Ginkgo biloba: Contraindications. Practice Points. FAQ

Contraindications and Precautions If unusual bleeding or bruising occurs, stop use immediately. Although new clinical evidence suggests that Ginkgo biloba does not affect clotting times, it may be prudent to suspend use for 1 week prior to major surgery. CEREBRAL HAEMORRHAGE AND EPILEPSY Recent, rare case reports have suggested that ginkgo should be used with caution in people with known risk factors for cerebral haemorrhage and epilepsy until further investigation can clarify its safety. Pregnancy Use Not recommended in pregnancy as insufficient reliable evidence is available to determine safety. Practice Points / Patient Counselling • Ginkgo biloba is a complex herb that contains many different active constituents and works by means of multiple mechanisms. Therefore, it has applications in many varied conditions. • It is an effective treatment in conditions of acquired cognitive impairment, including dementia of any degree of severity and intermittent claudication, according to evidence from meta-analyses. • Positive evidence also exists for premenstrual syndrome, sudden deafness, Raynaud’s syndrome and depression when associated with cognitive decline. • Largely based on the herb’s physiological Read more […]

Ginkgo biloba: Significant Interactions

PLATELET INHIBITOR DRUGS Due to its platelet-activating factor antagonist activity, Ginkgo biloba may theoretically enhance the effects of these drugs and increase risk of bruising or bleeding; however, three clinical trials have cast doubt on the clinical significance of this activity — observe patients taking this combination. WARFARIN Theoretically, ginkgo may increase bleeding risk when used together with warfarin; however, two randomised double-blind studies have found that Ginkgo biloba does not affect the pharmacokinetics, pharmacodynamics, INR or clinical effects of warfarin, and two clinical trials have not found evidence of significant effects on bleeding. Due to the potential seriousness of such an interaction, caution is still advised. CHOUNERGIC DRUGS Cholinergic activity has been identified for ginkgo; therefore, combined use may theoretically increase drug activity — observe patients using this combination, although the effects may be beneficial when used under supervision. DOXORUBICIN In vivo research suggests that ginkgo can prevent doxorubicin-induced cardiotoxicity suggesting a potentially beneficial interaction, although no human studies are available to confirm clinical significance. ANTIDEPRESSANT Read more […]

Ginkgo biloba: Uses. Dosage. Adverse Reactions

Other Uses Ginkgo biloba is used for many other indications, including improving connective tissue conditions such as haemorrhoids, common allergies, reducing the effects of exposure to radiation and to prevent some of the complications associated with diabetes. In the UK and other European countries, the cardioprotective effects of EGb 751 in myocardial ischaemia and reperfusion are currently being investigated in preclinical studies. ADJUNCT IN CANCER TREATMENT As a herb with significant antioxidant activity, ginkgo has been used to reduce the toxic side-effects of some chemotherapeutic drugs. Evidence from in vivo studies demonstrate protective effects against nephrotoxicity induced by cisplatin and cardiotoxicity induced by doxorubicin. Clinical trials are not yet available to determine its effectiveness in practice. CANCER PREVENTION A 2005 review puts forward the case that Ginkgo biloba should be more widely used as a safe, preventative agent for reducing cancer incidence. This recommendation is based on results from numerous in vitro and experimental studies showing that ginkgo affects many factors associated with the incidence and mortality of cancer. Dosage Range The recommended dose varies depending Read more […]

Ginkgo biloba: Clinical Use

Ginkgo biloba is a complex herb that contains many different active constituents and works by means of multiple mechanisms. In practice, its therapeutic effect is a result of interactions between constituents and mechanisms, giving it applications in many varied conditions. To date, most of the research conducted in Europe has used a standardised preparation known as EGb 761, available commercially as Rokan, Tanakan or Tebonin. DEMENTIA, MEMORY IMPAIRMENT Ginkgo biloba has been used and studied as a cognitive activator in a variety of populations, such as cognitively intact people, those with cerebral insufficiency, age-related memory impairment, Alzheimer’s dementia or multi-infarct dementia. A 2002 Cochrane review of the scientific literature concluded that Ginkgo biloba produces benefits superior to placebo within 12 weeks’ treatment in people with acquired cognitive impairment, including dementia, of any degree of severity. Cognition, activities of daily living and measures of mood and emotional function show significant benefit for ginkgo compared with placebo. Some clinical studies have also found that EGb 761 improves the capacity of geriatric patients to cope with the stressful demands of daily life. Clinical Read more […]

Ginkgo biloba: Background. Actions

Historical Note Ginkgo biloba is one of the world’s oldest living tree species, earning it the name ‘living fossil’. Its existence can be traced back more than 200 million years and it was commonly found in North America and Europe before the Ice Age. Ginkgo was first introduced into Europe in 1690 by the botanist Engelbert Kaempfer, who described it as the ‘tree with duck feet’. Ginkgo has been used medicinally for many centuries and is now one of the most popular therapeutic agents prescribed in Europe by medical doctors. It has been estimated that in Germany and France, prescriptions for ginkgo make up 1% and 1.3%, respectively, of total prescription sales. Also popular in the United States, it was the top selling herbal medicine in 1999 with sales of US$148 million. Common Name Ginkgo Other Names Adiantifolia, Arbre aux quarante ecus, bai guo ye, duck foot tree, fossil tree, gin-nan, icho, Japanese silver apricot, kew tree, maidenhair tree, salisburia, silver apricot, tempeltrae, temple balm, yinhsing Botanical Name / Family Ginkgo biloba (family Ginkgoaceae) Plant Parts Used In modern times the leaf is used, but traditionally the nut was also used. Chemical Components Important constituents present in Read more […]

