title: [Ginkgo biloba--effect, adverse events and drug interaction].
abstract: Ginkgo is probably one of the most widely used medicinal herbs  in Europe. In Norway products of ginkgo leaf extract have been approved  by the Norwegian Medicines Agency for the following indication:  traditionally used to improve blood circulation, for example, cold  hands and feet. Elsewhere, ginkgo is used for cognitive impairment  and dementia, acute ischaemic stroke, intermittent claudication,  tinnitus and age-related macular degeneration. Evidence of the efficacy of ginkgo for these indications has  previously been studied by the Cochrane Collaboration. In this update we  have repeated all the searches in Medline and EMBASE exactly as  described in the five Cochrane Systematic Reviews (last search date:  16.02.2011). We identified two new randomised and placebo-controlled  studies on cognitive impairment and dementia (3187 patients) and  one study on acute ischaemic stroke (3069 patients). The results  of these studies gave no reason to change the conclusions of earlier  reviews by the Cochrane Collaboration. There is no convincing evidence that  ginkgo is effective for cognitive impairment or dementia, acute  ischaemic stroke, intermittent claudication or tinnitus. There is still  a lack of conclusive evidence for the effect on age-related macular  degeneration. Ginkgo leaf extract appears to be safe to use, with no excess  side effects compared with placebo. It can cause some minor side  effects such as stomach upset, headache, dizziness, constipation,  forceful heartbeat, and allergic skin reactions. There is some concern  that ginkgo leaf extract might increase the risk of bruising and  bleeding, and interactions with anticoagulants/antiplatelet  drugs cannot be ruled out. As a general precaution, it is recommended  withdrawing ginkgo two weeks before elective surgery.
authors.affiliation: RELIS Midt-Norge, Avdeling for klinisk farmakologi, St. Olavs hospital, Norway. didrik@legemidler.no
authors.forename: Pål-Didrik Hoff
authors.initials: PD
authors.lastname: Roland
authors.forename: Cecilie Sogn
authors.initials: CS
authors.lastname: Nergård
mesh_terms: D003072:Cognition Disorders / Q000188:drug therapy; D003704:Dementia / Q000188:drug therapy; D019317:Evidence-Based Medicine; D020441:Ginkgo biloba / Q000009:adverse effects; D041743:Herb-Drug Interactions; D006801:Humans; D007383:Intermittent Claudication / Q000188:drug therapy; D008268:Macular Degeneration / Q000188:drug therapy; D008517:Phytotherapy / Q000009:adverse effects; D028321:Plant Preparations / Q000009:adverse effects / Q000627:therapeutic use; D020521:Stroke / Q000188:drug therapy; D014012:Tinnitus / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D028321:Plant Preparations