Categories & Effectiveness

Brain Health

Neuro-Repair Support

7/10

Strong evidence of effectiveness

Brain Antioxidant Shield

4/10

Moderate evidence of effectiveness

Brain Circulation Boost

4/10

Moderate evidence of effectiveness

Systemic Health

Anti-Inflammatory (Systemic)

7/10

Strong evidence of effectiveness

Systemic Antioxidant

7/10

Strong evidence of effectiveness

Vascular Health

4/10

Moderate evidence of effectiveness

Dosage & Side Effects

Recommended Dosage

The usual recommended dosage for adults is 120–240 mg per day of a standardized extract (like EGb 761®), typically divided into 2 or 3 doses taken with meals. While doses up to 480 mg/day have been studied, benefits are most consistently reported around 240 mg/day for cognitive symptoms, and higher doses increase the risk of adverse effects. Ginkgo Biloba should not be used by pregnant or breast-feeding women due to a lack of clinical data.

Potential Side Effects

Ginkgo Biloba is generally well-tolerated, but rare side effects can include gastrointestinal upset, headache, and skin reactions. High doses, long-term use, or consumption of Ginkgo seeds (which contain toxins) may lead to more severe risks like seizures, bleeding complications, and potential toxicity (including carcinogenicity observed in rodent studies). Individuals taking anticoagulant medications (like warfarin), aspirin, or drugs metabolized by CYP3A4 enzymes should use Ginkgo Biloba with caution due to potential interactions that increase bleeding risk or alter drug effectiveness.

Bioavailability & Half-Life

After oral administration, the active components of Ginkgo Biloba extract EGb 761®, specifically the terpene trilactones (ginkgolides A, B, and bilobalide), reach peak plasma concentrations within 1–2 hours and have relatively short elimination half-lives ranging from 4 hours (ginkgolide A, bilobalide) to 10 hours (ginkgolide B). Flavonoid glycosides have longer half-lives, around 10–17 hours. While one source suggests the primary components are excreted mainly in urine without undergoing significant metabolism, clinical interaction studies indicate EGb 761® can induce or inhibit cytochrome P450 enzymes, particularly CYP3A4, suggesting potential metabolic interactions with other drugs. The bioavailability of ginkgolides A, B, and bilobalide is reported to be high, around 80–90%.

Interactions & Stacks

Combining Ginkgo Biloba extract (EGb 761®) with acetylcholinesterase inhibitors (AChEIs) like donepezil may offer additional cognitive benefits for Alzheimer's disease patients, although evidence is limited and results are inconsistent. Use caution when combining Ginkgo Biloba with anticoagulants (e.g., warfarin), antiplatelet drugs (e.g., aspirin), or medications metabolized by the CYP3A4 enzyme system, as Ginkgo can affect drug metabolism and increase bleeding risk. User reports and meta-analyses highlight variability in effectiveness and potential safety concerns, emphasizing the need for standardized extracts and careful consideration of interactions.

Benefits by Use Case

Symptomatic Relief in Mild-to-Moderate Dementia

May help stabilize or slow the decline in cognition, daily living activities, and behavior over 22-26 weeks, especially at 240 mg/day and in patients with neuropsychiatric symptoms. Does not prevent dementia onset based on large trials.

Reducing Systemic Inflammation

Acts as an anti-inflammatory agent, potentially beneficial in conditions with an inflammatory component like respiratory diseases or cardiovascular issues. Effects depend on the specific condition and dosage.

Antioxidant Support

Provides potent antioxidant effects by scavenging various free radicals (ROS/RNS), protecting cells from oxidative stress associated with aging and various diseases. This is a primary mechanism contributing to its other benefits.

Improving Memory in Healthy Older Adults

May modestly enhance specific memory processes like delayed recall and recognition in cognitively intact older adults (e.g., 180mg/day for 6 weeks). Effects are not consistently strong across all studies or memory types.

