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Ginkgo Biloba

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Last Update: October 3, 2019.

Indications

There is no FDA approved indication, and there is insufficient evidence to support non-FDA approved use of Ginkgo biloba. 

Dementia/ Cognitive Impairment:

In terms of treatment for existing dementia, data has been contradictory regarding the efficacy of Ginkgo biloba extract (EGb). A 52-week, randomized, double-blind, placebo-controlled, parallel-group, multicenter study of 309 patients in 1997 concluded that EGb was safe and though modestly, it appeared to stabilize and improve the cognitive performance as well as social functioning of dementia patients for six months to 1 year.[1] Similarly, another 24-week randomized controlled trial with 410 outpatients found that treatment with EGb 761 using a once-daily dose of 240 mg was safe and demonstrated a statistically significant improvement in cognition, psychopathology, functional status and quality of life of patients and caregivers.[2] On the other hand, a randomized control trial of 513 outpatients with mild to moderate dementia of the Alzheimer type did not support the efficacy of Ginkgo extract.[3] A systematic review of 36 trials in 2009 and another review of 38 trials in 2018, though demonstrated that Ginkgo biloba was relatively safe, but did not support its clinical benefit for patients with cognitive impairment and dementia.[4][5] Conversely, a 2015 systematic review of 9 trials concluded that EGb761 at 240 mg/day was able to decelerate decline in cognition, function, behavior, and global change at 22 to 26 weeks in patients with dementia, especially for those with neuropsychiatric symptoms.[6] A 2017 study of 12 systematic reviews also suggested that at doses greater than 200mg/day for at least five months, EGb had potentially beneficial effects for patients with dementia.[7]    

In terms of preventing dementia, there is also insufficient evidence to support the use of ginkgo. The Ginkgo Evaluation of Memory (GEM) Study showed that Ginkgo biloba at 120 mg twice a day was not effective in reducing both all-cause dementia incidence and Alzheimer dementia incidence in elderly patients with normal cognition or with mild cognitive impairment.[8] Similarly, the GuidAge clinical trial conducted in patients aged 70 years or older who spontaneously reported memory complaints to their primary care physician in France. This trial randomized patients with either 120 mg standardized Ginkgo biloba extract or matching placebo and did not support the benefit of long-term use of standardized EGb in reducing the risk of progression to Alzheimer disease throughout five years.[9] A meta-analysis of two trials involving 5889 participants showed no significant difference in the rate of developing dementia between Ginkgo biloba and the placebo in late-life.[10] A 2012 meta-analysis did not find support for the use of Ginkgo biloba in enhancing cognitive function in healthy adults.[11]  

Cardiovascular disease (CVD)/ Cardiovascular Risk Factors Reduction 

Effects of Ginkgo on cardiovascular disease and risk factors, including hypertension and diabetes, have been the topic of many studies, though there has been a lack of large evidence-based, well-designed randomized controlled trials/studies to support its use in treating or preventing the incidence of cardiovascular disease. Though Ginkgo biloba extract has often been an option in the treatment of acute ischemic stroke in China, a systemic review in 2005 did not show the benefit of improving mortality or neurological recovery in the post-stroke period.[12] On the other hand, a randomized, open-label, blinded, controlled clinical trial in 2018 suggested that Ginkgo, in combination with aspirin treatment lessened cognitive and neurological impairment after acute ischemic stroke without increasing the incidence of vascular events.[13] A small randomized controlled trial of eighty patients with coronary artery disease showed that the use of EGb correlated with an increase in blood flow of left anterior descending coronary artery as measured by Doppler echocardiography as well as an increase in nitric oxide and a decrease in endothelin-1 level.[14]

