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mg/d) when administered together, but potential interactions with other medications used to treat dementia are not known Gingko has also been evaluated for its effect on intermittent claudication A meta-analysis of nine randomized, placebo-controlled, double-blinded trials of patients treated with EGb 761 showed a modest treatment effect in the increase of pain-free walking distance in favor of ginkgo over placebo There is insufficient evidence to support ginkgo s efficacy in treating tinnitus, acute mountain sickness, vertigo, or SSRIassociated sexual dysfunction
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Bent S et al Spontaneous bleeding associated with Ginkgo biloba A case report and systematic review of the literature J Gen Intern Med 2005 Jul;20(7):657 61 [PMID: 16050865] Burns NR et al Ginkgo biloba: no robust effect on cognitive abilities or mood in healthy young or older adults Hum Psychopharmacol 2006 Jan;21(1):27 37 [PMID: 16329161] Elsabagh S et al Differential cognitive effects of Ginkgo biloba after acute and chronic treatment in healthy young volunteers Psychopharmacology (Berl) 2005 May;179(2):437 46 [PMID: 15739076] Jiang X et al Effect of ginkgo and ginger on the pharmacokinetics and pharmacodynamics of warfarin in healthy subjects Br J Clin Pharmacol 2005 Apr;59(4):425 32 [PMID: 15801937] Mazza M et al Ginkgo biloba and donepezil: a comparison in the treatment of Alzheimer s dementia in a randomized, placebocontrolled, double blind study Eur J Neurol 2006 Sep;13(9): 981 5 [PMID: 16930364] Napryeyenko O et al; GINDEM-NP Study Group Ginkgo biloba special extract in dementia with neuropsychiatric features A randomized, placebo-controlled, double blind clinical trial Arzneimittelforschung 2007;57(1):4 11 [PMID: 17341003] Pittler MH et al Complementary therapies for peripheral arterial disease: systematic review Atherosclerosis 2005 Jul;181 (1):1 7 [PMID: 15939048]
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Van Doorn MB et al Effect of garlic powder on C-reactive protein and plasma lipids in overweight and smoking subjects Am J Clin Nutr 2006 Dec;84(6):1324 9 [PMID: 17158412] Williams MJ et al Aged garlic extract improves endothelial function in men with coronary artery disease Phytother Res 2005 Apr;19(4):314 9 [PMID: 16041725]
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The dried leaf of the ginkgo tree has been used medicinally for thousands of years More than 400 studies over the past 30 years have investigated ginkgo s ability to improve blood flow in a variety of conditions, including memory impairment, dementia, peripheral vascular disease, vertigo, tinnitus, asthma, SSRI-induced sexual dysfunction, and acute mountain sickness The German Commission E has approved a standardized form of ginkgo leaf extract (EGb 761) for the treatment of cognitive impairment and intermittent claudication Multiple pharmacologically active compounds have been isolated from ginkgo, including flavonoid glycosides and terpene lactones (ginkgolides) The flavonoids have antioxidant and free radical scavenging ability The terpene lactones (especially ginkgolide B) have platelet-activating factor antagonist activity In addition, ginkgo extracts increase the production of nitric oxide and activate certain central neurotransmitters, including the cholinergic system, which may contribute to their beneficial effects on memory and cognition EGb 761 the formulation that has been studied most extensively is standardized to contain 24% flavonoid glycosides and 6% terpene lactones Early studies that assessed ginkgo s efficacy on cognitive function in the elderly showed a modest improvement when compared with placebo The longest of these studies (1 year) showed stabilization of cognitive and functional abilities in 309 demented patients treated with EGb 761 compared with placebo, with no differences in adverse outcomes In contrast, EGb 761 was no more effective than placebo in 214 elderly Dutch patients with dementia or age-associated memory impairment There is conflicting evidence about ginkgo s ability to enhance memory in healthy individuals The NIH has funded investigators at the University of Pittsburgh to determine whether ginkgo taken over 5 years can prevent or delay the development of dementia in 3000 patients 75 years of age or older In general, ginkgo is well tolerated in healthy adults at recommended doses for up to 6 months Allergic skin reactions, gastrointestinal disturbances, and headache occur in less than 2% of patients There are theoretical concerns about a risk of increased bleeding because antiplatelet activating factor activity has been demonstrated in vitro Nearly 20 cases of increased bleeding in patients taking ginkgo have been reported, but establishing a causal relationship is challenging because many of these patients had other risk factors including age and use of medications, such as warfarin, aspirin, or NSAIDs Of note, no excess bleeding complications have been reported in clinical trials and no differences in coagulation, platelet function, or pharmacokinetics of warfarin have been noted in healthy male volunteers Caution should still be exercised in patients with bleeding disorders or who are taking anticoagulants, aspirin, or other herbs that may increase the risk of bleeding In one study, ginkgo (90 mg/d) did not show any adverse effects on the pharmacokinetics of donepezil (5
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