ginkgo biloba

Action and Spectrum

Actions and Spectrum: 

• Antioxidant Effects: ginkgo biloba contains flavonoids and terpenoids that act as antioxidants, helping to protect cells from oxidative damage caused by free radicals. This antioxidant activity may contribute to various health benefits. 
• Improved Blood Circulation: ginkgo biloba is known for its ability to improve blood flow, particularly to the brain and peripheral tissues. It may enhance microcirculation and vasodilation, which can improve oxygen and nutrient delivery to cells. 
• Neuroprotective Effects: ginkgo biloba has been studied for its potential neuroprotective properties. It may help protect neurons from damage and support overall brain health. Some research suggests it may enhance memory, cognition, and focus. 
• Anti-Inflammatory Effects: ginkgo biloba has anti-inflammatory properties and may help reduce inflammation in the body. It may inhibit the release of inflammatory mediators and modulate immune responses. 
• Anticoagulant Effects: ginkgo biloba has been shown to have mild anticoagulant properties. It may inhibit platelet aggregation and promote blood fluidity. Individuals taking anticoagulant medications should exercise caution and consult with a healthcare professional before using ginkgo biloba. 
• Eye Health Support: ginkgo biloba has been suggested to have benefits for eye health. It may improve blood flow to the eyes and protect retinal cells from oxidative damage. Some studies have investigated its potential use in conditions like glaucoma and age-related macular degeneration. 
• Anti-Anxiety and Antidepressant Effects: ginkgo biloba has been studied for its potential effects on mood and mental health. It may have anxiolytic and antidepressant properties, although further research is needed to fully understand these effects. 

Drug Interaction

Adverse Reaction

Frequency not defined  

Bleeding disorders 

Contact dermatitis 

Dizziness 

GI upset 

Nausea/vomiting 

Restlessness 

Subdural hematoma 

Vertigo (rare) 

Allergic skin reactions 

Constipation 

Diarrhoea 

Impaired fertility 

Headache 

Palpitations 

Seizures 

Weakness 

Black Box Warning

Black Box Warning 

There are no specific black box warnings associated with ginkgo biloba. 

Contraindication / Caution

Contraindications: 

• Bleeding Disorders: ginkgo biloba has been associated with a potential increase in bleeding risk. It may inhibit platelet aggregation and have anticoagulant effects.  
• Allergic and Sensitivity reactions: Some individuals may be allergic or sensitive to ginkgo biloba or its constituents. If you have a known allergy or sensitivity to ginkgo biloba or related plants, it is advisable to avoid its use. 
• Seizure Disorders: There have been rare reports of ginkgo biloba potentially lowering the seizure threshold.  
• Pregnancy and Lactation: The safety of ginkgo biloba during pregnancy and lactation has not been well-established.  
• Children: ginkgo biloba is generally not recommended for use in children due to limited safety data.

Cautions: 

• Medication Interactions: ginkgo biloba may interact with certain medications, including anticoagulants, antiplatelet drugs, and certain antidepressants. It may also interact with drugs that affect the liver’s cytochrome P450 enzymes 
• Bleeding Risks: ginkgo biloba has been associated with an increased risk of haemorrhage due to its potential antiplatelet and anticoagulant effects.  
• Seizure Disorders: Although rare, there have been reports of ginkgo biloba potentially lowering the seizure threshold.  
• Surgery: ginkgo biloba has an increased risk of bleeding during and after surgery. It is recommended to discontinue the use of ginkgo biloba at least two weeks prior to any scheduled surgical procedure.  

Comorbidities: 

• Bleeding Disorders: ginkgo biloba has the potential to increased risk of bleeding due to its antiplatelet and anticoagulant effects.  
• Seizure Disorders: There have been rare reports of ginkgo biloba potentially lowering the seizure threshold.  
• Hypertension: ginkgo biloba may have mild hypotensive effects, leading to a decrease in blood pressure. 
• Thyroid Disorders: ginkgo biloba may interfere with thyroid function and hormone levels. 
• Pregnancy and Lactation: The safety of ginkgo biloba during pregnancy and lactation has not been well-established. 

Pregnancy / Lactation

Pregnancy warnings:     

Pregnancy category: N/A 

Lactation: Excreted into human milk: Not known 

Pregnancy Categories:         

Category A: Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester. 

Category B: There were lack of studies on pregnant women and no evidence of risk to the foetus in animal experiments.   

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.   