A randomized controlled trial in 2010 that monitor CVD as a preplanned secondary outcome of the GEM study showed no evidence that Ginkgo reduced CV mortality or CVD events though it reported a smaller number of peripheral vascular disease events in Ginkgo arm.[15] A systemic review, however, suggested that that Ginkgo biloba had no statistical or clinically significant benefit for patients with peripheral arterial disease.[16] Data from the GEM study also demonstrated that EGb did not reduce blood pressure or the incidence of hypertension in elderly patients with a mean age of 79 years old.[17] Ginkgo biloba has also been shown to decrease plasma lipoprotein(a) level - a known risk factor for atherosclerotic diseases.[18] A small randomized controlled trial in 2018 showed that adjunct use of EGb along with metformin was more effective than metformin alone in improving outcomes in patients with type 2 diabetes mellitus as measured by blood HbA1c, fasting glucose, insulin level, BMI, waist circumference and visceral adiposity index without negatively affecting the liver, kidney, or hematopoietic functions.[19] 

Overall, due to the lack of strong evidence, the use of Ginkgo biloba extract is not indicated at this point for treatment or prevention of CVD. 

Psychiatric disorders: 

Studies have examined the role of Ginkgo biloba in treating depression and other psychiatric disorders. A small randomized controlled trial with 136 subjects suggested that EGb, as an adjunctive treatment along with citalopram, could improve depressive symptoms and cognitive function as measured by Hamilton Depression Rating Scale (HAMD) and Wisconsin Card Classification Test (WCST), respectively; it was also shown to decrease the expression of serum S100B, a marker of brain injury.[20] A randomized controlled trial of 157 patients with DSM-IV-diagnosed schizophrenia and tardive dyskinesia (TD) suggested EGb could help reduce the symptoms of TD.[21] A meta-analysis of four trials involving 1628 patients showed treatment with EGb improved behavioral and psychological symptoms of dementia and also caregiver distress associated with such symptoms.[22]    

Sexual Dysfunction

Many small studies have explored the role of EGb in treating sexual dysfunction. A triple-blind, placebo-controlled trial of 24 patients with sexual dysfunction due to antidepressant drugs showed no statistically significant differences in responses and side-effect profiles between the EGb group and the placebo group.[23] A randomized control trial of 108 patients showed that a nutritional supplement containing L-arginine, ginseng, ginkgo, damiana, multivitamins, and minerals, helped increase the level of sexual desire in premenopausal, perimenopausal, and postmenopausal women compared to placebo.[24] 

Vertigo

A multicenter double-blinded randomized control trial that followed 70 patients throughout 3 months showed that Ginkgo biloba extract could reduce the intensity, frequency, and duration of vertiginous syndrome compared (47% in the EGb group compared to 18% in the placebo group).[25] Another randomized controlled trial in 2014 showed that there was no statistically significant difference in vertigo treatment outcomes between Ginkgo biloba versus betahistine group though EGb had a better tolerance profile.[26] Again due to the lack of strength of the evidence, more studies are needed to establish the efficacy of Ginkgo biloba in treating vertigo.     

Tinnitus 

A Cochrane review in 2013, which included four trials with a total of 1543 participants, demonstrated that there was no evidence that Gingko biloba was effective in patients with a primary complaint of tinnitus.[27] Similarly, a 2018 study that extracted data from systematic reviews concluded the use of Ginkgo biloba did not alleviate the severity of tinnitus or improve the quality of life of patients.[28] 

Vitiligo 

A double-blind placebo-controlled trial of 52 vitiligo patients showed that treatment with Ginkgo biloba correlated with a statistically significant cessation of active progression of depigmentation.[29] Despite such a promising result, more studies are warranted to validate Ginkgo's role as a potential therapy of choice for vitiligo.   

Macular Degeneration

A 2012 systematic review identified one study of 20 patients with macular degeneration conducted in France, randomly allocated to Gingko Biloba extract EGb 761 80 mg twice daily or placebo and another study of 99 patients performed in Germany randomly allocated to two different doses of Ginkgo biloba extract EGb 761 (240 mg per day and 60 mg per day). Researchers followed the patients for six months in both trials. Their results could not be pooled, but both experiments demonstrated some beneficial effects of Ginkgo biloba on vision.[30]   

Glaucoma

A 2019 systematic review suggested that flavonoids, often found in Ginkgo biloba, had a beneficial effect in glaucoma, particularly in terms of increasing ocular blood flow and potentially halting the progression of visual field loss.[31] More quality research is warranted to determine the role of Gingko biloba in treating glaucoma.  

