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

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:

Relief of dementia syndromes.
Inhibits arterial spasm; decreases capillary fragility and blood viscosity.
Improved venous tone; relaxes vascular smooth muscle.
Decreased symptoms of premenstrual syndrome.

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;
Epilepsy.

Use Cautiously in:

Bleeding disorders;
Diabetes;
History of stroke or transient ischemic attack;
Surgery (discontinue use ≥2 wk before procedure);
OB: Safety not established in pregnancy;
Lactation: Safety not established in breastfeeding;
Pedi: Safety and effectiveness not established in children (fresh seeds have caused seizures and death).

Adv. Reactions/Side Effects ⬆ ⬇

CV: palpitations

GI: flatulence, stomach upset

Derm: allergic skin reaction

Hemat: bleeding

Neuro: dizziness, headache, SEIZURES, vertigo

Misc: hypersensitivity reactions

Interactions ⬆ ⬇

Natural-Drug Products:

Anticoagulants, thrombolytics, antiplatelet agents, and MAO inhibitors may ↑ risk of bleeding.
May ↑ 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 with angelica, arnica, chamomile, feverfew, garlic, ginger, and licorice.

Route/Dosage ⬆ ⬇

Organic Brain Syndromes

PO (Adults ): 120–240 mg/day of ginkgo leaf extract in 2 or 3 divided doses.

Intermittent Claudication

PO (Adults ): 120–240 mg/day of ginkgo leaf extract in 2 or 3 divided doses.

Vertigo and Tinnitus

PO (Adults ): 120–160 mg/day of ginkgo leaf extract in 2 or 3 divided doses.

Cognitive Function Improvement

PO (Adults ): 120–600 mg/day.

Premenstrual Syndrome

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

Availability ⬆ ⬇

Ginkgo leaf extract (acetone/water): ^OTC

Assessment ⬆ ⬇

Assess cognitive function (memory, attention, reasoning, language, ability to perform simple tasks) before and periodically during therapy. Exclude other treatable causes of dementia before starting treatment with ginkgo.
Intermittent Claudication: Assess frequency, duration, and severity of muscle cramps before and periodically throughout therapy.
Assess for headache and neurologic changes (thromboembolism).

Lab Test Considerations:

Monitor blood glucose and coagulation panels periodically during therapy.

Implementation ⬆ ⬇

Start dose at 120 mg/day and ↑ as needed to minimize side effects.
PO: Administer with or without food at the 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 patient to avoid crude ginkgo plant parts, which can cause severe allergic reactions.

Patient/Family Teaching ⬆ ⬇

Explain purpose and side effects of herb to patient.
Advise patient to consult with health care provider before using any herbal supplement, especially when taken concurrently with Rx or OTC medications or vitamins.
Advise patient to observe for easy bruising and other signs of bleeding and report to health care provider if they occur.
Advise patient if sudden severe headache, confusion, or slurred or garbled speech occur to seek immediate medical attention.
Caution patient to keep this herb out of the reach of children; may cause seizures or death.
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.
Advise patient not to exceed recommended doses; large doses may result in toxicity (restlessness, diarrhea, nausea and vomiting, headache).
Advise patient receiving anticoagulant or antiplatelet therapy not to take this medication without approval of health care provider and frequent monitoring.
Rep: Advise women of reproductive potential to notify health care provider if pregnancy is planned or suspected or breastfeeding before using this herb.

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