Mechanism of Action

Ginkgo Biloba extract, particularly EGb 761®, exerts its effects through multiple mechanisms primarily attributed to its flavonoid glycosides and terpene trilactones (ginkgolides, bilobalide). It acts as a potent antioxidant, scavenging reactive oxygen and nitrogen species (ROS/RNS) and enhancing endogenous antioxidant enzymes like SOD and catalase, thus protecting against oxidative stress and lipid peroxidation. Its anti-inflammatory actions involve inhibiting pathways like NF-κB and reducing pro-inflammatory cytokines (e.g., TNF-α, IL-6). Neuroprotective effects include improving mitochondrial function, protecting against Aβ-induced neurotoxicity (by inhibiting Aβ aggregation, lowering cholesterol, and potentially shifting APP metabolism), regulating neurotransmitters (including mild enhancement of prefrontal dopamine), modulating neuronal plasticity, and protecting against glutamate-induced excitotoxicity and ischemia. Ginkgolides also act as antagonists to Platelet-Activating Factor (PAF), contributing to improved blood flow and antiplatelet effects.

Frequently Asked Questions

Is Ginkgo Biloba safe?

Can Ginkgo Biloba prevent dementia or Alzheimer's?

Does Ginkgo Biloba improve memory?

When is the best time to take Ginkgo Biloba?

Does Ginkgo Biloba interact with other medications?

What dose of Ginkgo Biloba is most effective?

Are all Ginkgo Biloba supplements the same?

Summary & Expert Opinion

Ginkgo Biloba extract, particularly the standardized EGb 761®, shows moderate evidence for stabilizing or slowing the decline in cognition, daily function, and behavior in individuals with mild-to-moderate dementia, especially at doses of 240 mg/day. Its strengths lie in its antioxidant, anti-inflammatory, and potential neuroprotective mechanisms, but large-scale studies have failed to demonstrate effectiveness in preventing dementia or cognitive decline in healthy older adults. Individuals experiencing symptoms of mild cognitive impairment or dementia (particularly with neuropsychiatric features) might consider standardized Ginkgo extract under guidance. However, those taking blood-thinning medications, individuals with seizure disorders, pregnant or breastfeeding women, and potentially those taking medications metabolized by CYP3A4 should avoid Ginkgo Biloba due to safety concerns and interaction risks.

Research Studies

Showing 5 of 10 studies

Ginkgo Biloba (2023)

anti-inflammatory antioxidant cardiovascular effects +3 more

Authors:

Talal Alzahrani, Tran Nguyen

Findings:

This review summarizes evidence for Ginkgo biloba's diverse pharmacological properties (antioxidant, anti-inflammatory, neuroprotective, anticancer, antidiabetic, cardiovascular benefits, etc.) attributed to its bioactive components like flavonoids and terpenoids. Both preclinical and clinical studies support its potential therapeutic applications for conditions including dementia, respiratory diseases, metabolic syndrome, and tardive dyskinesia. However, the review also highlights potential adverse effects (especially with high doses/long-term use or seeds), drug interactions, and toxicity concerns, emphasizing the need for more rigorous, standardized research to confirm efficacy and safety for medicinal use.

Participants:

Review covers numerous preclinical (in vitro cell lines like A549, HepG2, HUVECs, neuroblastoma; animal models including mice, rats, rabbits, fish) and clinical studies (human patients with HCC, dementia, T2DM [N=60], schizophrenia with TD, GAD [N=25-30/group], vitiligo [N=12], depression [N=136], ADHD [N=50]).

Dosage:

Review covers a wide range of dosages across studies: Preclinical doses vary greatly (e.g., 5 mg/kg/day ginkgolide B in rats, 100-1225 mg/kg/day EGb 761 in mice, various µM/mg/mL concentrations in vitro). Clinical trials often used standardized extracts like EGb 761, typically ranging from 80-720 mg/day, with common doses being 120 mg/day (T2DM study) or 240 mg/day (dementia, TD studies). Specific examples include 60 mg BID (vitiligo), 19.2 mg TID (depression), 80-120 mg/day (ADHD). High doses or long-term use are associated with adverse effects.

