended.
Few side effects have been reported from ginkgo at recommended doses. The
most common complaints include stomach discomfort, nausea, headaches, dizziness
or restlessness. Adverse effects such as skin irritation and itching have
also occurred but are likely caused by ginkgo allergies. Rarely, heart
palpitations (rapid, pounding heartbeats) have been reported. Commonly used
doses of Ginkgo biloba do not seem to have any immediate or short-term
effects on blood pressure, heart rate, or elecrocardiographic (ECG) variables.
One serious concern with ginkgo is the possible increased risk of bleeding.
There are several cases of people bleeding inside their heads while taking
ginkgo, which may occur more frequently in people also taking drugs that
affect bleeding, such as aspirin or warfarin. Nosebleeds may also occur with
ginkgo use. You may need to stop taking ginkgo before some surgeries because
of the risk of bleeding; discuss this with a health care professional.
It has also been reported that ginkgo may interfere with fertility in both
men and women and may cause a decrease in muscle strength. These effects
have not been widely studied in humans.
It is possible that ginkgo may cause seizures, especially in people with
a history of seizure disorders or taking other medications that increase
the chance of having a seizure. Ginkgo may affect the outcome of electroconsulvie
therapy. Adverse effects on the eyes have been reported.
Pregnancy And Breast-Feeding
Ginkgo cannot be recommended during pregnancy or breast-feeding. There are
reports of seizures in children who have taken ginkgo.
Interactions with drugs, supplements and other herbs have not been thoroughly
studied. The interactions listed below have been reported in scientific
publications. If you are taking prescription drugs, speak with a health care
professional or pharmacist before using herbs or dietary supplements.
Interactions With Drugs
Ginkgo may increase the risk of bleeding when used with anticoagulants (blood
thinners) or antiplatelet drugs. Examples include warfarin (Coumadin), heparin
and clopidogrel (Plavix). Some pain relievers may also increase the risk
of bleeding if used with ginkgo. Examples include aspirin, ibuprofen (Motrin,
Advil) and naproxen (Naprosyn, Aleve, Anaprox). It has been suggested that
ginkgo may increase the risk of bleeding if taken with acetaminophen (Tylenol),
pentoxifylline (Trental) and vitamin E, although there is not a lot of
information in this area.
Individuals with a history of diabetes should be careful when taking ginkgo.
In theory, ginkgo may lower blood sugar levels. Caution is advised if you
are also taking drugs that may lower blood sugar levels. Patients taking
oral drugs for diabetes or using insulin should be monitored closely by a
health care professional while using ginkgo. Dosing adjustments may be necessary.
It is possible that ginkgo may cause seizures, especially in people with
a history of seizure disorders. You should avoid taking other drugs that
increase the risk of seizures if you are taking ginkgo.
Many other possible drug interactions could, in theory, lead to adverse effects.
Examples include increased side effects if used with antidepressants, such
as fluoxetine (Prozac); cholinesterase inhibitors, such as donepezil (Aricept);
or drugs used to treat high blood pressure. Possible beneficial drug interactions
that may, in theory, occur with the use of ginkgo are less toxicity associated
with chemotherapy, improvements in erectile function when used with papaverine,
and fewer adverse effects when used with antipsychotic drugs. Many of these
drug interactions have not been widely studied in humans.
Gingko may alter the way the liver breaks down certain drugs
Interactions With Herbs And Dietary Supplements
Very few interactions between ginkgo and herbs or supplements have been reported,
but some are considered possible. For example, side effects such as muscle
stiffness, rapid heartbeats, fever, restlessness and sweating may occur if
gingko is used with
John's wort. In theory, ginkgo may increase the risk of bleeding when
also taken with other products that are believed to increase the risk of
bleeding, such as
(Allium sativum). Vitamin E and ginkgo taken together may also increase
the risk of bleeding. It is also possible that ginkgo may lower blood sugar
levels. People using other herbs or supplements that may alter blood sugar
levels, such as
melon (Momordica charantia), should be monitored closely by a
health care professional while using ginkgo. Dosing adjustments may be necessary.
Although not widely studied, ginkgo may lower blood pressure levels and should
be used cautiously with other herbs or supplements that may affect blood
pressure levels, such as
(Crataegus oxyacantha). Gingko may alter the way the liver breaks
down herbs and supplements.
The doses listed below are based on scientific research, publications
or traditional use. Because most herbs and supplements have not been thoroughly
studied or monitored, safety and effectiveness may not be proven. Brands
may be made differently, with variable ingredients even within the same brand.
Combination products often contain small amounts of each ingredient and may
not be effective. Appropriate dosing should be discussed with a health care
professional before starting therapy; always read the recommendations on
a product's label. The dosing for unproven uses should be approached cautiously,
because scientific information is limited in these areas.
