GING-ko

Therapeutic Classification: antiplatelet agents, central nervous system stimulants

Complementary/Alternative Medicine: This monograph describes a natural or herbal product that is not subject to FDA guidelines for medicines. Patients and clinicians are advised to read package labels carefully to ensure safe and efficacious use.

• Symptomatic relief of organic brain dysfunction (dementia syndromes, short-term memory deficits, inability to concentrate, depression)
• Intermittent claudication
• Vertigo and tinnitus of vascular origin
• Improvement of peripheral circulation
• Premenstrual syndrome

• Improves tolerance to hypoxemia, especially in cerebral tissue.
• Inhibits development of cerebral edema and accelerates its regression.
• Improves memory, blood flow (microcirculation), compensation of disequilibrium, and rheological properties of blood.
• Inactivates toxic oxygen radicals.
• Antagonizes platelet-activating factor.
• Interferes with bronchoconstriction and phagocyte chemotaxis.

• Symptomatic relief of dementia syndromes.
• Inhibits arterial spasm, decreases capillary fragility and blood viscosity.
• Improves venous tone, relaxes vascular smooth muscle.

Absorption: 70–100% absorption.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-life: Unknown.

Contraindicated in:

• Hypersensitivity
• Pregnancy and lactation.

Use Cautiously in:

• Bleeding disorders
• Children (fresh seeds have caused seizures and death)
• Diabetes
• Epilepsy; Surgery (discontinue use 2 wk prior).

CNS: CEREBRAL BLEEDING, dizziness, headache, seizure, vertigo.

CV: palpitations.

GI: flatulence, stomach upset.

Derm: allergic skin reaction.

Hemat: bleeding.
Misc: hypersensitivity reactions.

Natural-Drug Products:

• Theoretically may potentiate effects of anticoagulants, thrombolytics, antiplatelet agents, and MAO inhibitors.
• May also ↑ risk of bleeding with some cephalosporins, valproic acid, and NSAIDs.
• May ↓ effectiveness of anticonvulsants.
• May alter insulin metabolism requiring dose adjustments of antidiabetic drugs.

Natural-Natural Products:

• May ↑ risk of bleeding when used with other herbs with antiplatelet effects (including angelica, arnica, chamomile, feverfew, garlic, ginger, and licorice).

Organic Brain Syndromes

• PO (Adults): 120–240 mg ginkgo leaf extract daily in 2 or 3 doses.

Intermittent Claudication

• PO (Adults): 120–240 mg ginkgo leaf extract daily in 2 or 3 doses.

Vertigo and Tinnitus

• PO (Adults): 120–160 mg ginkgo leaf extract daily in 2 or 3 doses.

Cognitive Function Improvement

• PO (Adults): 120–600 mg per day.

Premenstrual Syndrome

• PO (Adults): 80 mg BID starting on the 16th day of the menstrual cycle until the 5th day of the next cycle.

• Ginkgo leaf extract (acetone/water): 22–27% flavonoid glycosides; 5–7% terpene lactones; 2.6–3.2% bilobalide; <5 ppm of ginkgolic acids;

• Assess cognitive function (memory, attention, reasoning, language, ability to perform simple tasks) prior to and periodically during therapy. Exclude other treatable causes of dementia prior to instituting treatment with ginkgo.
• Assess frequency, duration, and severity of muscle cramps (claudication) experienced by the patient prior to and periodically throughout therapy.
• Assess for headache and neurologic changes (thromboembolism).

• PO: Start dose at 120 mg per day and increase as needed to minimize side effects.
• May be administered without regard to food. Administer at same time each day.
• Use of dried leaf preparations in the form of a tea is not recommended because of insufficient quantity of active ingredients.
• Advise patients to avoid crude ginkgo plant parts, which can cause severe allergic reactions.

• Advise patient to observe for easy bruising and other signs of bleeding and report to health care professional if they occur.
• Caution patient to keep this herb out of the reach of children; may cause seizures.
• Caution patient to avoid handling the pulp or seed coats because of the risk of contact dermatitis. Wash skin under free-flowing water promptly if contact does occur.
• Instruct patient not to exceed recommended doses; large doses may result in toxicity (restlessness, diarrhea, nausea and vomiting, headache).
• Notify patients receiving anticoagulant or antiplatelet therapy not to take this medication without approval of health care professional and frequent monitoring.
• Instruct patient to consult health care professional before taking any prescription or OTC medications concurrently with ginkgo.

• Improvement in walking distances pain-free.
• Improvement in tinnitus and vertigo.
• Improvement in short-term memory, attention span, and ability to perform simple tasks.
• Improvement in sexual function.
• Decreased symptoms of premenstrual syndrome.
• Administration for a minimum of 6–8 wk of 80 mg (tid) (not <6 wk) is required to determine response.

Bai guo ye, fossil tree, ginkgo folium, Japanese silver apricot, kew tree, maidenhair-tree, salisburia adiantifolia, yinhsing