Ginkgo biloba
Ginkgo Biloba has been used in alternative medicine as a possibly effective aid in improving mental function or treating anxiety, dementia, leg pain caused by blood circulation problems, premenstrual symptoms, vision problems caused by glaucoma or diabetes, vertigo (dizziness), or a movement disorder (tardive dyskinesia) caused by taking certain antipsychotic drugs.
Mechanism of effect
Ginkgoflavone glycosides: reduce capillary fragility, act as antioxidants
Ginkgolides: inhib. platelet activating factor
Documented incr in cerbral blood flow (greater effect in patients >50 years old)
Documented increase in peripheral blood flow in diabetes, intermittent claudication, hearing loss
Studies underway for SSRI-induced erectile dysfunction; initial results positive
Pharmacodynamic
The mechanism by which ginkgo biloba is thought to be effective for these conditions appears to be in part through active "ginkgolides" terpenoids and flavinoids that appear to inhibit platelet aggregation, neutrophil degranulation, and the induction of oxygen-free radical production
Pharmacokinetics
Not Available
Drug indications
vertigo , memory loss , glaucoma , Premenstrual Dysphoric Disorder , Dementia , cerebrovascular disorders , age-related macular degenerationAltitude sickness (prevention), cerebral vascular insufficiency, cognitive disorders, dementia, dizziness/vertigo, intermittent claudication, macular degeneration/glaucoma, memory loss, premenstrual syndrome, SSRI-induced sexual dysfunction, vasodilator
Dosage
Altitude Sickness, Prevention
Leaf extract: 80 mg PO BID
Cognitive Function
Leaf extract: 120-600 mg/d PO BID
Dementia
Leaf extract: 120-240 mg/d PO div BID-TID
Intermittent Claudication
Leaf extract: 120-240 mg/d PO div BID-TID
Premenstrual Syndrome
Leaf extract: 80 mg PO BID; start on day 16 and continue until day 5 of next cycle
SSRI-induced Sexual Dysfunction
Leaf extract: 60-240 mg PO BID
Vertigo/tinnitus
Leaf extract: 120-160 mg/d PO div BID-TID
Raynaud's Disease
Leaf extract: 360 mg/d PO div TID
Normal Tension Glaucoma
Leaf extract: 40 mg PO TID x 4 weeksDrug contraindications
surgery , Hypersensitivity to this drugHypersensitivity
Avoid prior to surgery: may cause bleeding
Attempting conceptionSide effects
Diarrhea , Headache , Seizures , vertigo , palpitations , Restlessness , allergic reactionsAllergic skin reactions
Bleeding disorders
Constipation
Contact dermatitis (topical use)
Diarrhea
Dizziness
Impaired fertility
GI upset
Headache
Nausea/vomiting
Palpitations
Restlessness
Seizures
Subdural hematoma
Weakness
Vertigo (rare)
Case reports of sponataneous bleeding from iris when used with aspirin
Interactions
Alteplase , Eptifibatide , Enoxaparin , Ibuprofen , Indomethacin , Prasugrel , Meclofenamate , Nabumetone , Oxaprozin , etodolac , fondaparinux , Forskolin , Flibanserin , Tenecteplase , Bemiparin , Cordyceps , Lornoxicam , Antithrombin III , feverfew , horse chestnut seed , mistletoe , Antithrombin alfa , Reteplase , Dalteparin , Aceclofenac , Celecoxib , Acemetacin , Sulindac , Agrimony , fenoprofen , fenbufen , Salsalate , Diflunisal , Tolfenamic Acid , Parecoxib , Abciximab , Epoprostenol , flurbiprofen , Anagrelide , Green tea , Ketoprofen , Dabigatran , Lomitapide , Phenindione , Bivalirudin , Argatroban , Tirofiban , Heparin , Warfarin , Vitamin K1 , Ketorolac , Clopidogrel , Aspirin , Diclofenac , Sulfasalazine , Garlic , Cilostazol , Mefenamic acid , Meloxicam , Protamine sulfat , Piroxicam , Tolmetin , Ticlopidine , Cinnamon , DipyridamoleAceclofenac-acemetacin-agrimony-alfalfa-alteplase-American ginseng-antithrombin alfa-antithrombin III-argatroban-aspirin-aspirin rectal-aspirin/citric acid/sodium bicarbonate-bemiparin-bivalirudin-celecoxib-choline magnesium trisalicylate-cinnamon-cordyceps-dabigatran-dalteparin-diclofenac-diflunisal-dong quai-enoxaparin-epoprostenol-etodolac-fenbufen-fennel-fenoprofen-feverfew-flibanserin-flurbiprofen-fondaparinux-forskolin-garlic-ginger-heparin-horse chestnut seed-ibuprofen-ibuprofen IV-indomethacin-ketoprofen-ketorolac-ketorolac intranasal-lomitapide-lornoxicam-meclofenamate-mefenamic acid-meloxicam-mistletoe-nabumetone-naproxen-nettle-oxaprozin-panax ginseng-parecoxib-pau d'arco-phenindione-phytoestrogens-piroxicam-protamine-reishi-reteplase-salicylates (non-asa)-salsalate-Siberian ginseng-sulfasalazine-sulindac-tenecteplase-tolfenamic acid-tolmetin-vitamin K1 (phytonadione)-warfarin-abciximab-anagrelide-anamu-cilostazol-clopidogrel-danshen-devil's claw-dipyridamole-eptifibatide-green tea-prasugrel-ticlopidine-tirofiban
Alerts
Bleeding disorders, concurrent seizure threshold lowering drugs, diabetes mellitus, seizure disorder
seeds & fruit pulp are toxic
May modulate some CYP 450 enzymes but clinical significance unknown, monitor when using concomitant substrates (eg, CYP3A4)
Points of recommendation
Do not use different forms (leaf extract, roasted seeds, tablets, tincture, teas, etc) of Ginkgo Biloba at the same time without medical advice. Using different formulations together increases the risk of an overdose.
Ginkgo Biloba can affect blood-clotting and may increase your risk of bleeding. If you need surgery, dental work, or a medical procedure, stop taking Ginkgo Biloba at least 2 weeks ahead of time.
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