What is it?

Ginkgo is an herbal medicine used to improve memory and concentration, as well as to treat dementia (loss of thinking skills), confusion, ringing in the ears, premenstrual syndrome (PMS), blood circulation problems, vision problems, and vertigo (dizziness).

Other names for ginkgo include: fossil tree, kew tree, maidenhair tree, Ginkgo biloba, oriental plum tree, and silver apricot.

Ask your doctor, nurse, or pharmacist if you need more information about this medicine or if any information in this leaflet concerns you.

Before Using:

Tell your doctor if you

• are taking medicine or are allergic to any medicine (prescription or over-the-counter (OTC) or dietary supplement).
• are pregnant or plan to become pregnant while using this medicine.
• are breastfeeding.
• have a history of seizures (26).
• have any other health problems, such as high blood pressure or heart or blood vessel disease.

Dosage:

Talk with your caregiver about how much ginkgo you should take. The amount depends on the strength of the medicine and the reason you are taking ginkgo. If you are using this medicine without instructions from your caregiver, follow the directions on the medicine bottle. Do not take more medicine or take it more often than the directions tell you to.

To store this medicine:

Keep all medicine locked up and away from children. Store medicine away from heat and direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down and not work the way it should work. Throw away medicine that is out of date or that you do not need. Never share your medicine with others.

Drug and Food Interactions:

Do not take ginkgo without talking to your doctor first if you are taking:

• Blood thinning medicine (examples: warfarin (Coumadin(R)); clopidogrel (Plavix(R)); aspirin; enoxaparin (Lovenox(R)), dalteparin (Fragmin(R))) (9,23,27)
• Medicines used for pain or swelling (examples: ibuprofen (Advil(R), Motrin(R)); naproxen (Aleve(R), Naprosyn(R)); nabumetone (Relafen(R))) (28)
• Medicine for depression (examples: sertraline (Zoloft(R)); paroxetine (Paxil(R)); fluoxetine (Prozac(R)); citalopram (Celexa(R)))
• Medicines for depression or Parkinson's disease (examples: isocarboxazid (Marplan(R)); phenelzine (Nardil(R)); selegiline (Eldepryl(R), Emsam(R), Zelapar(R)); tranylcypromine (Parnate(R))) (30)
• Medicine used for high blood pressure or chest pain (nifedipine (Adalat(R), Procardia(R))) (10)
• Medicine used for high blood pressure or swelling (water pills) (examples: chlorothiazide (Diuril(R)); hydrochlorothiazide (Esidrix(R), Hydro-Par(R), Microzide(TM))) (17)
• Medicine used for seizures or certain types of pain (examples: phenytoin (Dilantin(R)); carbamazepine (Tegretol(R)); gabapentin (Neurontin(R)); valproic acid (Depakote(R)), Depakene(R))) (29)
• Insulin (15)
• Buspirone (BuSpar(R)) (21)
• Papaverine (Para-Time SR(R)) (28)
• Risperidone (Risperidal(R)) (31) (
• Trazodone (Desyrel(R)) (18)
• St John's wort (21)
• Sulfinpyrazone (Anturane(R)) (23,24)
• Omeprazole (Prilosec(R)) (22)

Warnings:

• Before taking ginkgo, tell your doctor if you are pregnant or breastfeeding.
• Before having any surgery, tell your doctor that you take ginkgo. Ginkgo may cause bleeding problems during or after surgery. You may need to stop taking ginkgo before having surgery (4,25).

Side Effects:

Call your doctor right away if you have any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hand, swelling or tingling in your mouth or throat, chest tightness, trouble breathing, or rash
• Blistering, peeling, red skin rash
• Seizure or coma

Other Side Effects:

You may have the following side effects, but this medicine may also cause other side effects. Tell your doctor if you have side effects that you think are caused by this medicine.

• Fast or pounding heartbeat
• Dizziness
• Nausea (upset stomach) or headaches
• Unusual bruising or bleeding

References:

1. Blumenthal M, Busse WR, Goldberg A et al: The Complete Commission E Monographs; Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin, TX; 1998.

2. van Beek TA & Lelyveld GP: Concentration of ginkgolides and bilobalide in Ginkgo biloba leaves in relation to the time of year. Planta Med 1992; 58:413-416.

3. Kleijnen J & Knipschild P: Ginkgo-biloba for cerebral insufficiency. Br J Clin Pharmacol 1992a; 34:353-358.

4. Norred CL & Finlayson CA: Hemorrhage after the preoperative use of complementary and alternative medicines. AANA J 2000; 68:217-220.

5. Cohen AJ & Bartlick B: Ginkgo biloba for antidepressant-induced sexual dysfunction. J Sex Marital Ther 1998; 24:139-143.