Study Quality Assessment:

The review cites preclinical and clinical studies, including randomized controlled trials (RCTs), double-blind, placebo-controlled trials (e.g., N=60 T2DM study over 3 months; GAD study over 4 weeks), meta-analyses (e.g., for TD), and observational studies. Methods mentioned include HPLC-MS, LC-MS, flow cytometry, and microarray analysis. The review notes limitations such as heterogeneity in study methodologies complicating comparisons, potential for toxicity (genotoxicity, hepatotoxicity in rodents at high doses/long duration) and adverse effects (e.g., bleeding risk, seizures from seeds), drug interactions (e.g., with CYP substrates, warfarin), and the need for further verification of safety and efficacy, especially regarding dose-response and long-term effects.

All Effects:

anti-inflammatory antioxidant cardiovascular effects cognitive function neuroprotective toxicity

Ginkgo biloba: A Treasure of Functional Phytochemicals with Multimedicinal Applications (2022)

Ginkgo biloba extract EGb 761® in the symptomatic treatment of mild-to-moderate dementia: a profile of its use (2018)

activities of daily living behaviour cognition +2 more

Authors:

Kate McKeage

Findings:

EGb 761® showed positive effects on cognition, behaviour, and global change compared to placebo in randomized trials and meta-analyses involving adults with mild-to-moderate dementia, although results varied across studies and outcomes (e.g., significant improvement in SKT/ADAS-cog/NPI in some trials but not all). Effects may be more marked in patients with neuropsychiatric symptoms. Limited data suggests efficacy may be comparable to donepezil, and adding EGb 761® to AChEIs might offer additional benefits. EGb 761® is generally well tolerated.

Participants:

Adults with mild-to-moderate dementia (including Alzheimer's disease (AD) and/or vascular dementia (VD)), some specifically with neuropsychiatric symptoms (NPS). Also mentioned are elderly volunteers with subjective memory impairment, healthy males, healthy volunteers, elderly patients with peripheral artery disease or at risk of cardiovascular disease. Animal studies involved rats, gerbils, mice, and cats. Specific trial sample sizes are mentioned in tables (e.g., N=205 vs N=203).

Dosage:

Usual dosage discussed is 120–240 mg/day, divided into 2 or 3 doses, taken with meals. Specific RCTs evaluated 120 mg/day, 160 mg/day, 240 mg/day, or 160/240 mg/day. Other studies mentioned used 300 mg/day or 120, 240, and 480 mg/day.

Study Quality Assessment:

The review discusses findings from randomized, placebo-controlled clinical trials (RCTs), meta-analyses, and double-blind studies. Specific methodologies mentioned include intent-to-treat (ITT) analysis, trial durations (22-52 weeks), specific assessment scales (SKT, ADAS-cog, CGI-2, GERRI, NPI, ADCS-CGIC, NAB, NAA, VFT, TE4D, CDT, MMSE, DEMQOL-Proxy, GBS), subgroup analyses, and comparison with active controls (AChEIs). Sample sizes for individual trials are provided in tables. High heterogeneity (I2 scores 62-100%) is noted for several meta-analyses. One RCT [50] was criticized as potentially underpowered. The review mentions it received no external funding, authors are employees of Adis/Springer, and the marketing-authorization holder (Ipsen Pharma) reviewed data for scientific accuracy.