Altitude Sickness

The Prevention of High Altitude Illness Trial (PHAIT) that followed 614 healthy western trekkers showed that ginkgo was not effective at preventing acute mountain sickness when compared to placebo.[32] Besides, a 2017 systematic review demonstrated that Ginkgo biloba alone, neither used alone or as an adjunct to acetazolamide, was beneficial for altitude sickness.[33]

Mechanism of Action

Ginkgo biloba has two primary active ingredients at varying concentrations: terpene lactones (which most notably include ginkgolides and diterpenes) and ginkgo flavone glycosides (which most notably contain ginkgetin, bilobetin, and sciadopitysin).[34] Most of the studies that investigate the effect of ginkgo extract often use the standardized extract of Ginkgo biloba (EGb) 761. 

Ginkgo biloba extract has been shown to affect several neurotransmitter pathways and brain structures, mostly in animal studies. EGb761 limits stress-induced corticosterone hypersecretion by reducing the number of adrenal peripheral benzodiazepine receptors in rats.[35] Ginkgo extract is thought to have reversible inhibitory effects on rat brain monoamine oxidase by inhibiting the uptake of serotonin and dopamine.[36][37] EGb761 also has modest inhibitory activities on anticholinesterase, hence increasing cholinergic transmission in the brain.[38]

Several studies have suggested the neuroprotective effects of Ginkgo biloba extract. Long-term use of EGb761 appears to improve the short-term memory of middle-aged rats likely by reducing free radical production in the prefrontal cortex.[39] It also protects against age-related changes in the mouse hippocampus.[40] Additionally, Gingko biloba extract acts as a free radical scavenger and protects neurons from oxidative damage and apoptosis, which have been observed prominently in cerebral ischemia and Alzheimer disease.[41][42][43]   

The effects of Ginkgo on the cardiovascular system are widely studied and mostly observed as protective. Ginkgo's role includes a regulator of metabolism, membrane stabilizer, and vasodilator.[44] In the arterial endothelium, Ginkgo biloba extract triggers the release of endogenous relaxing factors, such as endothelium-derived relaxing factor and prostacyclin.[45] Under tissue-damaging inflammatory conditions such as ischemia, it can also moderate nitric oxide production and exert vasorelaxation properties.[46][47] Also, terpene lactones are potent antagonists of the platelet-activating factor.[48] Ginkgo extract also demonstrates fibrinolytic effects.[49] 

Administration

Ginkgo biloba extract administration is via the oral route. Most ginkgo extract is in the form of EGb 761. EGb 761 is standardized to include 6% terpenoids and 24% flavonoid glycosides.[50] Standard dosages of EGb 761 used in most studies and recommended by manufacturers are 40 mg three times per day, or 80 mg twice daily.

Adverse Effects

In general, Ginkgo biloba is safe and well-tolerated. The maximum recommended dose for ginkgo extract is 240 mg/day.[51] Mild adverse effects include headache, heart palpitations, gastrointestinal upset, constipation, allergic skin reactions.[34]

Though a systematic review and meta-analysis found no significant effect of Ginkgo on prothrombin time, activated partial thromboplastin time, and platelet aggregation, there had been several case reports that described a temporal association between using ginkgo and a bleeding event including severe intracranial bleeding.[52][53]

Contraindications

Use of ginkgo in patients with bleeding disorders or those who take nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet, or anticoagulant therapies requires caution. A case report described spontaneous bleeding from the iris into the anterior chamber of the eye in an elderly patient who took both aspirin and ginkgo.[54] A 2015 study in Large Veterans Administration Population demonstrated that coadministration of warfarin and gingko correlated with an increase in the risk of a bleeding event.[55]

There has been insufficient evidence about the perioperative risk of gingko use. One study recommended physicians to discontinue ginkgo at least 36 hours before a planned surgical procedure.[56]

There has been no existing data on the safety and efficacy of ginkgo in pregnant women, nursing mothers, or infants, so recommendations are against ginkgo use in these populations.[34]    

In epileptic patients or in patients who are prone to seizure, physicians should also be cautious with the administration of ginkgo as ginkgo toxin, mostly found in ginkgo seeds but still present in ginkgo leaves, could lower the seizure threshold.[57][58]

Monitoring

It is worth noting that dietary supplements such as Ginkgo biloba do not require extensive pre-marketing approval from the U.S. Food and Drug Administration, and on multiple occasions, nutritional supplements may contain several ingredients, and a discrepancy between labeled and actual ingredients or their amounts may occur. So physicians should be cautious regarding the safety or effectiveness of a dietary supplement.

