Scientific Name: Ginkgo Biloba
Other Names: Ginkgo, Japanese Silver Apricot, Kew Tree, Maidenhair Tree, Yinhsing

Who is this for?

Uses

Increasing amounts of evidence show that herbal products made from ginkgo leaves may help to relieve a condition known as cerebral insufficiency, which is a decrease in the blood supply to the brain. Frequently associated with aging, cerebral insufficiency may cause confusion, dementia, hearing problems, and memory loss. Dementia is an increasing decline in thought processes caused by brain damage or disease. Chemicals in ginkgo leaves are known to thin the blood and they may also normalize muscle tone in blood vessel walls. Both of these effects may improve blood flow to the brain, thereby increasing the brain’s oxygen supply and possibly relieving conditions associated with poor blood flow. Additionally, in laboratory studies, ginkgo leaf preparations seemed to prevent cell destruction caused by beta-amyloid proteins—chemicals thought to be involved in causing Alzheimer’s disease. Ginkgo’s possible effect on beta-amyloid proteins needs further study to determine its potential. At least one large, long-term study is underway to determine whether taking ginkgo can help to prevent or delay the start of dementia for healthy older adults. To date, no studies have found that supplementation with ginkgo leaf extract improves memory and thinking for individuals who do not have cerebral insufficiency or other conditions that affect thinking.

By increasing blood flow both in the small blood vessels at the back of the eyes and to the optic nerves, ginkgo leaf may also help to prevent or relieve some eye conditions. In animal and human studies, taking ginkgo leaf has restored at least part of color perception for individuals who have decreased color vision due to diabetes. Some evidence also suggests that ginkgo may also help to improve age-related macular degeneration (AMD), which is the destruction of the retinas’ centers. AMD may destroy vision in the middle of the visual field and it may lead to blindness. In addition, ginkgo has shown a protective effect against some forms of glaucoma, a disease caused by increased pressure within the eyes.

Because chemicals in ginkgo leaves affect all blood vessels in the same ways, ginkgo may also increase general blood flow throughout the body. As one result, taking ginkgo leaf preparations may help to relieve conditions such as intermittent claudication, which is leg pain that occurs while walking. Intermittent claudication usually results from peripheral vascular disease—narrowing of blood vessels that may cause an inadequate blood flow to the arms and legs. Ginkgo leaves have also been studied for increasing the ability to tolerate cold temperatures. In a condition known as Raynaud’s syndrome or Raynaud’s phenomenon, spasms of the blood vessels in the ears, fingers, toes, and other outer parts of the body cause the blood vessels in these areas to narrow when they get cold or during times of emotional stress. The vessel-widening chemicals in the leaves of ginkgo may prevent these spasms and the pain they cause. Because ginkgo may increase blood flow to the penis, it has also been studied for the treatment of erectile dysfunction (ED), the inability for a man to have or maintain an erection. A few small human studies show that ginkgo may have limited effectiveness for treating ED, especially for men who have ED as a side effect from taking antidepressant medications. In animal studies, however, ginkgo may have had negative effects on male reproductive functions. All these possible uses of ginkgo leaf show promise, but much more study is needed before it can be recommended for any of them.

In Germany, herbal medicines are evaluated by the German Commission E (of the German Federal Institute for Drugs and Medical Devices), the German governmental agency that evaluates the safety and effectiveness of herbal products. Commission E has approved ginkgo leaf extract for treating symptoms of dementia, intermittent claudication, and related conditions. The United States does not have an agency comparable to the German Commission E.

In studies of laboratory animals, ginkgo leaf extract showed some ability to relieve inflammation and heal ulcers of the stomach or small intestine. Because it is an antioxidant, ginkgo leaf extract has also been tested in laboratory studies of human cancer cells. Antioxidants are believed to protect body cells from damage caused by oxidation, the chemical breakdown of foods into components the body can use. Oxidation also produces by-products known as oxygen free radicals, which may suppress immune function. Ginkgo leaf extract has also reduced chemically caused liver fibrosis in animal studies. Fibrosis is the formation of scar-like fibers. Because the non-functioning fibers crowd out active liver tissue, liver function decreases gradually as the amount of fibrous tissue increases. Chronic hepatitis and drinking large amounts of alcoholic beverages are the major causes of liver fibrosis. Damage from exposure to chemicals or certain drugs may also result in liver fibrosis.