All Effects:

activities of daily living behaviour cognition dementia symptoms neuroprotection

Review of Ginkgo biloba-induced toxicity, from experimental studies to human case reports (2017)

adverse effects carcinogenicity clinical trial outcomes +2 more

Authors:

Nan Mei

Findings:

This review summarizes evidence on Ginkgo biloba toxicity from experimental studies and human reports. Ginkgo seeds contain the neurotoxin MPN (ginkgotoxin), causing poisoning (convulsions, vomiting). Ginkgo leaf extract showed carcinogenic activity (liver, thyroid) in NTP rodent studies and is classified as a possible human carcinogen (IARC Group 2B). Large clinical trials (GuidAge, GEM) found standardized extracts (EGb761) ineffective for preventing Alzheimer's disease, cognitive decline, dementia, or cardiovascular events in older adults, contradicting some earlier smaller studies. Adverse effects reported in humans include seizures, spontaneous bleeding (especially with anticoagulants like warfarin), potential drug interactions (via CYP enzyme induction/inhibition), and allergic reactions. Significant variability in chemical composition, quality control issues, and adulteration exist in commercial Ginkgo products.

Participants:

Review covers in vitro studies, in vivo animal studies (rats including F344/N, Wistar, SH, SD; mice including B6C3F1/N, Swiss albino, CD-1, ICR, C57B1I/6), human case reports, and human clinical trials (healthy volunteers, elderly individuals with/without cognitive impairment, patients with various conditions like Alzheimer's risk, peripheral arterial disease, macular degeneration, tinnitus, cognitive decline, stroke, epilepsy, schizophrenia). Specific trial populations mentioned include GuidAge (N=2854, mean age 76.8, 67% female) and GEM Study (N=3069, age >=75, mean age 79, 46% female, normal cognitive or mild cognitive impairment).

Dosage:

Clinical trials: Standardized extract EGb761 at 120 mg twice daily (GuidAge, GEM); other trials used 60–240 mg daily. Case reports/Interaction studies: 120 mg/day, 280 mg/day (two 70-mg tablets twice daily), 360 mg/day (e.g., 60 mg tablets 3 times daily). NTP rodent studies: 100, 300, or 1000 mg/kg (rats); 200, 600, or 2000 mg/kg (mice) daily via gavage. Other animal studies used various doses (e.g., 3.5-14 mg/kg/day, 25-100 mg/kg/day, 100-1225 mg/kg/day). Ginkgo seed poisoning reported after consuming ~50-80 nuts or 1 kg.

Study Quality Assessment:

Review synthesizes data from experimental studies (in vitro, in vivo including NTP 3-month and 2-year toxicity/carcinogenicity gavage bioassays in rats/mice), human case reports, systematic reviews (Cochrane), and large randomized controlled trials (RCTs) like GuidAge (N=2854, double-blind, placebo-controlled, 5 yrs) and GEM (N=3069, placebo-controlled, avg 6 yrs). Mentions specific methods (e.g., HPLC/MS, HPLC-UV, TLC, Comet assay, γ-H2A.X phosphorylation, Topo II inhibition assays, neutral red assay, bacterial gene mutation assays, mouse lymphoma assay, microarray analysis, Western blot, LD50 tests, histopathology, popliteal lymph node assay), IARC classification (Group 2B), NTP conclusions ('clear evidence of carcinogenic activity...in mice'). Use of standardized extract EGb761 in some trials is noted. Acknowledges limitations like inconsistent trial results (especially older/smaller trials vs newer/larger ones), variability/adulteration in commercial products, insufficient follow-up time for cancer endpoint in GEM study, and controversy over some findings (e.g., bleeding risk). Disclaimers regarding NLM/NIH endorsement and FDA position are present.

All Effects:

adverse effects carcinogenicity clinical trial outcomes drug interactions toxicity

Efficacy and adverse effects of Ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis (2014)

activities of daily living cognition global change +2 more

Findings:

The meta-analysis found that Ginkgo biloba extract EGb761, compared to placebo, showed favorable effects on cognition, activities in daily living (ADLs), and Clinicians' Global Impression of Change (CGIC), particularly at a dose of 240 mg/day. EGb761 at 240 mg/day was concluded to stabilize or slow decline in cognition, function, behavior, and global change over 22-26 weeks, especially in patients with neuropsychiatric symptoms. No important safety concerns were identified.

