What is it?
Ginkgo is an herb. The leaves are generally used to make “extracts” that are used as medicine. However, a few medicines are made from the seed, but these are not well studied.
Ginkgo is often used for memory disorders including Alzheimer’s disease. It is also used for conditions that seem to be due to reduced blood flow in the brain, especially in older people. These conditions include memory loss, headache, ringing in the ears, vertigo, difficulty concentrating, mood disturbances, and hearing disorders. Some people use it for other problems related to poor blood flow in the body, including leg pain when walking (claudication), and Raynaud’s syndrome (a painful response to cold, especially in the fingers and toes).
Ginkgo leaf is also used for thinking disorders related to Lyme disease and depression.
Some people use ginkgo to treat sexual performance problems. It is sometimes used to reverse the sexual performance problems that can accompany taking certain antidepressants called SSRIs.
Ginkgo been tried for eye problems including glaucoma, diabetic eye disease, and age-related macular degeneration (AMD).
The list of other uses of ginkgo is very long. This may be because this herb has been around for so long. Ginkgo biloba is one of the longest living tree species in the world. Ginkgo trees can live as long as a thousand years. Using ginkgo for asthma and bronchitis was described in 2600 BC.
In manufacturing, ginkgo leaf extract is used in cosmetics. In foods, roasted ginkgo seed, which has the pulp removed, is an edible delicacy in Japan and China. Remember, though, the whole seed is LIKELY UNSAFE to eat.
Ginkgo interacts with many medicines. Before taking it, talk with your healthcare provider if you take any medications.
How effective is it?
Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.
The effectiveness ratings for GINKGO are as follows:
Possibly effective for...
- Alzheimer’s disease and other forms of dementia. Some evidence shows that taking ginkgo leaf extract by mouth modestly improves symptoms of Alzheimer’s, vascular, or mixed dementias. However, there are concerns that findings from many of the early ginkgo studies may not be reliable. Although most clinical trials show ginkgo helps for symptoms of Alzheimer’s disease and other dementias, there are some conflicting findings, suggesting it may be hard to determine which people might benefit.
- Improving thinking problems caused by old age. Taking ginkgo leaf extract by mouth seems to improve thinking skills in some elderly people with mild to moderate age-related memory loss or thinking problems. Ginkgo leaf extract might modestly improve short-term visual memory and speed of mental processing in non-demented people with age-related memory loss.
- Improving thinking in young people. Taking ginkgo leaf extract by mouth seems to improve some thinking skills in healthy young to middle-aged people. Ginkgo might modestly improve memory and speed of mental processing in people without memory loss. Some evidence suggests a combination of Panax ginseng and ginkgo is effective for improving memory and that the combination might be more effective than either product alone.
- Painful response to cold especially in the fingers and toes (Raynaud’s syndrome). Taking ginkgo leaf extract by mouth seems to decrease the number of painful attacks per week in people with Raynaud’s syndrome.
- Leg pain when walking due to poor blood flow (claudication, peripheral vascular disease). Some evidence shows that taking ginkgo seems to increase the distance people with poor blood circulation in their legs can walk without pain. Taking ginkgo might also reduce the chance of requiring surgery.
- Vertigo and dizziness. Taking ginkgo leaf by mouth seems to significantly improve symptoms of dizziness and balance disorders.
- Premenstrual syndrome (PMS). Taking ginkgo leaf extract by mouth seems to produce significant relief in breast tenderness and other symptoms associated with PMS when started during the 16th day of the menstrual cycle and continued until the 5th day of the following cycle.
- Glaucoma. Taking ginkgo leaf extract by mouth seems to improve pre-existing damage to the visual field in people with normal tension glaucoma.
- Improving color vision in people with diabetes. There is some evidence that taking ginkgo leaf extract by mouth for six months can significantly improve color vision in people whose retinas have been damaged by diabetes.
Possibly ineffective for...
- Ringing in the ears (tinnitus).
- Winter depression in people with seasonal affective disorder (SAD).
- Sexual problems related to antidepressant medicines.
- Preventing symptoms of mountain or altitude sickness in climbers.
