Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Clinical use of ginkgo biloba

Robert B Saper, MD, MPH
Section Editor
Joann G Elmore, MD, MPH
Deputy Editor
Howard Libman, MD, FACP


Ginkgo biloba, more commonly known as ginkgo, has been used medicinally for over 1000 years [1]. The ginkgo tree is the world's oldest living tree species (picture 1).

Ginkgo was originally utilized by traditional Chinese clinicians for a variety of problems including asthma and digestive disorders [1]. More recently, ginkgo leaf extract has been utilized for its antioxidant properties, for a number of vascular problems, and for the treatment of memory loss, dementia, and macular degeneration [2]. Ginkgo represents one of the most studied and commonly used herbal remedies in the world. The National Health Interview Survey found that ginkgo was the ninth most popular natural product in the United States in 2012 [3]. Over 400 clinical trials have been performed looking at a variety of medicinal properties and clinical uses.


It is thought that there are two main groups of active constituents responsible for ginkgo biloba's medicinal effects: terpene lactones and ginkgo flavone glycosides, which are present in varying concentrations in the leaf of the ginkgo tree [4,5]. Approximately 40 different flavonoids have been isolated, including ginkgetin, bilobetin, and sciadopitysin [6]. Terpenes isolated include a number of ginkgolides and diterpenes, most importantly the ginkgolides A, B, and C along with bilobalide [4].

The bioactive properties of ginkgo biloba extracts are varied. Ginkgo biloba extract appears to alter neurotransmission and provide neuroprotection via a number of mechanisms demonstrated in animal models, including decreased glucose utilization in brain areas mediating somatosensory processing and vigilance [7]. Furthermore, ginkgo reduces the number of peripheral adrenal benzodiazepine receptors, altering corticosteroid secretion [8]. Ginkgo biloba extract also has been shown to protect against age-related changes in the mouse hippocampus [9]. Other studies indicate that ginkgo biloba extract reversibly inhibits monoamine oxidase A and B [10].

Other studies examining the mechanism of action include:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Oct 17, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Lawrence Review of Natural Products. Ginkgo Biloba. Facts and Comparisons, St. Louis 1998.
  2. Lin JH. Evaluating the alternatives. JAMA 1998; 279:706.
  3. Barnes PM, Bloom B, Nahin RL. Complementary and alternative medicine use among adults and children: United States, 2007. Natl Health Stat Report 2008; :1.
  4. Brown D, Gaby A, Reichert R, et al. Clinical Applications of Natural Medicine. In: Dementia and Age-Related Cognitive Decline, Natural Product Research Consultants, Seattle 1997. p.10.
  5. Ude C, Schubert-Zsilavecz M, Wurglics M. Ginkgo biloba extracts: a review of the pharmacokinetics of the active ingredients. Clin Pharmacokinet 2013; 52:727.
  6. Newall CA, Anderson LA, Phillipson JD. Ginkgo Biloba. In: Herbal Medicines: A Guide for Health-Care Professionals, Pharmaceutical Press, London 1996. p.138.
  7. Ginkgo biloba. Altern Med Rev 1998; 3:54.
  8. Marcilhac A, Dakine N, Bourhim N, et al. Effect of chronic administration of Ginkgo biloba extract or Ginkgolide on the hypothalamic-pituitary-adrenal axis in the rat. Life Sci 1998; 62:2329.
  9. Barkats M, Venault P, Christen Y, Cohen-Salmon C. Effect of long-term treatment with EGb 761 on age-dependent structural changes in the hippocampi of three inbred mouse strains. Life Sci 1995; 56:213.
  10. White HL, Scates PW, Cooper BR. Extracts of Ginkgo biloba leaves inhibit monoamine oxidase. Life Sci 1996; 58:1315.
  11. Pizzorno JE, Murray MT. A textbook of natural medicine, John Bastyr College Publications, Seattle 1985.
  12. 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 L. Chem Pharm Bull (Tokyo) 1988; 36:1779.
  13. Drieu K. Preparation and definition of Ginkgo biloba extract. In: Rokan (Ginkgo biloba): Recent Results in Pharmacology and Clinic, Funfgeld EW (Ed), Springer-Verlag, Berlin 1988. p.32.