Participants:

Patients with cognitive impairment and dementia (N=2,561 total across included trials). Subgroup analyses conducted for patients with neuropsychiatric symptoms and patients with Alzheimer's disease.

Dosage:

Benefits mainly associated with standardized Ginkgo biloba extract EGb761 at a dose of 240 mg/day.

Study Quality Assessment:

Systematic review and meta-analysis of nine randomized controlled trials. Trials were placebo-controlled and of 22-26 weeks duration. Databases searched include MEDLINE, EMBASE, Cochrane. Total sample size N=2,561. Statistical methods mentioned: weighted mean differences, standardized mean differences, Peto OR, subgroup analysis.

All Effects:

activities of daily living cognition global change neuropsychiatric symptoms safety

Efficacy and tolerability of Ginkgo biloba extract EGb 761® in dementia: a systematic review and meta-analysis of randomized placebo-controlled trials (2014)

activities of daily living cognition dementia +2 more

Authors:

Serge Gauthier

Findings:

In randomized, placebo-controlled trials and meta-analyses involving adults with mild-to-moderate dementia, EGb 761® showed positive effects compared to placebo on cognition, behaviour, and global change. Meta-analyses generally supported benefits for cognition, activities of daily living (ADL), and global ratings, though often with high heterogeneity. EGb 761® is reported as generally well tolerated with no significant safety issues identified over years of use.

Participants:

Adults with mild-to-moderate dementia (including Alzheimer's disease (AD) and/or vascular dementia (VD), some with neuropsychiatric symptoms (NPS)). Also mentions studies involving healthy males, elderly volunteers with subjective memory impairment, healthy volunteers, elderly patients with peripheral artery disease or at risk of cardiovascular disease, and animal models (rats, gerbils, mice, cat).

Dosage:

RCTs primarily evaluated 120–240 mg/day in divided doses. Usual recommended dosage is 120–240 mg/day divided into 2 or 3 doses. Other dosages mentioned in specific contexts include 160 mg/day, 300 mg/day, and 120, 240, 480 mg/day.

Study Quality Assessment:

Review of randomized, placebo-controlled clinical trials (RCTs) and meta-analyses. Mentions specific trial designs (e.g., double-blind, placebo-controlled, randomized), use of intent-to-treat (ITT) populations, specific trial durations (22-52 weeks), sample sizes (e.g., RCTs with >100 patients, specific N values cited), and assessment tools (e.g., SKT, ADAS-cog, NPI, CGI-2, GERRI, ADL scales). Notes limitations such as varying diagnostic criteria between RCTs, one RCT potentially being underpowered, and high heterogeneity in meta-analyses (I2 scores 62-100%). States the review preparation was not externally funded; authors are employees of Adis/Springer; marketing authorization holder (Ipsen Pharma) reviewed for scientific accuracy.

All Effects:

activities of daily living cognition dementia neuropsychiatric symptoms tolerability

[Ginkgo biloba--effect, adverse events and drug interaction] (2012)

A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761 in a sample of cognitively intact older adults: neuropsychological findings

delayed recall memory recognition memory +2 more

Findings:

Compared to placebo, Ginkgo biloba EGb 761 (180 mg/day for 6 weeks) significantly improved delayed free recall and recognition of auditory-verbal material (SRT) and delayed recognition of visual material (WMS-III FII, interpretation requires caution due to baseline differences). Subjective self-reports also showed significantly more participants in the EGb 761 group rated their memory as 'improved'. Overall results suggest potential efficacy for enhancing certain memory processes in cognitively intact older adults.

Participants:

N=262 community-dwelling volunteers (male and female), 60 years of age and older, cognitively intact (MMSE >= 26), with no history of dementia or significant neurocognitive impairments.

Dosage:

Ginkgo biloba extract EGb 761 at 180 mg/day for 6 weeks.