Research has noted several interactions between Ginkgo biloba and other medications, as well as other dietary supplements.

EGb doses higher than the recommended ones may lead to a weak induction of the CYP2C19-mediated omeprazole 5-hydroxylation, and weak inhibition of the CYP3A4-mediated midazolam 1'-hydroxylation through the clinical implications of such findings are unclear. Overall, as long as the maximum consumption of EGb 761 does not exceed 240 mg daily, pharmacokinetic herb-drug interactions are at an acceptable limit.[51]

As discussed above, physicians should be aware of the increased risk of bleeding when Ginkgo biloba was co-administered with other agents that have potential to increase bleeding (NSAIDs, antiplatelet, anticoagulant therapies, garlic, ginger, ginseng, etc.)   

Due to its properties as monoamine oxidase inhibitors,[36] ginkgo can precipitate serotonin syndrome in patients that are on other antidepressant medications.  

Also, ginkgo has an elevating effect on blood sugar, so if patients have diabetes and take ginkgo, closely monitoring of blood glucose levels is recommended.[59] 

Toxicity

Raw ginkgo seeds contain potentially toxic cyanogenic glycosides.[34] Contact or ingestion of ginkgo's seed can be poisonous. It can cause a serious allergic skin reaction such as acute generalized exanthematous pustulosis and also convulsions.[60][61] As discussed in this review, bleeding, seizure, serotonin syndrome could be potential consequences of ginkgo toxicity. There is no antidote for ginkgo. Treatment includes discontinuation of ginkgo and appropriate symptom control depending on the manifestation of each toxication case. 

Enhancing Healthcare Team Outcomes

Ginkgo is one of the most common dietary supplements used in the United States. Healthcare providers often overlook inquiry about the use of herbal medicine. Due to Ginkgo's several side effects and extensive interactions with other medications, it is important to educate the healthcare team (nurse practitioner, pharmacist, primary care provider, nursing staff) to incorporate the habit of asking patients about over-the-counter supplements and keep toxicity/interactions of these supplements with patient's other medications as potential causes of patient's presentation in their differentials. Patients should be educated by the team, including the clinician, nurse, and pharmacist about the possible side effects and interactions of Ginkgo and encouraged to disclose such information with their healthcare providers. The pharmacist should also review their medication profile and caution if there are any possible interactions, alerting the patient's clinician and/or nurse as well. Such an interprofessional healthcare team approach to ginkgo or any supplement can contribute to optimal patient outcomes if all providers are involved and communicating a consistent message. (Level V]

Questions

To access free multiple choice questions on this topic, click here.

