Ginkgo folium

Authors: Prof. Dr. med. Peter Altmeyer, Prof. Dr. med. Martina Bacharach-Buhles

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Last updated on: 05.08.2023

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Synonym(s)

Folia Gingko; Folia ginkgo gonis; ginkgo biloba; Ginkgo leaves

Definition
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Drug made from whole or cut and dried ginkgo leaves, which are used medicinally for their vasodilatory and circulation-enhancing properties.

Ginkgo leaves are often used in geriatric medicine; here in symptomatic treatment of brain-organic performance disorders (dementia syndrome) with the following leading symptoms: memory and concentration disorders, depressive moods, dizziness (H91.-), tinnitus (H93.-) and headaches.

The quality is defined in the European Pharmacopoeia (Ph. Eur.).

HMPC monograph: Ginkgo leaves in the form of dry extracts (DEV 35-67:1, extractant acetone 60%) well-established use: improvement of age-related cognitive impairment, improvement of quality of life.

Ginkgo leaves in powder form: traditional-use. Traditionally also used for feeling of heaviness in the legs, cold hands and feet, mild circulatory disorders.

ESCOP - Monograph: Standardized extracts for symptomatic treatment of mild to moderate dementia syndromes, primary degenerative dementia, vascular dementia, brain-organic performance disorders, neurosensory disorders: dizziness, balance disorders, tinnitus. Furthermore to improve cognitive performance and symptomatic treatment of peripheral arterial occlusive diseases.

Commission E: Dry extracts (DEV 35-67:1, extractant acetone/water): as for ESCOP.

Pharmacodynamics (Effect)
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Improvement of microcirculation, inhibition of platelet aggregation, erythrocyte adhesion, increase of erythrocyte flexibility, reduction of blood viscosity, arterioles and vein spasms Inactivation of oxygen radicals? Membrane protection by inhibition of radical-induced lipid peroxidation, stabilization of the mitochondrial membrane, improvement of glucose-oxygen uptake and utilization, tolerance of the nerve cell against ischemia and hypoxia, inhibition or accelerated regression of ischemic, metabolic and post-traumatic brain edema, promotion of choline uptake into the hippocampus, regression of age-related reduction of muscarinergic choline receptors and alpha-adrenoreceptors

Spectrum of action
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Ginkgo leaves contain terpenes (0.03 to 0.25%) mainly as terpene lactones (ginkgoloids A, B, C, bilobalide), flavonyglycosides and bisflavonoids (amentoflavone, gingketin); further ingredients are alicyclic acids (shikimic acid, quinic acid, ascorbic acid, ginkgol acid and hydroxygingolic acid), cyclic polyols (pinite, sequoyite), as well as sucrose.

Dosage and method of use
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2 x up to 120 mg per day, one film-coated tablet in the morning and one in the evening; at least 8 weeks. For finished products, see package insert.

Single dose: 120-240 mg; daily dose 240 m

Undesirable effects
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Mild gastrointestinal complaints, headache, allergic skin reactions, bleeding into individual organs (especially when taking anticoagulants at the same time
)Very common: headache, common: dizziness, gastrointestinal disordersFrequent: diarrhoea, abdominal pain, nausea, vomiting

Interactions
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In case of concomitant use with anticoagulants and NSA, an influence on metabolization via CYP450-3A4, -1-A2, - 2C19 cannot be excluded.
Nifedipine - effect enhancement. Efavirenz ; decreased plasma concentrations of efavirenz, if any.

Warfarin sodium: cave altered bleeding time.

Contraindication
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Hypersensitivity to Ginkgo biloba extracts, pregnancy and lactation; not recommended for children and adolescents under 18 years of age. Do not combine with warfarin sodium if bleeding time is altered.

Preparations
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Gingiumintens 120 film tablets, Gingopret film tablets, Gingopret solution, Ginkgo Sandoz 80 mg/120 mgfilm tablets, Kaveri80 mg/120 mgfilm tablets, Rökan plus 80 mg film tablets, Rökannovo 120 mg film tablets, Tebonin special 80 mg film tablets, Tebonin intensive 120 mg film tablets, Tebonin concentrate 240 mg film tablets.

Note(s)
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The HMPC as European authority has reviewed the indications of Ginkgo biloba extracts and, based on evaluable data, does not recommend their use in cases of tinnitus or dizziness, nor in cases of peripheral arterial occlusive disease (Note: In 2014, 3,000,000 packages of gingko preparations with a total value of 200 million Euros were sold in the Federal Republic of Germany.

Literature
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  1. Beck SM et al. (2016) Effects of Ginkgo biloba extract EGb 761® on cognitive control functions, mental activity of the prefrontal cortex and stress reactivity in elderly adults with subjective memory impairment - a randomized double-blind placebo-controlled trial. Hum Psychopharmacol 31:227-242.
  2. Dias MA et al (2015) The chemopreventive effect of Ginkgo biloba extract 761 against cisplatin ototoxicity: a pilot study. Int Tinnitus J 19:12-19.
  3. Deng Y et al. (2016) Effect of Ginkgo Biloba Extract on the Pharmacokinetics and Metabolism of Clopidogrel in Rats. Phytother Res doi: 10.1002/ptr.5691.European Union herbal monography on Ginkgo L, folium-Final, Jan 28, 2015.
  4. Koo JW et al. (2015) The efficacy and safety of systemic injection of Ginkgo biloba extract, EGb761, in idiopathic sudden sensorineural hearing loss: a randomized placebo-controlled clinical trial. Eur Arch Otorhinolaryngol 273:2433-2541.
  5. Krauss P et al. (2016) Therapeutic Value of Ginkgo biloba Extract EGb 761® in an Animal Model (Meriones unguiculatus) for Noise Trauma Induced Hearing Loss and Tinnitus. PLoS One. 11(6):e0157574.
  6. Wu Y et al. (2016) Study of neuroprotective function of Ginkgo biloba extract (EGb761) derived-flavonoid monomers using a three-dimensional stem cell-derived neural model. Biotechnol Prog 32:735-744.
  7. Zamberlam CR et al. (2016) Effects of standardized Ginkgo biloba extract on the acquisition, retrieval and extinction of conditioned suppression: Evidence that short-term memory and long-term memory are differentially modulated. Physiol Behav 165:55-68.
  8. Zheng W et al. (2016) Extract of Ginkgo biloba for Tardive Dyskinesia: Meta-analysis of Randomized Controlled Trials. Pharmacopsychiatry 49:107-111.
  9. https://www.ema.europa.eu/en/documents/herbal-monograph/final-european-union-herbal-monograph-ginkgo-biloba-l-folium_en.pdf
  10. https://arzneipflanzenlexikon.info/ginkgo.php.
  11. Wenigmann M. (2017) Phytotherapy medicinal drugs, phytopharmaceuticals, application. Urban & Fischer, pp. 112-114
  12. Miller LG (1998) Herbal medicinals: selected clinical considerations focusing on known or potential drug-herb interactions. Arch Intern Med. 9;158(20):2200-2211. doi: 10.1001/archinte.158.20.2200. PMID: 9818800.