Ginkgo biloba

What is Ginkgo biloba

Ginkgo is a dietary supplement derived from the leaves of Ginkgo biloba Linne (formerly known as Salisburia adiantifolia Sm.), an ornamental, deciduous tree. It is considered the world’s oldest living tree species. 

Ginkgo biloba is also known as gingko, gingkco, hill apricot, maiden hair tree, kew tree, oriental plum tree, silver apricot, silver fruit, and silver plume.

A standardized extract of Ginkgo biloba leaves (GBE or EGb 761) has been developed by Dr. Willmar Schwabe GmbH & Co. in Germany and is the common formulation available in Europe and used in clinical trials.

EGb761 is known as Ginkgold(R) in the US. Active ingredients of ginkgo leaf extract are flavonoids (dimeric bioflavones) including bilobetin, ginkgetin, isofenkgetin, sciadopitysin, quercetin and kaempferol flavone glycosides, various 20-carbon diterpene lactone derivatives (ginkgolides A, B, C, J, and M) and a 15-carbon sesquiterpene (bilobalide).

Other components include 6-hydroxykynurenic acid, organic acids (vanillic, ascorbic, shikimic, p-coumaric), iron-based superoxide dismutase, benzoic acid derivatives, carbohydrates, sterols and polyprenols.

Potency for nutraceutical products can vary substantially from manufacturer to manufacturer. Standardized GBE is produced through a complicated extraction process resulting in a final drug/extract ratio of 35—67:1 (average 50:1).

This extract contains 22—27% flavone glycosides (average 24%) determined as quercetin, kaempferol, and isorhamnetin and calculated as flavones with a molar mass of MMr=756.7 (quercetin glycosides) and MMr=740.7 (kaempferol glycosides); 5—7% terpene lactones (average 6%) (2.8—3.4% ginkgosides A, B, and C and 2.6—3.2% bilobalide) and < 5 parts per million (ppm) ginkgolic acids.

There is no such regulation for ginkgo products available in the US. Seasonal variation of the active compounds occurs with the highest concentrations occurring in the autumn when the leaves begin to change color.

Regardless of the time of year, the concentration of the active compounds in the leaves is very low, which is the reason for the extraction process. The use of crude leaf powder or tea from the leaves is probably ineffective.

Indications

  1. Alzheimer’s disease
  2. claudication
  3. peripheral vascular disease (PVD)
  4. premenstrual syndrome (PMS)
  5. sexual dysfunction
  6. tinnitus
  7. vascular dementia
  8. vertigo

For the treatment of Alzheimer’s disease or vascular dementia

Side Effects

  1. anaphylactic shock
  2. anaphylactoid reactions
  3. bleeding
  4. constipation
  5. contact dermatitis
  6. diarrhea
  7. edema
  8. erythema
  9. flatulence
  10. headache
  11. infertility
  12. nausea
  13. palpitations
  14. pruritus
  15. restlessness
  16. retinal hemorrhage
  17. seizures
  18. Stevens-Johnson syndrome
  19. stroke
  20. subdural hematoma
  21. vomiting
  22. weakness

Monitoring Parameters

  • laboratory monitoring not necessary

Contraindications

  • accidental exposure
  • anticoagulant therapy
  • atopy
  • bleeding
  • breast-feeding
  • children
  • coagulopathy
  • diabetes mellitus
  • GI bleeding
  • head trauma
  • hypertension
  • increased intracranial pressure
  • infants
  • infertility
  • intracranial bleeding
  • labor
  • obstetric delivery
  • pregnancy
  • retinal bleeding
  • retroperitoneal bleeding
  • seizure disorder
  • seizures
  • surgery
  • vitamin K deficiency

Interactions

  • Abciximab
  • Acetaminophen; Aspirin, ASA; Caffeine
  • Anagrelide
  • Anticoagulants
  • Aspirin, ASA
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Caffeine; Orphenadrine
  • Aspirin, ASA; Carisoprodol
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Citric Acid; Sodium Bicarbonate
  • Aspirin, ASA; Dipyridamole
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
  • Aspirin, ASA; Pravastatin
  • Bepridil
  • Calcium-channel blockers
  • Cilostazol
  • Clopidogrel
  • Dipyridamole
  • Eptifibatide
  • Ethanol
  • Flibanserin
  • Garlic, Allium sativum
  • Ginger, Zingiber officinale
  • Ginseng, Panax ginseng
  • Green Tea
  • Lomitapide
  • Methylsulfonylmethane, MSM
  • Nonsteroidal antiinflammatory drugs
  • Pentoxifylline
  • Platelet Inhibitors
  • Prasugrel
  • Thrombolytic Agents
  • Ticagrelor
  • Ticlopidine
  • Tirofiban
  • Trazodone
  • Vorapaxar
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