  14. Oyama Y, Fuchs PA, Katayama N, Noda K. Myricetin and quercetin, the flavonoid constituents of Ginkgo biloba extract, greatly reduce oxidative metabolism in both resting and Ca(2+)-loaded brain neurons. Brain Res 1994; 635:125.
  15. Behl C, Davis JB, Lesley R, Schubert D. Hydrogen peroxide mediates amyloid beta protein toxicity. Cell 1994; 77:817.
  16. Benzi G, Moretti A. Are reactive oxygen species involved in Alzheimer's disease? Neurobiol Aging 1995; 16:661.
  17. Ginkgo Biloba Extract (Egb761) Pharmacological Act and Clinical Application, DeFeudis FV (Ed), Elsevier, Paris 1991.
  18. Murray M. The Healing Power of Herbs, 2nd ed, Prima Publishing, Rocklin, CA 1995. p.147.
  19. Chen X, Salwinski S, Lee TJ. Extracts of Ginkgo biloba and ginsenosides exert cerebral vasorelaxation via a nitric oxide pathway. Clin Exp Pharmacol Physiol 1997; 24:958.
  20. Kobuchi H, Droy-Lefaix MT, Christen Y, Packer L. Ginkgo biloba extract (EGb 761): inhibitory effect on nitric oxide production in the macrophage cell line RAW 264.7. Biochem Pharmacol 1997; 53:897.
  21. Anadere I, Witte S. Hemorrheological findings in patients with completed stroke and the influence of GBE. Clin Hemorrheol 1985; 4:411.
  22. Stern RG, Mohs RC, Davidson M, et al. A longitudinal study of Alzheimer's disease: measurement, rate, and predictors of cognitive deterioration. Am J Psychiatry 1994; 151:390.
  23. Semlitsch HV, Anderer P, Saletu B, et al. Cognitive psychophysiology in nootropic drug research: effects of Ginkgo biloba on event-related potentials (P300) in age-associated memory impairment. Pharmacopsychiatry 1995; 28:134.
  24. Kanowski S, Herrmann WM, Stephan K, et al. Proof of efficacy of the ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi-infarct dementia. Pharmacopsychiatry 1996; 29:47.
  25. Rai GS, Shovlin C, Wesnes KA. A double-blind, placebo controlled study of Ginkgo biloba extract ('tanakan') in elderly outpatients with mild to moderate memory impairment. Curr Med Res Opin 1991; 12:350.
  26. Le Bars PL, Katz MM, Berman N, et al. A placebo-controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group. JAMA 1997; 278:1327.
  27. Schneider LS, DeKosky ST, Farlow MR, et al. A randomized, double-blind, placebo-controlled trial of two doses of Ginkgo biloba extract in dementia of the Alzheimer's type. Curr Alzheimer Res 2005; 2:541.
  28. Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2009; :CD003120.
  29. DeKosky ST, Williamson JD, Fitzpatrick AL, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial. JAMA 2008; 300:2253.
  30. Snitz BE, O'Meara ES, Carlson MC, et al. Ginkgo biloba for preventing cognitive decline in older adults: a randomized trial. JAMA 2009; 302:2663.
  31. Solomon PR, Adams F, Silver A, et al. Ginkgo for memory enhancement: a randomized controlled trial. JAMA 2002; 288:835.
  32. van Dongen MC, van Rossum E, Kessels AG, et al. The efficacy of ginkgo for elderly people with dementia and age-associated memory impairment: new results of a randomized clinical trial. J Am Geriatr Soc 2000; 48:1183.
  33. Carlson JJ, Farquhar JW, DiNucci E, et al. Safety and efficacy of a ginkgo biloba-containing dietary supplement on cognitive function, quality of life, and platelet function in healthy, cognitively intact older adults. J Am Diet Assoc 2007; 107:422.
