Ginkgo biloba Extracts Like EGb 761^® for Treatment of Non Common Indications – A Selection of Clinical Studies

Abstract

Extracts of Ginkgo biloba L. are one of the most commonly applied herbal medicines. The active constituents are flavonol glycosides and terpene trilactones in particular. The special extract EGb 761^® is mentioned in the German S3 clinical guideline “Demenzen” as treatment option (“kann” recommendation). Some small- and large-scale clinical studies for Ginkgo biloba leaf extracts are summarized in this publication for the indications: Tardive dyskinesia, vitiligo, anxiety/anxiety disorder, visual impairment, mountain sickness, sudden hearing loss, attention deficient hyperactivity disorder (ADHD) in children and fatigue. The studies are of different quality and show variable results. More research is warranted to draw conclusions about the effectiveness of Ginkgo biloba extracts for those indications.

Zusammenfassung

Extrakte aus Ginkgo biloba L. sind eines der am häufigsten verwendeten pflanzlichen Arzneimittel. Die aktiven Bestandteile stellen vor allem die Flavonolglykoside und die Terpentrilactone dar. Der Spezialextrakt EGb 761^® ist in der deutschen S3-Leitlinie „Demenzen“ mit einer „kann-Empfehlung“ als Behandlungsoption genannt. Extrakte aus Ginkgo-biloba-Blättern werden darüber hinaus auch klinisch für weitere Indikationen genutzt. Einige klein und groß angelegte klinische Studien zu Ginkgo-biloba-Spezialextrakten sind in dieser Publikation für folgende Krankheitsbilder zusammengefasst: Spätdyskinesie, Vitiligo, Angst/Angststörung, Sehstörungen, Höhenkrankheit, Hörsturz, Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) bei Kindern und Fatigue. Die Studien variieren hinsichtlich ihrer Qualität und zeigen unterschiedliche Ergebnisse. Weitere Untersuchungen sind erforderlich, um Schlussfolgerungen über die Wirksamkeit von Ginkgo-biloba-Extrakten bei diesen Indikationen zu ziehen.