Likely ineffective for...
- Heart disease. Taking ginkgo does not reduce the chance of having a heart attack, chest pain, or stroke in elderly people.
Insufficient evidence to rate effectiveness for...
GINKGO LEAF EXTRACT
- Age-related macular degeneration (AMD). There is some early evidence that ginkgo leaf extract might improve symptoms and distance vision in people with AMD.
- Anxiety. Preliminary clinical research shows that a specific ginkgo extract (EGb 761, Tanakan) can reduce symptoms of anxiety in adults with generalized anxiety disorder or adjustment disorder with anxious mood.
- Attention deficit-hyperactivity disorder (ADHD). There is preliminary evidence that a specific combination product (AD-fX, CV Technologies, Canada) containing ginkgo leaf extract, in combination with American ginseng (Panax quinquefolius), might help improve ADHD symptoms such as anxiety, hyperactivity, and impulsiveness in 3 to 17 year-old children.
- Stroke. There is contradictory evidence about the effectiveness of ginkgo for improving recovery in people with strokes caused by a clot.
- Hearing loss. There is some evidence that ginkgo might help short-term hearing loss due to unknown causes. However, many of these people recover their hearing on their own. So it’s hard to know if ginkgo has any effect.
- Fibromyalgia. There is some preliminary research that suggests taking ginkgo along with coenzyme Q-10 might increase feelings of wellness and perception of overall health and reduced pain.
- Radiation exposure. There is some research that suggests taking ginkgo might decrease some of the negative effects of radiation on the body.
- Vitiligo. There is some preliminary research that taking ginkgo might decrease the size and spread of skin lesions.
- High cholesterol.
- “Hardening of the arteries” (atherosclerosis).
- Blood clots, heart disease.
- Colorectal cancer.
- Ovarian cancer.
- Thinking problems related to Lyme disease.
- Chronic fatigue syndrome (CFS).
- Other conditions.
More evidence is needed to rate ginkgo leaf extract for these uses.
- Urinary problems.
- Digestion disorders.
- Skin sores.
More evidence is needed to rate ginkgo seeds for these uses.
Ginkgo seems to improve blood circulation, which might help the brain, eyes, ears, and legs function better. It may slow down Alzheimer’s disease by interfering with changes in the brain that interfere with thinking.
Ginkgo seeds contain substances that might kill the bacteria and fungi that cause infections in the body. The seeds also contain a toxin that can cause side effects like seizure and loss of consciousness.
Ginkgo LEAF EXTRACT is LIKELY SAFE when taken by mouth for most people. It can cause some minor side effects such as stomach upset, headache, dizziness, constipation, forceful heartbeat, and allergic skin reactions.
Ginkgo fruit and pulp can cause severe allergic skin reactions and irritation of mucous membranes. Ginkgo might cause an allergic reaction in people who are allergic to poison ivy, poison oak, poison sumac, mango rind, or cashew shell oil.
There is some concern that ginkgo leaf extract might increase the risk of bruising and bleeding. Ginkgo thins the blood and decreases its ability to form clots. A few people taking ginkgo have had bleeding into the eye and into the brain, and excessive bleeding following surgery. Ginkgo leaf extract can cause allergic skin reactions in some people.
The ROASTED SEED or crude ginkgo plant is POSSIBLY UNSAFE when taken by mouth. Eating more than 10 roasted seeds per day can cause difficulty breathing, weak pulse, seizures, loss of consciousness, and shock. The FRESH SEED is even more dangerous. Fresh seeds are poisonous, and eating them could cause seizures and death.
Not enough is known about the safety of ginkgo when applied to the skin to determine if it is safe.
Special precautions & warnings:
Pregnancy and breast-feeding: Ginkgo is POSSIBLY UNSAFE when used during pregnancy. It might cause early labor or extra bleeding during delivery if used near that time. Not enough is known about the safety of using ginkgo during breast-feeding. Don’t use ginkgo if you are pregnant or breast-feeding.
Children: Ginkgo leaf extract is POSSIBLY SAFE. Some research suggests that a specific combination of ginkgo leaf extract plus American ginseng might be safe in children when used short-term. Don’t let children eat the ginkgo seed. It is UNSAFE.