  34. Kleijnen J, Knipschild P. Ginkgo biloba. Lancet 1992; 340:1136.
  35. Schmidt U, Rabinovici K, Lande S. Einfluss eines Ginkgo biloba Specialextraktes auf doe befomdlickeit bei zerebraler Onsufficizienz. Muench Med Wochenschr 1991; 133(Suppl 1):S15.
  36. Bruchert E, Heinrich SE, Ruf-Kohler P. Wirksamkeit von LI 1370 bei alteren Patienten mit Himleistungsschwache. Multizentrische doppelblindstudie des fachverbandes Deutsher Allegemeinaezte. Muench Med Wochenschr 1991; 133(Suppl 1):S9.
  37. Wesnes K, et al. A double-blind placebo-controlled trial of Tanakan in the treatment of idiopathic cognitive impairment in the elderly. Hum Psychopharmacol 1987; 2:159.
  38. Hopfenmüller W. [Evidence for a therapeutic effect of Ginkgo biloba special extract. Meta-analysis of 11 clinical studies in patients with cerebrovascular insufficiency in old age]. Arzneimittelforschung 1994; 44:1005.
  39. Dodge HH, Zitzelberger T, Oken BS, et al. A randomized placebo-controlled trial of Ginkgo biloba for the prevention of cognitive decline. Neurology 2008; 70:1809.
  40. Schubert H, Halama P. Depressive episode primarily unresponsive to therapy in elderly patients: Efficacy of Ginkgo biloba (EGb 761) in combination with antidepressants. Geriatr Forsch 1993; 3:45.
  41. Lingaerde O, Føreland AR, Magnusson A. Can winter depression be prevented by Ginkgo biloba extract? A placebo-controlled trial. Acta Psychiatr Scand 1999; 100:62.
  42. Zhang WF, Tan YL, Zhang XY, et al. Extract of Ginkgo biloba treatment for tardive dyskinesia in schizophrenia: a randomized, double-blind, placebo-controlled trial. J Clin Psychiatry 2011; 72:615.
  43. Sikora R, Sohn M, Deutz FJ, et al. Ginkgo biloba extract in the therapy of erectile dysfunction. J Urol 1989; 141:188.
  44. Cohen, AJ, Bartlik, BD. Ginkgo biloba for drug-induced sexual dysfunction. Presented at the American Psychiatric Association Annual Meeting, San Diego 1997.
  45. Wheatley D. Triple-blind, placebo-controlled trial of Ginkgo biloba in sexual dysfunction due to antidepressant drugs. Hum Psychopharmacol 2004; 19:545.
  46. Ito TY, Polan ML, Whipple B, Trant AS. The enhancement of female sexual function with ArginMax, a nutritional supplement, among women differing in menopausal status. J Sex Marital Ther 2006; 32:369.
  47. Haguenauer JP, Cantenot F, Koskas H, Pierart H. [Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter double-blind drug vs. placebo study]. Presse Med 1986; 15:1569.
  48. Szczurko O, Shear N, Taddio A, Boon H. Ginkgo biloba for the treatment of vitilgo vulgaris: an open label pilot clinical trial. BMC Complement Altern Med 2011; 11:21.
  49. Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. Clin Exp Dermatol 2003; 28:285.
  50. Evans JR. Ginkgo biloba extract for age-related macular degeneration. Cochrane Database Syst Rev 2013; :CD001775.
  51. Ginkgo Biloba Extract (Egb 761): Pharmacological Activities and Clinical Applications, DeFeudis FV (Ed), Elsevier, Paris p.1991.
  52. Quaranta L, Bettelli S, Uva MG, et al. Effect of Ginkgo biloba extract on preexisting visual field damage in normal tension glaucoma. Ophthalmology 2003; 110:359.
  53. Roncin JP, Schwartz F, D'Arbigny P. EGb 761 in control of acute mountain sickness and vascular reactivity to cold exposure. Aviat Space Environ Med 1996; 67:445.
  54. Gertsch JH, Basnyat B, Johnson EW, et al. Randomised, double blind, placebo controlled comparison of ginkgo biloba and acetazolamide for prevention of acute mountain sickness among Himalayan trekkers: the prevention of high altitude illness trial (PHAIT). BMJ 2004; 328:797.