Some natural medicine experts recommend ginkgo products that contain 24 percent
flavoglycosides and 6 percent terpenes. Beneficial effects may not be seen
for four to six weeks.
Adults (Aged 18 Or Older)
Capsules/tablets: Doses of 80 to 240 milligrams daily of a 50:1
standardized leaf extract, divided into two or three doses, have been taken
by mouth. There is evidence that 240 milligrams daily is most beneficial
for intermittent claudication. For patients diagnosed with unilateral idiopathic
sudden sensorineural hearing loss, an oral dose of 120 milligrams EGb 761
twice daily has been used.
Liquid/fluid: Doses of three to six milliliters daily of an extract
concentrated to 40 milligrams per milliliter, divided into two or three doses,
have been taken by mouth. There is evidence that six milliliters daily is
most effective for intermittent claudication.
Tea: A preparation of 40 milligrams of ginkgo extract in a teabag
has been used, but there are no reliable data to recommend a specific tea
Children (Younger Than 18): The dosing and safety of ginkgo have not
been studied thoroughly in children, and use of this herb is not recommended.
Seizures have been reported in children.
Although ginkgo has been suggested for many conditions, it has been most
studied as a treatment for peripheral vascular disease, dementia and
cerebrovascular insufficiency. Ginkgo has not been proven for any other health
condition. It should be avoided in pregnant or breast-feeding women and in
children. If you are considering using ginkgo but have diabetes or seizures
or are prone to bleeding disorders, you should discuss this with a health
care professional. Beneficial effects may not be seen until ginkgo is used
for four to six weeks. Consult a health care professional immediately if
you experience side effects.
The information in this monograph was prepared by the professional staff
at Natural Standard, based on thorough systematic review of scientific evidence.
The material was reviewed by the Faculty of the Harvard Medical School with
final editing approved by Natural Standard.
Standard: An organization that produces scientifically based reviews
of complementary and alternative medicine (CAM) topics
for Complementary and Alternative Medicine (NCCAM): A division of the
U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Ginkgo
Natural Standard reviewed more than 965 articles to prepare the professional
monograph from which this version was created.
Some of the more recent studies are listed below:
Allain H, Raoul P, Lieury A, et al. Effect of two doses of ginkgo biloba
extract (EGb 761) on the dual-coading test in elderly subjects. Clin Ther
Bal Dit Sollier C, Caplain H, Drouet L. No alteration in platelet function
or coagulation induced by EGb761 in a controlled study. Clin Lab Haematol
Bauer U. Ginkgo biloba extract in the treatment of arteriopathy of the lower
extremities: a 65-week trial. Presse Med 1986;15(313):1546-1549.
Benjamin J, Muir T, Briggs K, et al. A case of cerebral haemorrhage: can
Ginkgo biloba be implicated? Postgrad Med J 2001;77(904):112-113.
Burschka MA, Hassan HA, Reineke T, et al. Effect of treatment with Ginkgo
biloba extract EGb 761 (oral) on unilateral idiopathic sudden hearing loss
in a prospective randomized double-blind study of 106 outpatients. Eur Arch
Castelli D, Colin L, Camel E, at al. Pretreatment of skin with a Ginkgo biloba
extract/sodium carboxymethyl-btra-1,3-gluacn formulatin appears to inhibit
the elicitation of allergic contact dermatitis in man. Contact Dermatitis
Cesarani A, Meloni F, Alpini D, et al. Ginkgo biloba (EGb 761) in the treatment
of equilibrium disorders. Adv Ther 1998;15(5):291-304.
Chen HS, Zhai F, Chu YF, et al. Clinical study on treatment of patients with
upper digestive tract malignant tumors of middle and late stage with Ginkgo
biloba exocarp polysaccharides capsule preparation Zhong Xi Yi Jie He Xue
Bao 2003;Sep, 1(3):189-191.
Chen K, Zhou WQ, Gao P. Clinical study on the effect of shuxuening tablet
in treatment of coronary heart disease. Zhongguo Zhong Xi Yi Jie He Za Zhi
Cieza A, Maier P, Poppel E. Effects of Ginkgo biloba on mental functioning
in healthy volunteers. Arch Med Res 2003;34(5):373-381.
Davydov L, Stirling AL. Stevens-Johnson syndrome with Ginkgo biloba. J Herbal
Destro MW, Speranzini MB, Cavalheiro Filho C, et al. Bilateral haematoma
after rhytidoplasty and blepharoplasty following chronic use of Ginkgo biloba.
Br J Plast Surg 2005;Jan, 58(1):100-101.