Diabetes: Ginkgo might interfere with the management of diabetes. If you have diabetes, monitor your blood sugar closely.
Seizures: There is a concern that ginkgo might cause seizures. If you have ever had a seizure, don’t use ginkgo.
Infertility: Ginkgo use might interfere with getting pregnant. Discuss your use of ginkgo with your healthcare provider if you are trying to get pregnant.
Bleeding disorders: Ginkgo might make bleeding disorders worse. If you have a bleeding disorder, don’t use ginkgo.
Surgery: Ginkgo might slow blood clotting. It might cause extra bleeding during and after surgery. Stop using ginkgo at least 2 weeks before a scheduled surgery.
Be cautious with this combination.
Taking ginkgo along with alprazolam might decrease the effects of alprazolam.
Ginkgo seems to affect the brain. Buspirone (BuSpar) also affects the brain. One person felt hyper and overexcited when taking ginkgo, buspirone (BuSpar), and other medications. It is unclear if this interaction was caused by ginkgo or the other medications.
Efavirenz (Sustiva) is used to treat HIV infection. Taking efavirenz (Sustiva) along with ginkgo extract might decrease the effects of efavirenz (Sustiva). Before taking ginkgo, talk to your healthcare provider if you take medications for HIV.
Taking ginkgo along with St. John's wort, other herbs, and fluoxetine (Prozac) might cause you to feel irritated, nervous, jittery, and excited. This is called hypomania. It's not known if this is a concern when just ginkgo is taken with fluoxetine (Prozac).
Ginkgo might slow blood clotting. Ibuprofen can also slow blood clotting. Taking ginkgo with ibuprofen might slow blood clotting too much and increase the chance of bruising and bleeding.
Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates)
Some medications are changed and broken down by the liver. Ginkgo might decrease how quickly the liver breaks down some medications. Taking ginkgo along with some medications that are changed by the liver might increase the effects and side effects of some medications. Before taking ginkgo, talk to your healthcare provider if you take any medications that are changed by the liver.
Some of these medications that are changed by the liver include clozapine (Clozaril), cyclobenzaprine (Flexeril), fluvoxamine (Luvox), haloperidol (Haldol), imipramine (Tofranil), mexiletine (Mexitil), olanzapine (Zyprexa), pentazocine (Talwin), propranolol (Inderal), tacrine (Cognex), theophylline, zileuton (Zyflo), zolmitriptan (Zomig), and others.
Medications changed by the liver (Cytochrome P450 2C19 (CYP2C19) substrates)
Some medications are changed and broken down by the liver. Ginkgo might increase how quickly the liver breaks down some medications. Taking ginkgo with these medications might decrease how well the medication works. Before taking ginkgo, talk to your healthcare provider if you take any medications that are changed by the liver.
Some of these medications that are changed by the liver include amitriptyline (Elavil), carisoprodol (Soma), citalopram (Celexa), diazepam (Valium), lansoprazole (Prevacid), omeprazole (Prilosec), phenytoin (Dilantin), warfarin (Coumadin), and many others.
Medications changed by the liver (Cytochrome P450 2C9 (CYP2C9) substrates)
Some medications are changed and broken down by the liver. Ginkgo might decrease how quickly the liver breaks down some medications. Taking ginkgo along with these medications that are changed by the liver might increase the effects and side effects of your medication. Before taking ginkgo, talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include amitriptyline (Elavil), diazepam (Valium), zileuton (Zyflo), celecoxib (Celebrex), diclofenac (Voltaren), fluvastatin (Lescol), glipizide (Glucotrol), ibuprofen (Advil, Motrin), irbesartan (Avapro), losartan (Cozaar), phenytoin (Dilantin), piroxicam (Feldene), tamoxifen (Nolvadex), tolbutamide (Tolinase), torsemide (Demadex), warfarin (Coumadin), and others.