Occasionally, the seeds of the ginkgo tree are used as medicine, more commonly in Asia than in Europe or North America, and only after they have been heated. Roasting the seeds destroys some of the potentially harmful chemicals they contain. These chemicals may cause seizures or death—especially in children. Toasted ginkgo seeds may limit the coughing reflex and also make mucus easier to eliminate from the lungs. Both these effects may make ginkgo seeds useful for controlling the coughing of asthma and other chronic respiratory conditions. Safer and more effective prescription and non-prescription drugs are available to treat coughing, however. The use of ginkgo seeds is not recommended. If ginkgo seeds are used, they should be used only occasionally and their use should be limited to no more than ten seeds per day for no more than a few days at a time.

Because ginkgo leaf products decrease the blood’s ability to clot, they should not be used by individuals who have bleeding disorders such as hemophilia.

Taking ginkgo leaves or ginkgo seeds may “lower the seizure threshold”—meaning that it may make individuals with epilepsy or other seizure disorders more likely to have seizures. Therefore, individuals who take medications to prevent seizures and individuals who have ever had a seizure should avoid taking ginkgo.

Ginkgo leaf may affect blood sugar levels in more than one way. It may decrease insulin levels in the blood, but it may also stimulate the pancreas to produce more insulin. For individuals with diabetes, taking ginkgo leaf may cause unpredictable changes in blood sugar levels. Therefore, ginkgo leaf products should not be taken by individuals with diabetes.

Precautions

Although laboratory studies have shown no adverse effects from ginkgo on pregnant or newborn animals, very little information is available on how ginkgo leaf might affect a developing human fetus, an infant, or a small child. Therefore, its use is not recommended during pregnancy, breast-feeding, or early childhood.

What side effects should I watch for?

Major Side Effects

Cases of seizures have been reported in individuals who were taking ginkgo leaf or ginkgo seed. Many of these individuals had not experienced seizures before taking ginkgo.

Taking ginkgo leaf has been associated with sudden bleeding under the surface of the skin or into the eyes.

Consuming fresh ginkgo seeds or more than ten ginkgo seeds that have been roasted may result in:

• Difficult breathing
• Seizures
• Unconsciousness
• Death

Touching ginkgo fruit pulp often causes severe irritation of the skin. The resulting blisters, intense itching, redness, and swelling may last for several days. All individuals touching ginkgo fruit may experience this effect, but individuals who have had rashes from poison ivy are more likely to have similar reactions from touching ginkgo pulp.

Less Severe Side Effects

Rarely, ginkgo leaf extract has been associated with mild gastrointestinal complaints, headaches, or muscle weakness.

Taking roasted ginkgo seeds by mouth has resulted in:

• Diarrhea
• Nausea
• Restlessness
• Upset stomach
• Vomiting

Oral forms of ginkgo may cause allergic skin reactions such as rashes and itching.

Eating ginkgo fruit may cause itching, redness, or swelling around the mouth.

What interactions should I watch for?

Prescription Drugs

Ginkgo leaf is known to increase the time blood needs to clot. When it is taken with antiplatelet or anticoagulant drugs, the effect of the drug possibly may be slightly increased, potentially resulting in uncontrolled bleeding.

• Antiplatelets include clopidogrel and Ticlid
• Anticoagulants include heparin and warfarin

Because it is broken down by certain enzymes in the liver, ginkgo leaf extract may possibly interfere with the use of prescription drugs that are processed by the same enzymes. Although recent small studies of interactions with specific drugs have shown that ginkgo generally had no significant effects, other studies have shown a definite interference with major liver enzymes that break down drugs such as:

• Allergy drugs such as fexofenadine
• Antifungal drugs such as itraconazole and ketoconazole
• Cancer drugs such as etoposide, paclitaxel, vinblastine, or vincristine
• Drugs for high cholesterol such as lovastatin
• nicardipine (Cardene)and propranolol (Inderal), drugs for high blood pressure
• Oral contraceptives
• phenobarbital, which is used for insomnia and seizures

Either ginkgo leaf or ginkgo seed may make seizures more likely to occur for individuals who have had seizures in the past. Known as “lowering the seizure threshold”, this effect may also decrease the effects of anticonvulsants—drugs to prevent seizures.
Anticonvulsants include:

• barbiturates such as phenobarbital
• benzodiazepines such as diazepam
• carbamazepine (Tegretol)
• Cerebyx
• Keppra
• Lamictal
• phenytoin (Dilantin)
• Topamax
• Trileptal
• valproic acid (Depakene)
• Zonegran

Additionally, a chemical in ginkgo has blocked the effects of an immunosuppressant agent, cyclosporine. Although they may be used to treat several conditions, immunosuppressants usually are given to prevent the rejection of transplanted organs. Interactions between ginkgo and other immunosuppressants have not been identified, but they are possible.