Korean ginseng: Practice Points – Patient Counselling. FAQ

Contraindications and Precautions Korean ginseng is generally contraindicated in acute infections with fever, and in persons who are very hot, tense and overly stimulated. Overuse may result in headache, insomnia and palpitation. Ginseng should not be taken concurrently with other stimulants including caffeine and should be discontinued 1 week before major surgery. Use in hypertension should be supervised however it may prove beneficial for this indication. Pregnancy Use Ginseng is traditionally used in Korea as a tonic during pregnancy. The Commission E does not list any restrictions. However, due to the potential teratogenicity of some compounds (ginsenoside Rb1) observed under experimental conditions, ginseng should be used cautiously during the first trimester of pregnancy. In a two-generation rat study, a ginseng extract fed at doses as high as 1 5 mg/kg/day did not produce adverse effects on reproductive performance, including embryo development and lactation. Practice Points / Patient Counselling TRADITIONAL USE Ginseng is traditionally used for deficiency of Qi (energy/life force) manifested by shallow respiration, shortness of breath, cold limbs, profuse sweating and a weak pulse (such as may occur Read more […]

Korean ginseng: Adverse Reactions. Significant Interactions

Adverse Reactions Ginseng abuse syndrome (hypertension, nervousness, insomnia, morning diarrhea, inability to concentrate and skin reactions) has been reported and there has been a report of a 28-year-old woman who had a severe headache after ingesting a large quantity of ethanol-extracted ginseng. Cerebral angiograms showed ‘beading’ appearance in the anterior and posterior cerebral and superior cerebellar arteries, consistent with cerebral arteritis. High doses (1 5 g/day) have been associated with confusion, depression and depersonalisation in four patients. However, the majority of the scientific data suggest that ginseng is rarely associated with adverse events or drug interactions. A systematic review found that the most commonly experienced adverse events are headache, sleep and gastrointestinal disorders. Data from clinical trials suggest that the incidence of adverse events with ginseng mono-preparations is similar to that of placebo. Any documented effects are usually mild and transient. Combined preparations are more often associated with adverse events, but causal attribution is usually not possible. A case of suspected ginseng allergy has recently been reported in the scientific literature. The case Read more […]

Korean ginseng: Other Uses. Dosage

Other Uses GASTROPROTECTION DURING HEART SURGERY In a trial of 24 children undergoing heart surgery for congenital heart defects, 12 children received 1.35 mg/kg ginsenoside compound or placebo intravenously before and throughout the course of cardiopulmonary bypass surgery. Ginseng administration resulted in attenuation of gastrointestinal injury and inflammation. RESPIRA TORY DISEASE Ginseng extract (G115) has been shown significantly (P < 0.05) to improve pulmonary function test, maximum voluntary ventilation, maximum inspiratory pressure and maximal oxygen consumption (VO2max) in a study of 92 patients suffering moderately severe chronic obstructive pulmonary disease (n = 49, G115 100 mg twice daily for 3 months). HEUCOBACTER PYLORI Helicobacter pylori can provoke gastric inflammation, ulceration and DNA damage, resulting in an increased risk of carcinogenesis. As preliminary evidence suggests that Panax ginseng inhibits the growth of Helicobacter pylori and can inhibit adhesion it may be useful as a gastroprotective agent against Helicobacter pylori-associated gastric mucosal cell damage. HIV INFECTION Long-term intake of Korean ginseng slows the depletion of CD4+ T cells and may delay disease progression Read more […]

Korean ginseng: Clinical Use

In the scientific arena, ginseng and the various ginsenosides are used in many forms and administered via various routes. This review will focus primarily on those methods commonly used in clinical practice. CANCER PREVENTION The various anticancer actions of Panax ginseng, as demonstrated in animal and in vitro trials, support its use as an agent to prevent the development and progression of cancer. A 5-year prospective study of 4634 patients over 40 years of age found that ginseng reduced the relative risk of cancer by nearly 50%. A retrospective study of 905 case-controlled pairs taking ginseng showed that ginseng intake reduced the risk of cancer by 44% (odds ratio equal to 0.56). The powdered and extract forms of ginseng were more effective than fresh sliced ginseng, juice or tea. The preventative effect was highly significant (P < 0.001). There was a significant decline in cancer occurrence with increasing ginseng intake (P < 0.05). Epidemiological studies in Korea strongly suggest that cultivated Korean ginseng is a non-organ-specific human cancer preventative agent. In case-control studies, odds ratios of cancer of lip, oral cavity and pharynx, larynx, lung, oesophagus, stomach, liver, pancreas, Read more […]

Korean ginseng: Other Actions

PREVENTION OF DAMAGE FROM TOXINS Ginseng extract has been shown to be beneficial in the prevention and treatment of testicular damage induced by environmental pollutants. Dioxin is one of the most potent toxic environmental pollutants. Exposure to dioxin either in adulthood or during late fetal and early postnatal development causes a variety of adverse effects on the male reproductive system. The chemical decreases spermatogenesis and the ability to conceive and carry a pregnancy to full term. Pretreatment with 100 or 200 mg/kg ginseng aqueous extract intraperitoneally for 28 days prevented toxic effects of dioxin in guinea pigs. There was no loss in body weight, testicular weight or damage to spermatogenesis. In guinea pigs Panax ginseng also improves the survival and quality of sperm exposed dioxin. PROMOTING HAEMOPOIESIS Ginseng is traditionally used to treat anaemia. The total saponin fraction, and specifically Rg1 and Rb1, have been shown to promote haemopoiesis by stimulating proliferation of human granulocyte-macrophage progenitors. ANTIOXIDANT In vitro studies did not find various extracts of ginseng to be particularly potent antioxidants against several different free radicals. However, animal models Read more […]