Publication History

Article published online:
05 December 2023

• References

• 1 Kulic Z, Lehner MD, Dietz GPH. Ginkgo biloba leaf extract EGb 761^® as a paragon of the product by process concept. Front Pharmacol 2022; 13: 1007746 DOI: 10.3389/fphar.2022.1007746.
• 2 Chan ES, Bautista DT, Zhu Y. et al. Traditional Chinese herbal medicine for vascular dementia. Cochrane Database Syst Rev 2018; 12: CD010284 DOI: 10.1002/14651858.CD010284.pub2.
• 3 Koltringer P, Eber O, Klima G. et al. [Microcirculation in parenteral Ginkgo biloba extract therapy]. Wien Klin Wochenschr 1989; 101: 198-200
• 4 Birks J, Grimley Evans J. Ginkgo biloba for cognitive impairment and dementia. Cochrane Database Syst Rev 2009; CD003120 DOI: 10.1002/14651858.CD003120.pub3.
• 5 Pincemail J, Dupuis M, Nasr C. et al. Superoxide anion scavenging effect and superoxide dismutase activity of Ginkgo biloba extract. Experientia 1989; 45: 708-712 DOI: 10.1007/BF01974564.
• 6 Achete de Souza G, de Marqui SV, Matias JN. et al. Effects of Ginkgo biloba on diseases related to oxidative stress. Planta Med 2020; 86: 376-386 DOI: 10.1055/a-1109-3405.
• 7 European Medicines Agency. Ginkgo folium. Zugriff am 30.10.2023 https://www.ema.europa.eu/en/medicines/herbal/ginkgo-folium
• 8 European Directorate For The Quality Of Medicines & Healthcare. European Pharmacopoeia (Ph. Eur). 10^th Ed. 2020
• 9 Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) und Deutsche Gesellschaft für Neurologie (DGN). S3-Leitlinie „Demenzen“ Langversion. 2016; Zugriff am 30.10.2023 https://register.awmf.org/assets/guidelines/038-013l_S3-Demenzen-2016-07.pdf
• 10 Fleischhacker WW, Hofer A, Jagsch C. et al. [Antipsychotic-induced tardive syndromes]. Neuropsychiatr 2016; 30: 123-130 DOI: 10.1007/s40211-016-0189-7.
• 11 Ricciardi L, Pringsheim T, Barnes TRE. et al. Treatment recommendations for tardive dyskinesia. Can J Psychiatry 2019; 64: 388-399 DOI: 10.1177/0706743719828968.
• 12 Zhang XY, Zhou DF, Zhang PY. et al. A double-blind, placebo-controlled trial of extract of Ginkgo biloba added to haloperidol in treatment-resistant patients with schizophrenia. J Clin Psychiatry 2001; 62: 878-883 DOI: 10.4088/jcp.v62n1107.
• 13 Hoenders HJR, Bartels-Velthuis AA, Vollbehr NK. et al. Natural medicines for psychotic disorders: A systematic review. J Nerv Ment Dis 2018; 206: 81-101 DOI: 10.1097/NMD.0000000000000782.
• 14 Zhang XY, Zhou DF, Su JM, Zhang PY. The effect of extract of Ginkgo biloba added to haloperidol on superoxide dismutase in inpatients with chronic schizophrenia. J Clin Psychopharmacol 2001; 21: 85-88 DOI: 10.1097/00004714-200102000-00015.
• 15 Correll CU, Citrome LL. Measurement-based diagnosis and treatment for tardive dyskinesia. J Clin Psychiatry 2021; 82: NU20016AH2C DOI: 10.4088/JCP.NU20016AH2C.
• 16 Tanemura A. Understanding of pathomechanisms and clinical practice for vitiligo. Ann Dermatol 2023; 35: 333-341 DOI: 10.5021/ad.23.065.
• 17 Bergqvist C, Ezzedine K. Vitiligo: A review. Dermatology 2020; 236: 571-592 DOI: 10.1159/000506103.
• 18 Parsad D, Pandhi R, Juneja A. Effectiveness of oral Ginkgo biloba in treating limited, slowly spreading vitiligo. Clin Exp Dermatol 2003; 28: 285-287 DOI: 10.1046/j.1365-2230.2003.01207.x.
• 19 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 DOI: 10.1186/1472-6882-11-21.
• 20 Cohen BE, Elbuluk N, Mu EW, Orlow SJ. Alternative systemic treatments for vitiligo: A review. Am J Clin Dermatol 2015; 16: 463-474 DOI: 10.1007/s40257-015-0153-5.
• 21 Kwak YT, Yang Y, Koo MS. Anxiety in dementia. Dement Neurocogn Disord 2017; 16: 33-39 DOI: 10.12779/dnd.2017.16.2.33.
• 22 Bachinskaya N, Hoerr R, Ihl R. Alleviating neuropsychiatric symptoms in dementia: the effects of Ginkgo biloba extract EGb 761. Findings from a randomized controlled trial. Neuropsychiatr Dis Treat 2011; 7: 209-215 DOI: 10.2147/NDT.S18741.
• 23 Gavrilova SI, Preuss UW, Wong JW. et al. Efficacy and safety of Ginkgo biloba extract EGb 761 in mild cognitive impairment with neuropsychiatric symptoms: a randomized, placebo-controlled, double-blind, multi-center trial. Int J Geriatr Psychiatry 2014; 29: 1087-1095 DOI: 10.1002/gps.4103.
• 24 Scripnikov A, Khomenko A, Napryeyenko O, Group G-NS. Effects of Ginkgo biloba extract EGb 761 on neuropsychiatric symptoms of dementia: findings from a randomised controlled trial. Wien Med Wochenschr 2007; 157: 295-300 DOI: 10.1007/s10354-007-0427-5.
• 25 Eckmann F. [Cerebral insufficiency--treatment with Ginkgo-biloba extract. Time of onset of effect in a double-blind study with 60 inpatients]. Fortschr Med 1990; 108: 557-560
• 26 Szuhany KL, Simon NM. Anxiety disorders: A review. JAMA 2022; 328: 2431-2445 DOI: 10.1001/jama.2022.22744.
• 27 Woelk H, Arnoldt KH, Kieser M, Hoerr R. Ginkgo biloba special extract EGb 761 in generalized anxiety disorder and adjustment disorder with anxious mood: a randomized, double-blind, placebo-controlled trial. J Psychiatr Res 2007; 41: 472-480 DOI: 10.1016/j.jpsychires.2006.05.004.
• 28 WHO, World Health Organization. Blindness and visual impairment. Zugriff am: 27.10.2023 https://www.who.int/news-room/fact-sheets/detail/blindness-and-visual-impairment
• 29 Fies P, Dienel A. [Ginkgo extract in impaired vision--treatment with special extract EGb 761 of impaired vision due to dry senile macular degeneration]. Wien Med Wochenschr 2002; 152: 423-426 DOI: 10.1046/j.1563-258x.2002.02066.x.
• 30 Wimpissinger B, Berisha F, Garhoefer G. et al. Influence of Ginkgo biloba on ocular blood flow. Acta Ophthalmol Scand 2007; 85: 445-449 DOI: 10.1111/j.1600-0420.2007.00887.x.
• 31 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: 296-301 DOI: 10.1001/archinte.165.3.296.
• 32 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 DOI: 10.1136/bmj.38043.501690.7C.
• 33 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: 445-452
• 34 Tsai TY, Wang SH, Lee YK, Su YC. Ginkgo biloba extract for prevention of acute mountain sickness: a systematic review and meta-analysis of randomised controlled trials. BMJ Open 2018; 8: e022005 DOI: 10.1136/bmjopen-2018-022005.
• 35 Burschka MA, Hassan HA, Reineke T. et al. Effect of treatment with Ginkgo biloba extract EGb 761 (oral) on unilateral idiopathic sudden hearing loss in a prospective randomized double-blind study of 106 outpatients. Eur Arch Otorhinolaryngol 2001; 258: 213-219 DOI: 10.1007/s004050100343.
• 36 Uebel-von Sandersleben H, Rothenberger A, Albrecht B. et al. Ginkgo biloba extract EGb 761^® in children with ADHD. Z Kinder Jugendpsychiatr Psychother 2014; 42: 337-347 DOI: 10.1024/1422-4917/a000309.
• 37 Cieza A, Maier P, Poppel E. Effects of Ginkgo biloba on mental functioning in healthy volunteers. Arch Med Res 2003; 34: 373-381 DOI: 10.1016/j.arcmed.2003.05.001.
• 38 Johnson SK, Diamond BJ, Rausch S. et al. The effect of Ginkgo biloba on functional measures in multiple sclerosis: a pilot randomized controlled trial. Explore (NY) 2006; 2: 19-24 DOI: 10.1016/j.explore.2005.10.007.