ginkgo

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.

REMS

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

Action ⬆ ⬇

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.

Therapeutic effects:

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

Pharmacokinetics ⬆ ⬇

Absorption: 70–100% absorption.

Distribution: Unknown.

Metabolism/Excretion: Unknown.

Half-Life: Unknown.

Time/Action Profile ⬆ ⬇

ROUTE	ONSET	PEAK	DURATION
PO	unknown	unknown	unknown

Contraind./Precautions ⬆ ⬇

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).

Adv. Reactions/Side Effects ⬆ ⬇

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

CV: palpitations

GI: flatulence, stomach upset

Derm: allergic skin reaction

Hemat: bleeding

Misc: hypersensitivity reactions

Interactions ⬆ ⬇

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).

Route/Dosage ⬆ ⬇

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.

Availability ⬆ ⬇

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

Assessment ⬆ ⬇

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).

Implementation ⬆ ⬇

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.

Patient/Family Teaching ⬆ ⬇

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.

Evaluation/Desired Outcomes ⬆ ⬇

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.

section name header

Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