Drabaek H, Petersen JR, Winberg N, et al. The effect of Ginkgo biloba extract
in patients with intermittent claudication. Ugeskr Laeger 1996;158(27):3928-3931.
Drew S, Davies E. Effectiveness of Ginkgo biloba in treating tinnitus: double
blind, placebo controlled trial. Br Med J 2001;322(7278):73.
Dubreuil C. Therapeutic trial in acute cochlear deafness: a comparative study
of Ginkgo biloba extract and nicergoline. Presse Med 1986;15(31):1559-1561.
Engelsen J, Nielsen JD, Hansen KF. Effect of Coenzyme Q10 and Ginkgo biloba
on warfarin dosage in patients on long-term warfarin treatment: a randomized,
double-blind, placebo-controlled cross-over trail. Ugeskr Laeger
Ernst E, Pittler MH. Ginkgo biloba for dementia: a systematic review of
double-blind, placebo-controlled trials. Clin Drug Invest 1999;17(4):301-308.
Evans JR. Ginkgo biloba extract for age-related macular degeneration. Cochrane
Database Syst Rev 2000;(2):CD001775.
Fies P, Dienel A. Ginkgo extract in impaired vision: treatment with special
extract EGb 761 of impaired vision due to dry senile macular degeneration.
Wien Med Wochenschr 2002;152(15-16):423-426.
Fraunfelder FW. Ocular side effects from herbal medicines and nutritional
supplements. Am J Ophthalmol 2004;Oct, 138(4):639-647.
Garg RK, Nag D, Agrawal A. A double blind placebo controlled trial of ginkgo
biloba extract in actue cerebral ischaemia. J Assoc Physicians India
Gertsch JH, Basnyat B, Johnson EW, et al. Randomised, double blind, placebo
controlled comparison of ginkgo biloba and acetazolamide for prevention of
acute mountain sickness among Himalayan trekkers: the prevention of high
altitude illness trial (PHAIT). Br Med J 2004;328(7443):797.
Gertsch JH, Seto TB, Mor J, et al. Ginkgo biloba for the prevention of sever
acute mountain sickness (AMS) starting one day before rapid ascent. High
Alt Med Biol 2002;3(1):29-37.
Grassel E. Effect of Ginkgo-biloba extract on mental performance: double-blind
study using computerized measurement conditions in patients with cerebral
insufficiency. Fortschr Med 1992;110(5):73-76.
Haguenauer JP, Cantenot F, Koskas H, et al. Treatment of equilibrium disorders
with Ginkgo biloba extract: a multicenter double-blind drug vs. placebo study.
Presse Med 1986;15(31):1569-1572.
Haller CA, Meier KH, Olson KR. Seizures reported in association with use
of dietary supplements. Clin Toxicol (Phila) 2005;43(1):23-30.
Hartley DE, Elsabagh S, File SE. 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. Nutr Neurosci 2004;Oct-Dec, 7(5-6):325-333.
Hauns B, Haring B, Kohler S, et al. Phase II study of combined
5-fluorouracil/Ginkgo biloba extract (GBE 761 ONC) therapy in 5-fluorouracil
pretreated patients with advanced colorectal cancer. Phytother Res
Hauns B, Haring B, Kohler S, et al. Phase II study with 5-fluorouracil and
ginkgo biloba extract (GBE 761 ONC) in patients with pancreatic cancer.
Hemmeter U, Annen B, Bischof R, et al. Polysomnographic effects of adjuvant
ginkgo biloba therapy in patients with major depression medicated with
trimipramine. Pharmacopsychiatry 2001;34(2):59.
Hep A, Robek O, Skricka T. Treatment of hemorrhoids from the viewpoint of
the gastroenterologist: personal experience with the Ginkor Fort preparation.
Vnitr Lek 2000;46(5):282-285.
Hilton M, Stuart E. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev
Ho LJ, Lai JH. Chinese herbs as immunomodulators and potential disease-modifying
antirheumatic drugs in autoimmune disorders. Curr Drug Metab 2004;Apr,
Hoffmann F, Beck C, Schutz A, et al. Ginkgo extract EGb 761 (tenobin)/HAES
versus naftidrofuryl (Dusodril)/HAES. A randomized study of therapy of sudden
deafness. Laryngorhinootologie 1994;73(3):149-152.
Horsch S, Walther C. Ginkgo biloba special extract EGb 761 in the treatment
of peripheral arterial occlusive disease (PAOD): a review based on randomized,
controlled studies. Int J Clin Pharmacol Ther 2004;Feb, 42(2):63-72.
Ito TY, Trant AS, Polan ML. A double-blind placebo-controlled study of ArginMax,
a nutritional supplement for enhancement of female sexual function. J Sex
Marital Ther 2001;27(5):541-549.
