Ginkgo
CAM (enhances cerebral blood flow, antioxidant, antiinflammatory, reduces beta-amyloid plaques)
- Age-related cognitive decline2
- Dementia (prevention/treatment)2
- Tardive dyskinesia1 (as Tebonin)
- Not studied in vascular depression but may work based on mechanism and ability to improve cognition after stroke.
- Negative symptoms of schizophrenia3, also improves positive symptoms and EPS as augmentation3
- ADHD (augmented stimulants in children)3
- Generalized anxiety disorder3
- Ineffective: sexual dysfunction
Features
Dosing
Ginkgo biloba 120mg/d x7days then 240mg/d (can go up to 480 mg for anxiety).
Prevention of cognitive side effects from ECT: Start 200 mg/day 2 days before ECT, continue until end of treatment.
Post-stroke cognition: Titrate to 450 mg daily, give with 81-100 mg aspirin daily.
Tebonin (egb-761) is a patented ginkgo extract used in cognition and TD trials: Ginkgo extract (EGb-761) 80mg 3 po qd. But it is more expensive.
INTERACTIONS: May increase effects of anticoagulants. Avoid with MAOIs (serotonin syndrome).
Management
Ginkgo (as tebonin) is ranked in neurology practice guidelines for tardive dyskinesia (TD).
In multiple trials of dementia, ginkgo in various forms improved cognition and ADLs at doses greater than 200 mg/day (usually 240 mg/day), but effects delayed (6 months)
TOLERABILITY: Well-tolerated. Nausea, indigestion, headache, dizziness, and palpitations.
RISKS: Avoid in pregnancy. Anticoagulant (stop 2 weeks before surgery).
EMR Text
Cognition
Ginkgo use based on large, randomized controlled trials in cognitive decline due to aging or vascular disease.
Ginkgo side effects reviewed with patient.
TD
Ginkgo use based on large, randomized controlled trials in tardive dyskinesia (Zhang WF et al, J Clin Psychiatry. 2011;72(5):615-21).
Ginkgo side effects reviewed with patient.
Extrapyramidal side effects (EPS, Parkinsonism)
Ginkgo use based on a randomized controlled trial where it treated extrapyramidal side effects of antipsychotics (Mohebbi N et al, Iran J Pharm Res. 2023;22(1):e134722).
Ginkgo side effects reviewed with patient.
Schizophrenia
Ginkgo use based on a randomized controlled trials in negative and positive symptoms of schizophrenia and reduced antipsychotic side effects (including EPS and TD) (Doruk A et al, Int Clin Psychopharmacol. 2008;23(4):223-7; Zhang XY et al, Clin Psychiatry. 2001;62(11):878-83).
Ginkgo side effects reviewed with patient.
ADHD
Ginkgo use based on a randomized placebo-controlled trial in ADHD (Shakibaei F et al, Complement Ther Clin Pract. 2015;21(2):61-7).
Ginkgo side effects reviewed with patient.
Dementia
Ginkgo use based on multiple randomized trials where it improved cognition and functioning in dementia (Yuan Q et al, J Ethnopharmacol. 2017;195:1-9).
Ginkgo side effects reviewed with patient.
Generalized Anxiety Disorder
Ginkgo use based on multiple a randomized, placebo controlled trial in generalized anxiety disorder (Woelk H et al, J Psychiatr Res. 2007;41(6):472-80).
Ginkgo side effects reviewed with patient.
Vascular depression
Ginkgo use based on large randomized trials where it improved cognition in vascular disease, as well as other psychiatric symptoms like anxiety, well being and overall functioning (Li S et al, Stroke Vasc Neurol. 2017;2(4):189-197).
Ginkgo side effects reviewed with patient.