Medications changed by the liver (Cytochrome P450 2D6 (CYP2D6) substrates)
Some medications are changed and broken down by the liver. Ginkgo might decrease how quickly the liver breaks down some medications. Taking ginkgo along with some medications that are changed by the liver can increase the effects and side effects of your medication. Before taking ginkgo, talk to your healthcare provider if you take any medications that are changed by the liver.
Some medications that are changed by the liver include amitriptyline (Elavil), clozapine (Clozaril), codeine, desipramine (Norpramin), donepezil (Aricept), fentanyl (Duragesic), flecainide (Tambocor), fluoxetine (Prozac), meperidine (Demerol), methadone (Dolophine), metoprolol (Lopressor, Toprol XL), olanzapine (Zyprexa), ondansetron (Zofran), tramadol (Ultram), trazodone (Desyrel), and others.
Medications changed by the liver (Cytochrome P450 3A4 (CYP3A4) substrates)
Some medications are changed and broken down by the liver. Ginkgo might affect how quickly the liver breaks down some medications, and lead to a variety of effects and side effects. Before taking ginkgo, talk to your healthcare provider if you are taking any medications that are changed by the liver.
Some medications changed by the liver include lovastatin (Mevacor), clarithromycin (Biaxin), cyclosporine (Neoral, Sandimmune), diltiazem (Cardizem), estrogens, indinavir (Crixivan), triazolam (Halcion), and others.
Medications for diabetes (Antidiabetes drugs)
Diabetes medications are used to lower blood sugar. Ginkgo might increase or decrease insulin and blood sugar in people with type 2 diabetes. Taking ginkgo along with diabetes medications might decrease how well your medication works. Monitor your blood sugar closely. The dose of your diabetes medication might need to be changed.
Some medications used for diabetes include glimepiride (Amaryl), glyburide (DiaBeta, Glynase PresTab, Micronase), insulin, pioglitazone (Actos), rosiglitazone (Avandia), chlorpropamide (Diabinese), glipizide (Glucotrol), tolbutamide (Orinase), and others.
Medications that increase the chance of having a seizure (Seizure threshold lowering drugs)
Some medications increase the chance of having a seizure. Taking ginkgo might cause seizures in some people. If this combination is taken, it might greatly increase the chance of having a seizure. Do not take ginkgo with medications that increase the chance of having a seizure.
Some medications that increase the chance of having a seizure include anesthesia (propofol, others), antiarrhythmics (mexiletine), antibiotics (amphotericin, penicillin, cephalosporins, imipenem), antidepressants (bupropion, others), antihistamines (cyproheptadine, others), immunosuppressants (cyclosporine), narcotics (fentanyl, others), stimulants (methylphenidate), theophylline, and others.
Medications that slow blood clotting (Anticoagulant / Antiplatelet drugs)
Ginkgo might slow blood clotting. Taking ginkgo along with medications that also slow clotting might increase the chances of bruising and bleeding.
Some medications that slow blood clotting include aspirin, clopidogrel (Plavix), dalteparin (Fragmin), enoxaparin (Lovenox), heparin, indomethacin (Indocin), ticlopidine (Ticlid), warfarin (Coumadin), and others.
Medications used to prevent seizures (Anticonvulsants)
Medications used to prevent seizures affect chemicals in the brain. Ginkgo can also affect chemicals in the brain in a way that might possibly decrease the effectiveness of medications used to prevent seizures.
Some medications used to prevent seizures include phenobarbital, primidone (Mysoline), valproic acid (Depakene), gabapentin (Neurontin), carbamazepine (Tegretol), phenytoin (Dilantin), and others.
Trazodone (Desyrel) affects chemicals in the brain. Ginkgo can also affect chemicals in the brain. Taking trazodone (Desyrel) along with ginkgo might cause serious side effects in the brain. One person taking trazodone and ginkgo went into a coma. Do not take ginkgo if you are taking trazodone (Desyrel).
Warfarin (Coumadin) is used to slow blood clotting. Ginkgo might also slow blood clotting. Taking ginkgo along with warfarin (Coumadin) might increase the chances of bruising and bleeding. Be sure to have your blood checked regularly. The dose of your warfarin (Coumadin) might need to be changed.