References

1.
Braquet P, Hosford D. Ethnopharmacology and the development of natural PAF antagonists as therapeutic agents. J Ethnopharmacol. 1991 Apr;32(1-3):135-9. [PubMed: 1881152]
2.
Drugs and Lactation Database (LactMed) [Internet]. National Library of Medicine (US); Bethesda (MD): 2006. Ginkgo. [PubMed: 30000868]
3.
Marcilhac A, Dakine N, Bourhim N, Guillaume V, Grino M, Drieu K, Oliver C. Effect of chronic administration of Ginkgo biloba extract or Ginkgolide on the hypothalamic-pituitary-adrenal axis in the rat. Life Sci. 1998;62(25):2329-40. [PubMed: 9651122]
4.
White HL, Scates PW, Cooper BR. Extracts of Ginkgo biloba leaves inhibit monoamine oxidase. Life Sci. 1996;58(16):1315-21. [PubMed: 8614288]
5.
Rojas P, Rojas C, Ebadi M, Montes S, Monroy-Noyola A, Serrano-García N. EGb761 pretreatment reduces monoamine oxidase activity in mouse corpus striatum during 1-methyl-4-phenylpyridinium neurotoxicity. Neurochem. Res. 2004 Jul;29(7):1417-23. [PubMed: 15202774]
6.
Zhang L, Li D, Cao F, Xiao W, Zhao L, Ding G, Wang ZZ. Identification of Human Acetylcholinesterase Inhibitors from the Constituents of EGb761 by Modeling Docking and Molecular Dynamics Simulations. Comb. Chem. High Throughput Screen. 2018;21(1):41-49. [PubMed: 29173156]
7.
Ribeiro ML, Moreira LM, Arçari DP, Dos Santos LF, Marques AC, Pedrazzoli J, Cerutti SM. Protective effects of chronic treatment with a standardized extract of Ginkgo biloba L. in the prefrontal cortex and dorsal hippocampus of middle-aged rats. Behav. Brain Res. 2016 Oct 15;313:144-150. [PubMed: 27424157]
8.
Barkats M, Venault P, Christen Y, Cohen-Salmon C. Effect of long-term treatment with EGb 761 on age-dependent structural changes in the hippocampi of three inbred mouse strains. Life Sci. 1995;56(4):213-22. [PubMed: 7823780]
9.
Liu Q, Jin Z, Xu Z, Yang H, Li L, Li G, Li F, Gu S, Zong S, Zhou J, Cao L, Wang Z, Xiao W. Antioxidant effects of ginkgolides and bilobalide against cerebral ischemia injury by activating the Akt/Nrf2 pathway in vitro and in vivo. Cell Stress Chaperones. 2019 Mar;24(2):441-452. [PMC free article: PMC6439064] [PubMed: 30815818]
10.
Islam BU, Jabir NR, Tabrez S. The role of mitochondrial defects and oxidative stress in Alzheimer's disease. J Drug Target. 2019 Nov;27(9):932-942. [PubMed: 30775938]
11.
Li W, Qinghai S, Kai L, Xue M, Lili N, Jihua R, Zhengxiang L, Xiaoling L, Di G, Qi Y, Mengyun D, Jianfeng F. Oral administration of Ginkgolide B alleviates hypoxia-induced neuronal damage in rat hippocampus by inhibiting oxidative stress and apoptosis. Iran J Basic Med Sci. 2019 Feb;22(2):140-145. [PMC free article: PMC6396993] [PubMed: 30834078]
12.
Tian J, Liu Y, Chen K. Ginkgo biloba Extract in Vascular Protection: Molecular Mechanisms and Clinical Applications. Curr Vasc Pharmacol. 2017;15(6):532-548. [PubMed: 28707602]
13.
Auguet M, Delaflotte S, Hellegouarch A, Clostre F. [Pharmacological bases of the vascular impact of Ginkgo biloba extract]. Presse Med. 1986 Sep 25;15(31):1524-8. [PubMed: 2947093]
14.
Shen J, Wang J, Zhao B, Hou J, Gao T, Xin W. Effects of EGb 761 on nitric oxide and oxygen free radicals, myocardial damage and arrhythmia in ischemia-reperfusion injury in vivo. Biochim. Biophys. Acta. 1998 Apr 28;1406(3):228-36. [PubMed: 9630646]
15.
Li Q, Ye T, Long T, Peng X. Ginkgetin exerts anti-inflammatory effects on cerebral ischemia/reperfusion-induced injury in a rat model via the TLR4/NF-κB signaling pathway. Biosci. Biotechnol. Biochem. 2019 Apr;83(4):675-683. [PubMed: 30570395]