Study Quality Assessment:

Randomized controlled trial (RCT), double-blind, placebo-controlled, parallel-group, fixed-dose, 6-week duration. Sample size N=262 (n=131 EGb 761, n=131 placebo). Used standardized neuropsychological measures (SRT, WAIS-III BD, WAIS-III DS, WMS-III FI, WMS-III FII) and a Follow-up Self-report Questionnaire. Acknowledged limitation: significant difference in baseline WMS-III FII scores requires caution in interpreting that specific result.

All Effects:

delayed recall memory recognition memory verbal memory visual memory

Effects of Ginkgo biloba in dementia: systematic review and meta-analysis

dementia

Authors:

Stefan Weinmann

Findings:

Meta-analysis of two trials (N=5,889) indicated no significant difference in dementia rate between Ginkgo biloba and placebo groups (OR=1.05, 95% CI 0.89-1.23). There was no considerable heterogeneity between the trials.

Participants:

N=5,889 participants involved in two trials

Study Quality Assessment:

Meta-analysis of two trials; N=5,889; Placebo comparison; Statistical analysis (OR=1.05, 95% CI 0.89-1.23); Heterogeneity assessed (none considerable).

Ginkgo Biloba for Mild Cognitive Impairment and Alzheimer's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Alzheimer's disease activities of daily living adverse events +2 more

Findings:

Ginkgo biloba, particularly in combination with conventional medicine, showed potential benefits for improving cognitive function (MMSE scores) and activities of daily living (ADL scores) in patients with mild cognitive impairment or Alzheimer's disease compared to conventional medicine alone. Findings compared to placebo or conventional medicine in individual trials were similar but inconsistent. Adverse events were mild. More research is needed due to limitations.

Participants:

2608 patients with mild cognitive impairment or Alzheimer's disease across 21 trials.

Study Quality Assessment:

Systematic Review and Meta-Analysis of Randomized Controlled Trials (21 trials, N=2608). Search included PubMed, Cochrane Library, four Chinese databases. General methodological quality of included trials was rated moderate to poor. Limitations mentioned: limited sample size, inconsistent findings, methodological quality.

All Effects:

Alzheimer's disease activities of daily living adverse events cognitive function mild cognitive impairment

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Categories & Effectiveness

Brain Health

Neuro-Repair Support

Brain Antioxidant Shield

Brain Circulation Boost

Systemic Health

Anti-Inflammatory (Systemic)

Systemic Antioxidant

Vascular Health

Dosage & Side Effects

Recommended Dosage

Potential Side Effects

Bioavailability & Half-Life

Interactions & Stacks

Benefits by Use Case

Symptomatic Relief in Mild-to-Moderate Dementia

Reducing Systemic Inflammation

Antioxidant Support

Improving Memory in Healthy Older Adults

Mechanism of Action

Frequently Asked Questions

Summary & Expert Opinion

Research Studies

Ginkgo Biloba (2023)

Authors:

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Ginkgo biloba: A Treasure of Functional Phytochemicals with Multimedicinal Applications (2022)

Authors:

Study Quality Assessment:

Ginkgo biloba extract EGb 761® in the symptomatic treatment of mild-to-moderate dementia: a profile of its use (2018)

Authors:

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Review of Ginkgo biloba-induced toxicity, from experimental studies to human case reports (2017)

Authors:

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Efficacy and adverse effects of Ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis (2014)

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Efficacy and tolerability of Ginkgo biloba extract EGb 761® in dementia: a systematic review and meta-analysis of randomized placebo-controlled trials (2014)

Authors:

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

[Ginkgo biloba--effect, adverse events and drug interaction] (2012)

A double-blind, placebo-controlled, randomized trial of Ginkgo biloba extract EGb 761 in a sample of cognitively intact older adults: neuropsychological findings

Findings:

Participants:

Dosage:

Study Quality Assessment:

All Effects:

Effects of Ginkgo biloba in dementia: systematic review and meta-analysis

Authors:

Findings:

Participants:

Study Quality Assessment:

Ginkgo Biloba for Mild Cognitive Impairment and Alzheimer's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Findings:

Participants:

Study Quality Assessment:

All Effects:

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