Be watchful with this combination.
Hydrochlorothiazide is used to help decrease swelling and control blood pressure. Taking hydrochlorothiazide along with ginkgo might increase blood pressure. Before taking ginkgo, talk to your healthcare provider if you take medications for high blood pressure.
Omeprazole (Prilosec) is changed and broken down by the liver. Ginkgo might increase how fast the liver breaks down omeprazole (Prilosec). Taking ginkgo with omeprazole (Prilosec) might decrease how well omeprazole (Prilosec) works.
Herbs and supplements that increase the risk of seizure
Ginkgo seeds contain a chemical that can cause seizures in high doses. People who are already taking supplements that may increase seizure risk might be at greater risk if they take ginkgo, too. Seizures after using ginkgo leaf have been reported in people with no history of seizure as well as in people with well- controlled epilepsy.
It's best to avoid taking ginkgo with herbs and supplements that can increase the risk of seizure. These herbs and supplements include: butanediol (BD), cedar leaf, Chinese club moss, EDTA, folic acid, gamma butyrolactone (GBL), gamma hydroxybutyrate (GHB), glutamine, huperzine A, hydrazine sulfate, hyssop oil, juniper, L-carnitine, melatonin, rosemary, sage, wormwood, and others.
Herbs and supplements that might slow blood clotting
Using herbs and supplements that slow blood clotting along with ginkgo could increase the risk of bleeding in some people. This is because ginkgo might slow blood clotting. Some other herbs of this type include angelica, clove, danshen, garlic, ginger, Panax ginseng, and others.
St. John's wort
Ginkgo, in combination with buspirone (BuSpar), fluoxetine (Prozac), melatonin, and St. John's wort might cause manic symptoms in people with depression. No one knows whether ginkgo alone, or in combination with St. John's wort, can cause these symptoms.
There are no known interactions with foods.
The following doses have been studied in scientific research:
- For dementia syndromes: a dosage of 120-240 mg per day of ginkgo leaf extract, divided in two or three doses.
- For cognitive function improvement in healthy young people: dosages of 120-600 mg per day.
- For Raynaud’s disease: a dosage of 360 mg per day of ginkgo leaf extract, divided into three doses.
- For walking pain due to poor circulation (claudication, peripheral vascular disease): a dosage of 120-240 mg per day of ginkgo leaf extract, divided into two or three doses, has been used; however, the higher dose may be more effective.
- For vertigo: dosages of 120-160 mg per day of ginkgo leaf extract, divided into two or three doses.
- For premenstrual syndrome (PMS): 80 mg twice daily, starting on the sixteenth day of the menstrual cycle until the fifth day of the next cycle.
- For the treatment of normal tension glaucoma: ginkgo leaf extract 40 mg 3 times daily up to four weeks.
For all uses, start at a lower dose of not more than 120 mg per day to avoid gastrointestinal (GI) side effects. Increase to higher doses indicated as needed. Dosing may vary depending on the specific formulation used. Most researchers used specific standardized Ginkgo biloba leaf extracts. Some people take 0.5 mL of a standard 1:5 tincture of the crude ginkgo leaf three times daily.
You should avoid crude ginkgo plant parts. These can contain dangerous levels of the toxic chemicals found in the seed of the plant and elsewhere. These chemicals can cause severe allergic reactions.
Abricot Argenté Japonais, Adiantifolia, Arbre aux Écus, Arbre aux Quarante Écus, Arbre du Ciel, Arbre Fossile, Bai Guo Ye, Baiguo, Extrait de Feuille de Ginkgo, Extrait de Ginkgo, Fossil Tree, Ginkgo biloba, Ginkgo Biloba Leaf, Ginkgo Extract, Ginkgo Folium, Ginkgo Leaf Extact, Ginkgo Seed, Graine de Ginkgo, Herba Ginkgo Biloba, Japanese Silver Apricot, Kew Tree, Maidenhair Tree, Noyer du Japon, Pei Go Su Ye, Salisburia Adiantifolia, Yen Xing, Yinhsing.
To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).
To see all references for the Ginkgo page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/333.html.
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