Ginkgo folium

Drug made from whole or cut and dried gingko leaves, which is used medicinally due to its vasodilating and circulation-promoting properties.

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

The quality is laid down 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 heaviness in the legs, cold hands and feet, mild circulatory disorders.

ESCOP - Monograph: Standardized extracts for the symptomatic treatment of mild to moderate dementia syndromes, primary degenerative dementia, vascular dementia, organically induced brain disorders; neurosensory disorders: dizziness, balance disorders, tinnitus; furthermore for the improvement of cognitive performance and symptomatic treatment of peripheral arterial occlusive disease.

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

Improvement of microcirculation, inhibition of platelet aggregation, erythrocyte adhesion, increase of erythrocyte flexibility, reduction of blood viscosity, arteriolar and venous spasms, inactivation of oxygen radicals? Membrane protection through inhibition of radical-induced lipid peroxidation, stabilization of the mitochondrial membrane, improvement of glucose-oxygen uptake and utilization, tolerance of the nerve cell to ischemia and hypoxia, inhibition or accelerated regression of ischemic, metabolic and post-traumatic brain edema, promotion of choline uptake in the hippocampus, regenerative upregulation of age-related reduction in the density of muscarinic choline and alpha-adrenoceptors

Ginkgo leaves contain terpenes (0.03 to 0.25%) mainly as terpene lactones (ginkgoloids A, B, C, bilobalide), flavonol glycosides and bisflavonoids (amentoflavone, gingketin); other ingredients are alicyclic acids (shikimic acid, quinic acid, ascorbic acid, ginkgolic acid and hydroxyginkgolic acid), cyclic polyols (pinite, sequoyite) and sucrose.

2 x up to 120 mg per day, one film-coated tablet in the morning and evening; at least 8 weeks. Observe package insert for finished products.

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

Mild gastrointestinal complaints, dizziness (common); headaches (very common), allergic skin reactions, bleeding in individual organs (especially when taking anticoagulants at the same time)

If taken at the same time as anticoagulants and NSAIDs, an influence on metabolization via CYP450-3A4, -1-A2, - 2C19 cannot be ruled out.
Nifedipine - increased effect. Efavirenz ; possibly decreased plasma concentrations of efavirenz.

Warfarin sodium: Cave altered bleeding time.

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.

Gingium intens 120 film-coated tablets; Gingopret film-coated tablets, Gingopret solution; Ginkgo Sandoz 80 mg/120 mg film-coated tablets, Kaveri 80 mg/120 mg film-coated tablets; Rökan plus 80 mg film-coated tablets, Rökan novo 120 mg film-coated tablets; Tebonin spezial 80 mg film-coated tablets, Tebonin concentrate 240 mg film-coated tablets.

The HMPC , as the European authority, has reviewed the indications for Ginkgo biloba extracts and, based on evaluable data, does not endorse their use for tinnitus or dizziness, nor for peripheral arterial occlusive disease (note: in 2014, 3,000,000 packs of Ginkgo preparations with a total value of 200 million euros were sold in the Federal Republic of Germany).

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.