Ginkgo leaf may change the ways that the body makes and uses natural insulin. Therefore, it may also alter the effects of injected insulin. Individuals who inject insulin to control diabetes may experience changing blood sugar levels if ginkgo is also taken. Blood sugar may need to be monitored more closely and insulin doses may need more frequent adjustment.

Taking ginkgo leaf preparations may also interfere with oral drugs for diabetes, such as:

• Actos
• Avandia
• glimepiride
• glipizide
• glyburide
• Glyset
• metformin
• Prandin
• Precose

In several cases, taking ginkgo while a thiazide diuretic was also taken caused a rise in blood pressure. Usually taken to lower blood pressure, thiazide diuretics are drugs that promote the loss of water from the body. They include:

• chlorothiazide
• chlorthalidone
• hydrochlorothiazide
• metolazone
• polythiazide

In one small study, lower blood levels of omeprazole (Prilosec), a proton pump inhibitor, resulted when ginkgo was taken at the same time. Omeprazole is used to treat stomach and intestinal ulcers and esophageal conditions such as erosive esophagitis and gastroesophageal reflux disease (GERD). Possibly, ginkgo could interfere with omeprazole’s effectiveness.

One case of coma has been reported in an elderly Alzheimer’s disease patient who began taking ginkgo leaf extract while taking the antidepressant drug, trazodone (Desyrel). The patient recovered after emergency medical attention and discontinuation of both ginkgo and trazodone. Although the interaction has not been reported again, ginkgo and trazodone are not recommended for use together.

Non-prescription

Ginkgo leaf may decrease the ability of blood to clot after an injury. Aspirin can also delay clotting, so ginkgo leaf should not be taken orally at the same time as aspirin.

Some non-prescription products that are used to treat allergies or colds contain ingredients such as dexchlorpheniramine and pseudoephedrine, which may possibly make seizures more likely to recur. Although the risk is thought to be slight, taking any ginkgo product may also increase the possibility of seizures for individuals who have had seizures previously. Therefore, taking ginkgo at the same time as a non-prescription antihistamine or decongestant is not recommended.

Herbals

Theoretically, if ginkgo leaf is used with other herbs that affect blood clotting, bleeding may occur. Some of the most common herbal products that might inhibit blood clotting are:

• Danshen
• Devil's Claw
• Eleuthero
• Garlic
• Ginger (in high amounts)
• Horse Chestnut
• Panax Ginseng
• Papain
• Red Clover
• Saw Palmetto

Either ginkgo leaves or seeds may "lower the seizure threshold", which means they may make seizures more likely to recur in individuals who have had previous seizures. When ginkgo is taken with other herbal products that may also induce seizures, this risk increases. Some other herbals that may lower the seizure threshold include:

• Borage
• Evening Primrose
• Juniper
• Wormwood

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how ginkgo leaf products or ginkgo seeds interact with drugs, other herbals, and foods and the severity of those interactions, please use our Drug Interactions Checker to check for possible interactions.

Should I take it?

Ginkgo is thought to be the oldest tree species on earth: with fossilized ginkgo dated at over 220 million years old. Furthermore, historical records kept in China may place the age of individual, still-living ginkgo trees at 1,000 years or older. Under favorable growing conditions, ginkgo trees may reach over 100 feet in height. However, the ginkgos most familiar to residents of the United States are generally small trees. They are often planted in cities because they can survive in harsh weather and they resist damage from diseases, insects, and pollution.

Ginkgos are easily recognized by their distinctive fan-shaped leaves—light green in summer, but turning to a brilliant yellow in the autumn. For use in medicine, ginkgo leaves are picked while they are green, dried, and extracted. Extracts are concentrated liquid preparations usually made by soaking chopped or mashed plant parts in a liquid such as alcohol or acetone, and then straining out the solid parts. The resulting liquid may then be dried and placed in capsules or made into tablets.

