indication

Appears to be effective in: alleviating age-related memory impairment in some elderly people with mild to moderate age-related memory or cognitive impairment; improving cognitive function in healthy young to middle-aged people; improving symptoms of Alzheimer's, vascular or mixed dementia; improving damage to the visual field in patients with normal tension glaucoma; decreasing the number of painful attacks in patients with Raynaud's syndrome; and may improve symptoms of vertigo and dizziness in some patients.

pharmacology

The mechanism by which ginkgo biloba is thought to be effective for these conditions appears to be in part through active "ginkgolides" terpenoids and flavinoids that appear to inhibit platelet aggregation, neutrophil degranulation, and the induction of oxygen-free radical production

mechanism of action

The compounds found in ginkgo may have a protective role in different stages of the decline of intellectual function via several mechanisms of action: vasoregulating activity of arteries, capillaries, and veins (increased blood flow); platelet activating factor (PAF) antagonism; homeostasis of inflammation and oxidative stress; and prevention of cell membrane damage causedby free radicals; and neurotransmission modulation. The most important substances are flavonoids (ginkgo flavone glycosides) and terpenoids (ginkgolides and bilobalide).The compounds inginkgo act to varying degrees as scavengers for free radicals.

toxicity

Fresh seeds are toxic may cause death. Roasted seed and crude ginkgo plant should not be used orally. Consumption of greater than 10 roasted seeds may cause difficulty breathing, weak pulse, seizures, loss of consciousness, and shock. Standardized ginkgo leaf extracts have been used safely in trials lasting several weeks to six years; however, cases of spontaneous hemorrhages have been reported with the conventional use of the standardized extract. As with all medications, individual risk factors must be considered in the assessment of safety of this medication. This medication is well-tolerated at standard oral doses. Ginkgo biloba may cause gastrointestinal upset, headache, dizziness, palpitations, nausea, vomiting, lack of muscle tone and weakness.

drug interactions

Abciximab: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Acenocoumarol: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Acetylsalicylic acid: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Alteplase: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Anagrelide: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Argatroban: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Bivalirudin: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Cilostazol: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Citalopram: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Clopidogrel: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Dabigatran etexilate: Additive anticoagulant/antiplatelet effects of gingko may increase bleed risk for patients on dabigatran. Concomitant therapy should be avoided.

Diclofenac: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Diflunisal: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Dipyridamole: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Enoxaparin: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Eptifibatide: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Escitalopram: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Etodolac: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Fenoprofen: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Fluoxetine: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Flurbiprofen: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Fluvoxamine: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Fondaparinux sodium: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Ginseng: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Heparin: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Ibuprofen: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Indomethacin: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Ketoprofen: Increased risk of bleeding due to additive antiplatelet properties of the two agents. Concomitant therapy should be avoided or monitored carefully for bleeding, bruising and altered mental status, which may be caused by CNS bleeds.

Ketorolac: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Lepirudin: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Meclofenamic acid: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Meloxicam: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Nabumetone: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Naproxen: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Oxaprozin: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Paroxetine: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Piroxicam: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Prasugrel: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Reteplase: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Rivaroxaban: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

S-Adenosylmethionine: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Sertraline: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Sulindac: Ginkgo biloba may enhance the anticoagulant effect of sulindac. Increased risk of bleeding, bruising and altered mental status due to CNS bleeds. Concomitant therapy should be avoided.

Tacrine: Ginkgo biloba may cause additive/toxic cholinergic effects when administered with Tacrine. Monitor for cholinergic toxicity.

Tenecteplase: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Tiaprofenic acid: Increased risk of bleeding due to additive antiplatelet properties of the two agents. Concomitant therapy should be avoided or monitored carefully for bleeding, bruising and altered mental status, which may be caused by CNS bleeds.

Ticlopidine: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Tirofiban: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.

Tolmetin: Increased risk of bleeding due to additive antiplatelet properties of the two agents. Concomitant therapy should be avoided or monitored carefully for bleeding, bruising and altered mental status, which may be caused by CNS bleeds.

Trazodone: Increased effect and toxicity of both agents

Urokinase: Increased risk of bleeding.

Warfarin: Additive anticoagulant/antiplatelet effects may increase bleed risk. Concomitant therapy should be avoided.