16.
Naderi GA, Asgary S, Jafarian A, Askari N, Behagh A, Aghdam RH. Fibrinolytic effects of Ginkgo biloba extract. Exp Clin Cardiol. 2005 Summer;10(2):85-7. [PMC free article: PMC2716226] [PubMed: 19641664]
17.
Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group. JAMA. 1997 Oct 22-29;278(16):1327-32. [PubMed: 9343463]
18.
Herrschaft H, Nacu A, Likhachev S, Sholomov I, Hoerr R, Schlaefke S. Ginkgo biloba extract EGb 761® in dementia with neuropsychiatric features: a randomised, placebo-controlled trial to confirm the efficacy and safety of a daily dose of 240 mg. J Psychiatr Res. 2012 Jun;46(6):716-23. [PubMed: 22459264]
19.
Schneider LS, DeKosky ST, Farlow MR, Tariot PN, Hoerr R, Kieser M. A randomized, double-blind, placebo-controlled trial of two doses of Ginkgo biloba extract in dementia of the Alzheimer's type. Curr Alzheimer Res. 2005 Dec;2(5):541-51. [PubMed: 16375657]
20.
Vellas B, Coley N, Ousset PJ, Berrut G, Dartigues JF, Dubois B, Grandjean H, Pasquier F, Piette F, Robert P, Touchon J, Garnier P, Mathiex-Fortunet H, Andrieu S., GuidAge Study Group. Long-term use of standardised Ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): a randomised placebo-controlled trial. Lancet Neurol. 2012 Oct;11(10):851-9. [PubMed: 22959217]
21.
Charemboon T, Jaisin K. Ginkgo biloba for prevention of dementia: a systematic review and meta-analysis. J Med Assoc Thai. 2015 May;98(5):508-13. [PubMed: 26058281]
22.
Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev. 2009 Jan 21;(1):CD003120. [PubMed: 19160216]
23.
DeKosky ST, Williamson JD, Fitzpatrick AL, Kronmal RA, Ives DG, Saxton JA, Lopez OL, Burke G, Carlson MC, Fried LP, Kuller LH, Robbins JA, Tracy RP, Woolard NF, Dunn L, Snitz BE, Nahin RL, Furberg CD., Ginkgo Evaluation of Memory (GEM) Study Investigators. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA. 2008 Nov 19;300(19):2253-62. [PMC free article: PMC2823569] [PubMed: 19017911]
24.
Butler M, Nelson VA, Davila H, Ratner E, Fink HA, Hemmy LS, McCarten JR, Barclay TR, Brasure M, Kane RL. Over-the-Counter Supplement Interventions to Prevent Cognitive Decline, Mild Cognitive Impairment, and Clinical Alzheimer-Type Dementia: A Systematic Review. Ann. Intern. Med. 2018 Jan 02;168(1):52-62. [PubMed: 29255909]
25.
Yuan Q, Wang CW, Shi J, Lin ZX. Effects of Ginkgo biloba on dementia: An overview of systematic reviews. J Ethnopharmacol. 2017 Jan 04;195:1-9. [PubMed: 27940086]
26.
Tan MS, Yu JT, Tan CC, Wang HF, Meng XF, Wang C, Jiang T, Zhu XC, Tan L. Efficacy and adverse effects of ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis. J. Alzheimers Dis. 2015;43(2):589-603. [PubMed: 25114079]
27.
Laws KR, Sweetnam H, Kondel TK. Is Ginkgo biloba a cognitive enhancer in healthy individuals? A meta-analysis. Hum Psychopharmacol. 2012 Nov;27(6):527-33. [PubMed: 23001963]
28.
Zeng X, Liu M, Yang Y, Li Y, Asplund K. Ginkgo biloba for acute ischaemic stroke. Cochrane Database Syst Rev. 2005 Oct 19;(4):CD003691. [PubMed: 16235335]
29.
Li S, Zhang X, Fang Q, Zhou J, Zhang M, Wang H, Chen Y, Xu B, Wu Y, Qian L, Xu Y. Ginkgo biloba extract improved cognitive and neurological functions of acute ischaemic stroke: a randomised controlled trial. Stroke Vasc Neurol. 2017 Dec;2(4):189-197. [PMC free article: PMC5829919] [PubMed: 29507779]