Female ginkgo trees bear foul-smelling, tannish-colored fruits about the size and shape of large cherries. The pulp of ginkgo fruits contains chemicals that cause irritation when they come in contact with human skin. Although the fruits are not eaten as food, the large seed contained in each fruit may be used in medicine, but only after being heated to remove some of the potentially harmful chemicals. Ginkgo seeds resemble peeled almonds in color, shape, and size. Occasionally, ginkgo seeds have been used in combination herbal preparations to treat chronic cough and congestion. Sometimes, they are used in small quantities as a ceremonial food for special occasions in oriental counties. Taking ginkgo seeds by mouth is not recommended.

Dosage and Administration

Ginkgo leaf is most commonly available as an extract, which is made by soaking dried, green ginkgo leaves in a liquid such as acetone, straining out the solid particles, and then evaporating the acetone to produce a concentrate. Ginkgo leaf extract may be used as a liquid or it may be dried and made into capsules or tablets. Ginkgo leaf preparations are often standardized to contain between 22% and 27% of chemicals known as ginkgo flavonol glycosides and between 5% and 7% of another group of chemicals known as terpene lactones. Standardization by the manufacturer should assure the same amount of active ingredient in every batch of the commercial preparation. Standardization of herbal products is not required by the U.S. Food and Drug Administration (FDA), so not every product sold in this country will contain the same amounts of active ingredients.

Daily amounts of ginkgo are usually divided into two doses or three doses. For treating dementia and related symptoms such as memory loss, recommended amounts of ginkgo leaf extract range from 120 mg to 240 mg per day. The suggested daily amount for intermittent claudication is 120 mg to 160 mg. Higher oral doses have not shown any additional value and ginkgo leaf extract may take between 6 weeks and 8 weeks to reach full effectiveness.

Taking ginkgo seeds is not advised. Individuals who decide to use ginkgo seeds should not try to harvest and roast the seeds themselves. Although no recommendations for dosing amounts or intervals of ginkgo seeds are available in scientific literature, most sources recommend no more than ten commercially prepared seeds per day. Additionally, taking ginkgo seed products should be very limited—no more than a few days at any one time and very few times a year. If ginkgo seeds are used, a reputable commercial preparation should be purchased and the dosing recommendations on the package should be followed exactly. Most often, ginkgo seed is included in combination herbal products.

Summary

The leaves of the ginkgo tree contain chemicals that decrease the thickness of blood and increase the size of blood vessels. The resulting increased blood flow improves oxygen levels which may relieve conditions such as memory loss, intermittent claudication, macular degeneration, and glaucoma.

Roasted ginkgo seeds may sometimes be used to treat chronic respiratory conditions such as asthma.

Risks

Pregnant women, women who are breast-feeding, and young children should also avoid ginkgo leaf because too little is known about its possible effects for those groups. Ginkgo seeds may cause seizures; however, so they should not be given to children. Adults should limit the use of roasted ginkgo seeds to no more than 10 per day for just a few days, at most. Fresh ginkgo seeds and ginkgo fruits should never be taken by mouth.

Side Effects

Either ginkgo leaf or—more likely—ginkgo seed may trigger seizures.

Taking ginkgo leaf preparations may cause unexpected bleeding into the eyes or under the skin. Mild headache, muscle weakness, or stomach upset may also be attributed to using ginkgo leaf.

Consuming any amount of fresh ginkgo seeds or more than about ten roasted seeds at one time has resulted in breathing difficulty, unconsciousness, or death.

Eating or touching ginkgo fruits may be associated with skin irritation, redness, or swelling.

Interactions

Ginkgo leaf extract may increase the effects of drugs and herbals that reduce blood clotting. It may interfere with insulin and oral drugs or herbs that affect blood sugar.

Taking either ginkgo leaf or ginkgo seed may decrease the effects of anticonvulsant drugs. They may also increase the chance of a seizure if they are taken with several different types of prescription and non-prescription drugs or herbal products that may also make seizures more likely to occur.

Last Revised September 9, 2007

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Last Revised September 9, 2007

Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.

In general, herbal products are not subject to review or approval by the U.S. Food and Drug Administration (FDA). They are not required to be standardized, meaning that the amounts of active ingredients or contaminants they contain may vary between brands or between different batches of the same brand. Not all of the risks, side effects, or interactions associated with the use of herbal products are known because few reliable studies of their use in humans have been done.

This information is provided for your education only. Please share this information with your healthcare provider and be sure that you talk to your doctor and pharmacist about all the prescription and non-prescription medicines you take before you begin to use any herbal product.

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