6. McGuffin M, Hobbs C, Upton R et al (eds): American Herbal Products Association's Botanical Safety Handbook. CRC Press, Boca Raton, FL; 1997.

7. Wada K, Ishigaki S, Ueda K et al: Studies on the constitution of edible and medicinal plants, I: isolation and identification of 4-O-methylpyridoxine, toxic principle from the seed of Ginkgo biloba. Chem Pharm Bull 1988; 36:1779-1782.

8. Shinozuka K, Umegaki K, Kubota Y et al: Feeding of Ginkgo biloba extract (GBE) enhances gene expression of hepatic cytochrome P-450 and attenuates the hypotensive effect of nicardipine in rats. Life Sci 2002; 70(23): 2783-2792.

9. Hauser D, Gayowski T & Singh N: Bleeding complications precipitated by unrecognized Ginkgo biloba use after liver transplantation. Transpl Int 2002; 15(7):377-379.

10. Smith M, Lin KM & Zheng YP: An open trial of nifedipine-herb interactions: nifedipine with St. John's wort, ginseng, or Ginkgo biloba (abstract). Clin Pharmacol Ther 2001; 69(2):P86.

11. Reynolds JEF (ed): Martindale: The Extra Pharmacopoeia (electronic version). Micromedex, Inc, Englewood, CO; 1997.

12. Fachinformation: Roekan(R):, ginkgo extract: Intersan Gmbh, Ettlingen, Germany; 1996.

13. Fachinformation: Tebonin(R), ginkgo extract. Dr Willmar Schwae Gmbh & Co, Karlsruhe, Germany; 1996.

14. Yagi M, Wada K, Sakata M et al: Studies on the constituents of edible and medicinal plants. IV. Determination of 4'-O-methylpyridoxine in serum of the patient with Gin-nan food poisoning. Yakugaku Zasshi 1993; 113:596-599.

15. Kudolo GB: The effect of 3-month ingestion of Ginkgo biloba extract on pancreatic beta-cell function in response to glucose loading in normal glucose tolerant individuals. J Clin Pharmacol 2000; 40(6):647-654.

16. Sikora R, Sohn M, Deutz F-J et al: Ginkgo biloba extract in the therapy of erectile dysfunction. J Urol 1989; 141:188A.

17. Shaw D, Leon C, Kolev S et al: Traditional remedies and food supplements: a 5-year toxicological study (1991-1995). Drug Safety 1997; 17(5):342-356.

18. Galluzzi S, Zanetti O, Trabucchi M et al: Coma in a patient with Alzheimer's disease taking low-dose trazodone and Ginkgo biloba. J Neurol Neurosurg Psychiatry 2000; 68(5):679-680.

19. Anon: Ginkgo. The Lawrence Review, Facts and Comparisons, St. Louis, MO, USA; 1998.

20. Norred CL & Finlayson CA: Hemorrhage after the preoperative use of complementary and alternative medicines. AANA J 2000; 68:217-220.

21. Spinella M & Eaton LA: Hypomania induced by herbal and pharmaceutical psychotropic medicines following mild traumatic brain injury. Brain Injury 2002; 16(4):359-367.

22. Yin OQP, Tomlinson B, Waye MMY et al: Pharmacogenetics and herb-drug interactions: experience with Ginkgo biloba and omeprazole. Pharmacogenetics 2004; 14(12):841-850.

23. Gilbert GJ: Ginkgo biloba. Neurology 1997; 48:1137.

24. Matthews MK: Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998; 50:1933-1934.

25. Fessenden JM, Wittenborn W & Clarke L: Ginkgo biloba: a case report of herbal medicine and bleeding postoperatively from a laparoscopic cholescystectomy. Am Surg 2001; 67(1):33-35.

26. Gregory PJ: Seizure associated with Ginkgo biloba? Ann Intern Med 2001; 134(4):344.

27. Rosenblatt M & Mindel J: Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997; 336:1108.

28. Meisel C, Johne A & Roots I: Fatal intracerebral mass bleeding associated with Ginkgo biloba and ibuprofen. Atherosclerosis 2003; 167(2):367.

29. Granger AS: Ginkgo biloba precipitating epileptic seizures. Age Ageing 2001; 30(6):523-525.

30. White HL, Scates PW & Cooper BR: Extracts of ginkgo biloba leaves inhibit monoamine oxidase. Life Sci 1996; 58(16):1315-1321.

31. Lin YY, Chu SJ, & Tsai SH: Association between priapism and concurrent use of risperidone and Ginkgo biloba. Mayo Clin Proc 2007; 82(10):1289-1290.