Ivaniv OP. The results of using different forms of a Ginkgo biloba extract
(EGb 761) in the combined treatment of patients with circulatory encephalopathy.
Lik Sprava 1998;(8):123-128.
Jacoby D, Mohler ER 3rd. Drug treatment of intermittent claudication. Drugs
Janssens D, Michiels C, Guillaume G, et al. Increase in circulating endothelial
cells in patients with primary chronic venous insufficiency: protective effect
of Ginkor Fort in a randomized double-blind, placebo-controlled clinical
trial. J Cardiovasc Pharmacol 1999;33(1):7-11.
Jezova D, Duncko R, Lassanova M, et al. Reduction of rise in blood pressure
and cortisol release during stress by Ginkgo biloba extract (EGb 761) in
healthy volunteers. J Physiol Pharmacol 2002;53(3):337-348.
Kalus JS, Piotrowski AA, Fortier CR, et al. Hemodynamic and electrocardiographic
effects of short-term Ginkgo biloba. Ann Pharmacother 2003;37(3):345-349.
Kampman K, Majewska MD, Tourian K, et al. A pilot trial of piracetam and
ginkgo biloba for the treatment of cocaine dependence. Addict Behav
Kang BJ, Lee SJ, Kim MD, et al. A placebo-controlled, double-blind trial
of Ginkgo biloba for antidepressant-induced sexual dysfunction. Hum
Kanowski S, Herrmann WM, Stephan K, et al. Proof of efficacy of the ginkgo
biloba special extract EGb 761 in outpatients suffering from mild to moderate
primary degenerative dementia of the Alzheimer type or muti-infarct dementia.
Keltner NL, Zielinski AL, Hardin MS. Drugs used for cognitive symptoms of
Alzheimer's disease. Perspect Psychiatr Care 2001;Jan-Mar, 37(1):31-34.
Kennedy DO, Scholey AB, Wesnes KA. The dose-dependent cognitive effects of
acute administration of Ginkgo biloba to healthy young volunteers.
Psychopharmacology (Berl) 2000;151(4):416-423.
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. Blood Coagul
Fibrinolysis 2004;Jun, 15(4):303-309.
Kurz A, Van Baelen B. Ginkgo biloba compared with cholinesterase inhibitors
in the treatment of dementia: a review based on meta-analyses by the cochrane
collaboration. Dement Geriatr Cogn Disord 2004;18(2):217-226. Epub 2004;Jun
Lanthony P, Cosson JP. The course of color vision in early diabetic retinopathy
treated with Ginkgo biloba extract: a preliminary double-blind versus placebo
study. J Fr Ophtalmol 1988;11(10):671-674.
Le Bars PL, Velasco FM, Ferguson JM, et al. Influence of the severity of
cognitive impairment on the effect of the Ginkgo biloba extract EGb 761 in
Alzheimers disease. Neuropsychobiology 2002;45(1):19-26.
Le Bars PL, Katz MM, Berman N, et al. A placebo-controlled, double-blind,
randomized trial of an extract of Ginkgo biloba for dementia: North American
EGb Study Group. JAMA 1997;278(16):1327-1332.
Le Bars PL, Kieser M, Itil KZ. A 26-week analysis of a double-blind,
placebo-controlled trial of the Ginkgo biloba extract EGb 761 in dementia.
Dement Geriatr Cogn Disord 2000;11(4):230-237.
Lebuisson DA, Leroy L, Rigal G. Treatment of senile macular degeneration
with Ginkgo biloba extract: a preliminary double-blind drug vs. placebo study.
Presse Med 1986;15(31):1556-1558.
Li MH, Liu YH, Yang BY. Clinical observation on treatment of asthma in moderate
degree with fluticasone inhalation combined with jinacon. Zhongguo Zhong
Xi Yi Jie He Za Zhi 2001;21(11):819-821.
Li MH, Liu YH, Yang BY. Effects of ginkgo leave concentrated oral liquor
in treating asthma. Zhong Xi Yi Jie He Za Zhi 1997;17(4):216-218.
Lingaerde O, Foreland AR, Magnusson A. Can winter depression be prevented
by Ginkgo biloba extract? A placebo-controlled trial. Acgta Psychiatr Scand
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herbs sold as a remedy for cellulite. Phytother Res 1999;13(7):627-629.
Lister RE. An open, pilot study to evaluate the potential benefits of coenzyme
Q10 combined with Ginkgo biloba extract in fibromyalgia syndrome. J Inte
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on memory in healthy male volunteers. Physiol Behav 2001;73(4):659-665.
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limited, slowly spreading vitiligo. Clin Exp Dermatol 2003;28(3):285-287.
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Last updated July 11, 2005