344 /GINKGO PDR FOR HERBAL MEDICINESPRECAUTIONS AND ADVERSE REACTIONS
General: Health risks or side effects following the proper
administration of designated therapeutic dosages are not
recorded. Mild gastrointestinal complaints could occur as
side effects (Cohen, 1998). Also, blood pressure problems,
allergic reactions and phlebitis have occasionally been
documented after parenteral administration. Allergic skin
reactions have been observed on extremely rare occasions.
The possible hypersensitivity reactions consist of occurrence
of spasms and cramps and, in cases of acute toxicity, atonia
and adynamia.Fertility: Ginkgo has adverse effects on oocytes (Ondrizek,
1999):Hematologic Effects: Spontaneous bilateral subdural hemato-
mas, subarachnoid hemorrhage and an increase in bleeding
time have been associated with chronic Ginkgo biloba
ingestion (Rowin, 1996; Vale. 1998).Drug Interactions: Antithrombolytic Agents (anticoagulants,
antiplatelets and aspirin) — Spontaneous bleeding has been
associated with the herb due to its potent inhibitory effect on
the platelet-activating factor (PAF). Case reports involving
the herb associated with subarachnoid hemorrhage and
intracerebral hemorrhage suggests an additional risk of
intracerebral hemorrhage with the use of thrombolytic
therapy (Matthews, 1998; Rowin, 1996; Vale, 1998).DOSAGE
Mode of Administration: Ginkgo is available in liquid or
solid pharmaceutical forms, for oral intake and parenterally
for homeopathic use.How Supplied:
Capsules—30 mg, 40 mg, 50 mg, 60 mg, 100 mg, 120 mg,
260 mg, 400 mg, 420 mg, 440 mg, 450 mg, 500 mgExtract—50:1Liquid—40mg/5mLTablets—30 mg, 40 mg, 60 mg, 80 mg, 120 mg, 260 mg
Daily Dosage: Ginkgo biloba extract should be standardized
to contain 24% flavone and 6% terpene lactones: 40 to 80
mg three times a day (van Beek, 1998). Studies have
demonstrated efficacy with 120 mg daily in 2 to 3 divided
doses for dementia, peripheral arterial occlusive disease and
for equilibrium disorders like tinnitus or vertigo (Cesarani,
1998; Le Bar, 1998; Peters, 1998).Chinese Medicine: In traditional Chinese medicine, the daily
dose is 3 to 6 g of leaves as an infusion.
Homeopathic Dosage: 5 drops, 1 tablet or 10 globules every
30 to 60 minutes (acute) or 1 to 3 times daily (chronic);
parenterally: 1 to 2 ml acute, 3 times daily; chronic: once a
day (HAB1).
Storage: Ginkgo must be protected from light and moisture.
LITERATURE
American Psychiatric Association (Ed.), DSM-IV. Diagnostic
and Statistical Manual of Mental Disorders, 4th Ed. R. R.
Donnelly & Sons Company 1994.
Amling R. Phytotherapeutika in der Neurologic In: ZPT
12(1):9. 1991.
Anonym. Ginkgo und Crataegus. In: DAZ 137(20): 1751-1753.
1997.
Anonym. Phytopharmaka fur altere Menschen: Ginkgo, Kava,
Hypericum und Crataegus. In: DAZ 135(5):400-402. 1995.
Anonym. Psycho-Phytos: Ginkgo, Johanniskraut und Kava-Kava.
In: DAZ 135(18): 1632-1634. 1995.
Bach D, Behandlung der benignen Prostatahypertrophie. In: ZPT
17(4):209-218. 1996.
Bauer R, Zschocke S, Medizinische Anwendung von Ginkgo
biloba Geschichtliche Entwicklung. In: ZPT 17(5):275-283.
1996.
Beske F, Kunczik T, (1991) Fruhzeitige Therapie kann
Milliarden sparen. Der Kassenarzt 42:36-42.
Blaha L, (1989) Differential diagnose der zerebralen Insuffizienz
in der Praxis. Geriatrie und Rehabilitation 2,1:23-28.
Braquet P (Ed.), Ginkgolides. Chemistry, Biology,
Pharmacology and Clinical Perspectives. Vol I. JR Prous
Science, Barcelona 1988.
Braquet P (Ed.), Ginkgolides. Chemistry, Biology,
Pharmacology and Clinical Perspectives. Vol II, JR Prous
Science, Barcelona 1989.
Briichert E, Heinrich SE, Ruf-Kohler P, (1991) Wirksamkeit
von LI 1370 bei alteren Patienten mit Hirnleistungsschwache.
Munch Med Wschr 133(Suppl 1):9-14.
Bundesgesundheitsamt, (1991) Empfehlungen zum
Wirksamkeitsnachweis von Nootropika im Indikationsbereich
"Demenz" (Phase HI). Bundesgesundheitsblatt 7:342-350.
Burkard G, Lehrl S, (1991) Verhaltnis von Demenzen vom
Multiinfarkt- und vom Alzheimertyp in arztlichen Praxen.
Munch Med Wschr 133(Supp. l):38-43.
Caesar W, Alles uber Ginkgo. In: DAZ 134(44):4363. 1994.
Cesarani A, Meloni F, Alpini D et al., Ginkgo biloba (EGb
761) in the treatment of equilibrium disorders. Adv Ther 1998
Sep-Oct;15(5):291-304.
Chung KF, Dent G, McCusker M et al., Effect of a ginkgolide
mixture (BN 52063) in antagonising skin and platelet responses
to platelet activating factor in man. Lancet 1987 Jan
31;1(8527):248-51.
Cohen AJ & Bartlick B: Ginkgo biloba for antidepressent-
induced sexual dysfunction. J Sex Marital Ther 1998; 24:139-
143.