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category

Pharmacology

Pharmacology 

The pharmacology of ginkgo biloba involves its active constituents, such as flavonoids and terpenoids, which exert various effects in the body. ginkgo biloba exhibits antioxidant activity, protecting cells from oxidative damage. It improves blood circulation and vasodilation, enhancing oxygen and nutrient delivery. ginkgo biloba also has antiplatelet effects, reducing the risk of blood clot formation. It has neuroprotective properties, potentially benefiting memory and cognition.

Additionally, ginkgo biloba possesses anti-inflammatory effects, modulating immune responses. While its pharmacological mechanisms are not fully understood, ginkgo biloba’s broad spectrum of actions contributes to its traditional use for cognitive function, circulatory health, and overall well-being. However, further research is needed to fully elucidate its pharmacological effects and interactions.  

Pharmacodynamics 

• Antioxidant Activity: ginkgo biloba contains flavonoids, terpenoids, and other antioxidants that scavenge free radicals and reduce oxidative stress.  
• Vasodilation and Improved Blood Flow: ginkgo biloba has been shown to improve blood circulation, particularly in the brain and peripheral tissues.  
• Platelet Aggregation Inhibition: ginkgo biloba has mild antiplatelet effects, meaning it can inhibit platelet aggregation and reduce the risk of excessive blood clotting.  
• Anti-Inflammatory Effects: ginkgo biloba has been found to possess anti-inflammatory properties. It inhibits the production of inflammatory mediators, such as cytokines and prostaglandins, and modulate immune responses.  
• Regulation of Neurotransmitters: ginkgo biloba may influence the levels and activity of certain neurotransmitters in the brain, including acetylcholine, serotonin, and norepinephrine.

Pharmacokinetics 

Absorption   

When consumed orally, the active constituents of ginkgo biloba extract are absorbed from the gastrointestinal tract. However, the bioavailability of these constituents can vary among different formulations and products. Absorption can be affected by factors such as food intake, the presence of other substances, and individual differences in metabolism. 

Distribution 

Once absorbed, the constituents of ginkgo biloba are distributed throughout the body. These compounds can reach different tissues and organs, including the brain, where ginkgo biloba is thought to exert its cognitive effects. 

Metabolism 

The metabolism of ginkgo biloba constituents primarily occurs in the liver. The main metabolic pathway involves enzymes of the cytochrome P450 system, particularly the CYP3A4 isoenzyme. These enzymes help convert the active constituents into metabolites, which may have different properties than the original compounds. 

Elimination and excretion 

After metabolism, the metabolites of ginkgo biloba are excreted from the body mainly through the urine and feces. The elimination half-life of ginkgo biloba constituents varies, but it is considered to be long, ranging from a few hours to several days. 

Adminstartion

Administration:  

• Oral Supplements: ginkgo biloba is widely available in the form of oral supplements, such as capsules, tablets, and liquid extracts. These supplements usually contain standardized extracts of ginkgo biloba leaves, which are prepared to ensure a consistent concentration of active compounds.  
• Tea: ginkgo biloba tea can be prepared by steeping ginkgo biloba leaves in hot water. However, it is important to note that commercially available ginkgo biloba teas may vary in their potency and quality. If using ginkgo biloba tea, it is recommended to purchase from reputable sources and follow the instructions for preparation and dosage. 
• Topical Preparations: ginkgo biloba extracts are sometimes used in topical formulations, such as creams or gels. These are directly applied to the skin for various purposes, including improving circulation or promoting wound healing. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ginkgo biloba 

Pronounced: (gin-koh bih-LOH-buh)  

Why do we use ginkgo biloba? 

• Cognitive Function: ginkgo biloba is often marketed as a supplement to support cognitive function and memory.  
• Peripheral Arterial Disease (PAD): PAD is a condition characterized by decreased blood flow to the legs, often resulting in leg pain and cramping during physical activity.  
• Tinnitus: Tinnitus refers to the perception of ringing or buzzing in the ears. ginkgo biloba has been used as a potential treatment for tinnitus due to its ability to improve blood circulation and protect against oxidative stress.  
• Age-Related Macular Degeneration (AMD): AMD is a common eye condition that leads to vision loss in older adults. ginkgo biloba has been investigated as a potential adjunctive treatment for AMD due to its antioxidant and neuroprotective properties.  
• Anxiety and Depression: ginkgo biloba has been explored as a complementary treatment for anxiety & depression. It is believed to have anxiolytic and antidepressant effects. However, the evidence supporting its effectiveness for these conditions is limited and inconsistent.