30.
Wu YZ, Li SQ, Zu XG, Du J, Wang FF. Ginkgo biloba extract improves coronary artery circulation in patients with coronary artery disease: contribution of plasma nitric oxide and endothelin-1. Phytother Res. 2008 Jun;22(6):734-9. [PubMed: 18446847]
31.
Kuller LH, Ives DG, Fitzpatrick AL, Carlson MC, Mercado C, Lopez OL, Burke GL, Furberg CD, DeKosky ST., Ginkgo Evaluation of Memory Study Investigators. Does Ginkgo biloba reduce the risk of cardiovascular events? Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):41-7. [PMC free article: PMC2858335] [PubMed: 20123670]
32.
Nicolaï SP, Kruidenier LM, Bendermacher BL, Prins MH, Stokmans RA, Broos PP, Teijink JA. Ginkgo biloba for intermittent claudication. Cochrane Database Syst Rev. 2013 Jun 06;(6):CD006888. [PubMed: 23744597]
33.
Brinkley TE, Lovato JF, Arnold AM, Furberg CD, Kuller LH, Burke GL, Nahin RL, Lopez OL, Yasar S, Williamson JD., Ginkgo Evaluation of Memory (GEM) Study Investigators. Effect of Ginkgo biloba on blood pressure and incidence of hypertension in elderly men and women. Am. J. Hypertens. 2010 May;23(5):528-33. [PMC free article: PMC2989407] [PubMed: 20168306]
34.
Momtazi-Borojeni AA, Katsiki N, Pirro M, Banach M, Rasadi KA, Sahebkar A. Dietary natural products as emerging lipoprotein(a)-lowering agents. J. Cell. Physiol. 2019 Aug;234(8):12581-12594. [PubMed: 30637725]
35.
Aziz TA, Hussain SA, Mahwi TO, Ahmed ZA, Rahman HS, Rasedee A. The efficacy and safety of Ginkgo biloba extract as an adjuvant in type 2 diabetes mellitus patients ineffectively managed with metformin: a double-blind, randomized, placebo-controlled trial. Drug Des Devel Ther. 2018;12:735-742. [PMC free article: PMC5896648] [PubMed: 29670330]
36.
Dai CX, Hu CC, Shang YS, Xie J. Role of Ginkgo biloba extract as an adjunctive treatment of elderly patients with depression and on the expression of serum S100B. Medicine (Baltimore). 2018 Sep;97(39):e12421. [PMC free article: PMC6181482] [PubMed: 30278520]
37.
Zhang WF, Tan YL, Zhang XY, Chan RC, Wu HR, Zhou DF. Extract of Ginkgo biloba treatment for tardive dyskinesia in schizophrenia: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry. 2011 May;72(5):615-21. [PubMed: 20868638]
38.
Savaskan E, Mueller H, Hoerr R, von Gunten A, Gauthier S. Treatment effects of Ginkgo biloba extract EGb 761® on the spectrum of behavioral and psychological symptoms of dementia: meta-analysis of randomized controlled trials. Int Psychogeriatr. 2018 Mar;30(3):285-293. [PubMed: 28931444]
39.
Wheatley D. Triple-blind, placebo-controlled trial of Ginkgo biloba in sexual dysfunction due to antidepressant drugs. Hum Psychopharmacol. 2004 Dec;19(8):545-8. [PubMed: 15378664]
40.
Ito TY, Polan ML, Whipple B, Trant AS. The enhancement of female sexual function with ArginMax, a nutritional supplement, among women differing in menopausal status. J Sex Marital Ther. 2006 Oct-Dec;32(5):369-78. [PubMed: 16959660]
41.
Haguenauer JP, Cantenot F, Koskas H, Pierart H. [Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter double-blind drug vs. placebo study]. Presse Med. 1986 Sep 25;15(31):1569-72. [PubMed: 2947102]
42.
Sokolova L, Hoerr R, Mishchenko T. Treatment of Vertigo: A Randomized, Double-Blind Trial Comparing Efficacy and Safety of Ginkgo biloba Extract EGb 761 and Betahistine. Int J Otolaryngol. 2014;2014:682439. [PMC free article: PMC4099171] [PubMed: 25057270]
43.
Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. Clin. Exp. Dermatol. 2003 May;28(3):285-7. [PubMed: 12780716]
44.
Evans JR. Ginkgo biloba extract for age-related macular degeneration. Cochrane Database Syst Rev. 2000;(2):CD001775. [PubMed: 10796819]
45.
Hilton MP, Zimmermann EF, Hunt WT. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev. 2013 Mar 28;(3):CD003852. [PubMed: 23543524]
46.
Quidel Kramer F, Ortigoza Á. Ginkgo biloba for the treatment of tinnitus. Medwave. 2018 Oct 17;18(6):e7295. [PubMed: 30339143]
47.
Loskutova E, O'Brien C, Loskutov I, Loughman J. Nutritional supplementation in the treatment of glaucoma: A systematic review. Surv Ophthalmol. 2019 Mar - Apr;64(2):195-216. [PubMed: 30296451]
48.
Gertsch JH, Basnyat B, Johnson EW, Onopa J, Holck PS. 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). BMJ. 2004 Apr 03;328(7443):797. [PMC free article: PMC383373] [PubMed: 15070635]
49.
Sridharan K, Sivaramakrishnan G. Pharmacological interventions for preventing acute mountain sickness: a network meta-analysis and trial sequential analysis of randomized clinical trials. Ann. Med. 2018 Mar;50(2):147-155. [PubMed: 29166795]
50.
O'Hara M, Kiefer D, Farrell K, Kemper K. A review of 12 commonly used medicinal herbs. Arch Fam Med. 1998 Nov-Dec;7(6):523-36. [PubMed: 9821826]
51.
Unger M. Pharmacokinetic drug interactions involving Ginkgo biloba. Drug Metab. Rev. 2013 Aug;45(3):353-85. [PubMed: 23865865]
52.
Pennisi RS. Acute generalised exanthematous pustulosis induced by the herbal remedy Ginkgo biloba. Med. J. Aust. 2006 Jun 05;184(11):583-4. [PubMed: 16768668]
53.
Hasegawa S, Oda Y, Ichiyama T, Hori Y, Furukawa S. Ginkgo nut intoxication in a 2-year-old male. Pediatr. Neurol. 2006 Oct;35(4):275-6. [PubMed: 16996402]
54.
Kellermann AJ, Kloft C. Is there a risk of bleeding associated with standardized Ginkgo biloba extract therapy? A systematic review and meta-analysis. Pharmacotherapy. 2011 May;31(5):490-502. [PubMed: 21923430]
55.
Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with ginkgo biloba: a case report and systematic review of the literature: a case report and systematic review of the literature. J Gen Intern Med. 2005 Jul;20(7):657-61. [PMC free article: PMC1490168] [PubMed: 16050865]
56.
Jang HS, Roh SY, Jeong EH, Kim BS, Sunwoo MK. Ginkgotoxin Induced Seizure Caused by Vitamin B6 Deficiency. J Epilepsy Res. 2015 Dec;5(2):104-6. [PMC free article: PMC4724850] [PubMed: 26819944]
57.
Harms SL, Garrard J, Schwinghammer P, Eberly LE, Chang Y, Leppik IE. Ginkgo biloba use in nursing home elderly with epilepsy or seizure disorder. Epilepsia. 2006 Feb;47(2):323-9. [PubMed: 16499756]
58.
Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N. Engl. J. Med. 1997 Apr 10;336(15):1108. [PubMed: 9091822]
59.
Stoddard GJ, Archer M, Shane-McWhorter L, Bray BE, Redd DF, Proulx J, Zeng-Treitler Q. Ginkgo and Warfarin Interaction in a Large Veterans Administration Population. AMIA Annu Symp Proc. 2015;2015:1174-83. [PMC free article: PMC4765589] [PubMed: 26958257]
60.
Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA. 2001 Jul 11;286(2):208-16. [PubMed: 11448284]
61.
Xin QQ, Liu Y, Yang L, Fu CG, Chen KJ. [Ginkgo preparations of Chinese medicine and treatment of diabetes: mechanisms and clinical applications]. Zhongguo Zhong Yao Za Zhi. 2014 Dec;39(23):4509-15. [PubMed: 25911792]
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