  55. Chow T, Browne V, Heileson HL, et al. Ginkgo biloba and acetazolamide prophylaxis for acute mountain sickness: a randomized, placebo-controlled trial. Arch Intern Med 2005; 165:296.
  56. Hilton MP, Zimmermann EF, Hunt WT. Ginkgo biloba for tinnitus. Cochrane Database Syst Rev 2013; :CD003852.
  57. Bent S, Goldberg H, Padula A, Avins AL. Spontaneous bleeding associated with ginkgo biloba: a case report and systematic review of the literature: a case report and systematic review of the literature. J Gen Intern Med 2005; 20:657.
  58. Rosenblatt M, Mindel J. Spontaneous hyphema associated with ingestion of Ginkgo biloba extract. N Engl J Med 1997; 336:1108.
  59. Rowin J, Lewis SL. Spontaneous bilateral subdural hematomas associated with chronic Ginkgo biloba ingestion. Neurology 1996; 46:1775.
  60. Gilbert GJ. Ginkgo biloba. Neurology 1997; 48:1137.
  61. Vale S. Subarachnoid haemorrhage associated with Ginkgo biloba. Lancet 1998; 352:36.
  62. Pedroso JL, Henriques Aquino CC, Escórcio Bezerra ML, et al. Ginkgo biloba and cerebral bleeding: a case report and critical review. Neurologist 2011; 17:89.
  63. Destro MW, Speranzini MB, Cavalheiro Filho C, et al. Bilateral haematoma after rhytidoplasty and blepharoplasty following chronic use of Ginkgo biloba. Br J Plast Surg 2005; 58:100.
  64. Kellermann AJ, Kloft C. Is there a risk of bleeding associated with standardized Ginkgo biloba extract therapy? A systematic review and meta-analysis. Pharmacotherapy 2011; 31:490.
  65. Siegers CP. Cytotoxicity of alkylphenols from Ginkgo biloba. Phytomedicine 1999; 6:281.
  66. Pennisi RS. Acute generalised exanthematous pustulosis induced by the herbal remedy Ginkgo biloba. Med J Aust 2006; 184:583.
  67. Hasegawa S, Oda Y, Ichiyama T, et al. Ginkgo nut intoxication in a 2-year-old male. Pediatr Neurol 2006; 35:275.
  68. Herb Contraindications and Drug Interactions, 2nd ed, Brinker F (Ed), Eclectic Medical Publications, Sandy, OR 1998.
  69. Yasui-Furukori N, Furukori H, Kaneda A, et al. The effects of Ginkgo biloba extracts on the pharmacokinetics and pharmacodynamics of donepezil. J Clin Pharmacol 2004; 44:538.
  70. von Moltke LL, Weemhoff JL, Bedir E, et al. Inhibition of human cytochromes P450 by components of Ginkgo biloba. J Pharm Pharmacol 2004; 56:1039.
  71. American Herbal Products Association's Botanical Safety Handbook, McGuffin M, Hobbs C, Upton R, et al (Eds), CRC Press, Boca Raton, FL 1997.
  72. Ramassamy C, Christen Y, Clostre F, Costentin J. The Ginkgo biloba extract, EGb761, increases synaptosomal uptake of 5-hydroxytryptamine: in-vitro and ex-vivo studies. J Pharm Pharmacol 1992; 44:943.
  73. O'Hara M, Kiefer D, Farrell K, Kemper K. A review of 12 commonly used medicinal herbs. Arch Fam Med 1998; 7:523.
  74. www.fda.gov/bbs/topcs/NEWS/2007/NEW01657.html (Accessed on October 09, 2007).
  75. Ang-Lee MK, Moss J, Yuan CS. Herbal medicines and perioperative care. JAMA 2001; 286:208.
  76. Gregory PJ. Seizure associated with Ginkgo biloba? Ann Intern Med 2001; 134:344.
  77. Granger AS. Ginkgo biloba precipitating epileptic seizures. Age Ageing 2001; 30:523.
  78. Kupiec T, Raj V. Fatal seizures due to potential herb-drug interactions with Ginkgo biloba. J Anal Toxicol 2005; 29:755.