✓ No active regulatory warningsFDA MedWatch, EMA EudraVigilance, WHO VigiBase, WADA Prohibited List · 2026-05-29
⚠ Patient on anticoagulant + ginkgo — spontaneous hemorrhage cases reported. Discontinue pre-surgery [1]
⚠ Patient buying ginkgo to PREVENT dementia — GEM trial was negative; redirect expectations [2]
⚠ Patient with existing dementia — ginkgo 240 mg/day (EGb 761) may provide modest benefit comparable to cholinesterase inhibitors [3]
⚠ Ginkgo SEEDS (not leaves) contain ginkgotoxin — seizure risk with overconsumption [1]
ℹ️ Not obtained from food. Not applicable — this is not obtained from food in meaningful amounts; supplementation is the practical route.
🔬 Lab interpreter
Recommended test
No routine monitoring for healthy users
No routine monitoring for healthy users
Reference range / target
N/A
N/A
Monitor INR if combining with warfarin [1].
Full lab monitoring ↓⚕ For professionals — confirm ranges against your local laboratory.
Clinical verdict
GEM trial killed the dementia-prevention claim — 3,069 elderly adults, 6+ years, NO benefit. But ginkgo may modestly help EXISTING dementia (comparable to cholinesterase inhibitors). Bleeding risk from PAF inhibition — discontinue 2 weeks before surgery. Prescription drug in Germany/France for cognitive impairment. EGb 761 is the only extract worth recommending [1] [2] [3].
1 How much do I need?
👤 Adults: Specific dosage data under clinical review
👴 Elderly: Specific dosage data under clinical review
🤰 Pregnancy: See guidance
Antiplatelet activity — avoid in pregnancy [1].
👦 Pediatric: See guidance
No pediatric data. Not recommended for children [1].
🏃 Athletes: Standard dose
⚖️ Obesity: Standard dose
Fat-soluble compounds may require dose adjustment in obesity.
🩺 Renal: Consult specialist
Dose adjustment may be needed in renal impairment.
🌱 Vegan: Standard dose
How to take
🍽 Timing: 120 mg BID or 240 mg once daily. 4–6 weeks for effect [3].
💊 With food: Take with food to reduce GI upset [1].
🚫 Avoid: Anticoagulants/antiplatelets without monitoring. Surgery within 2 weeks. Ginkgo seeds in excess [1].
2 Which form?
| Form | Bioavailability | Vegan | Cost |
|---|---|---|---|
| ['EGb 761 (Tebonin, Tanakan)', 'preferred', 'Standardized to 24% flavonoid glycosides + 6% terpene lactones. Gold-standard extract used in virtually all major clinical trials [3].'] | Standard | Check label | |
| ['Generic ginkgo extract', 'common', 'Should be standardized to 24/6 ratio. Quality varies. Ensure removal of ginkgolic acids (<5 ppm — potential allergen and toxin) [1].'] | Standard | Check label | |
| ['Dried leaf / tea', '', 'Non-standardized. Variable potency. Not recommended for therapeutic use [1].'] | Standard | Check label |
3 Common questions
Does ginkgo prevent dementia? ▼
No. The GEM trial (n=3,069), the largest and most rigorous study, showed NO benefit for dementia prevention in elderly adults taking 240 mg/day for 6+ years [2]. Ginkgo should NOT be marketed for dementia prevention.
Does ginkgo help existing dementia? ▼
Meta-analyses suggest modest cognitive improvement in existing dementia (Alzheimer's and vascular) with 240 mg/day EGb 761 — effect sizes comparable to cholinesterase inhibitors [3]. It is used as a prescription drug for this in Germany and France.
Is ginkgo safe with blood thinners? ▼
Caution needed. Ginkgo inhibits PAF and has antiplatelet effects. Cases of spontaneous hemorrhage (subdural hematoma, hyphema) have been reported. Discontinue 2 weeks before surgery [1].
Can healthy people benefit? ▼
No convincing evidence that ginkgo improves cognition in healthy young or middle-aged adults [2].
4 Clinical evidence
Strong
EGb 761 increases cerebral blood flow (measured by Doppler and PET imaging) [1]. PAF inhibition and antiplatelet effects are well-established pharmacologically [1]. GEM trial (n=3,069): NO benefit for dementia prevention or cognitive decline prevention in elderly [2]. HIGH
Moderate
Existing dementia (Alzheimer + vascular): meta-analyses show modest improvement in cognitive scores with 240 mg/day EGb 761 — effect size similar to cholinesterase inhibitors [3]. Intermittent claudication (PAD): some evidence for modest improvement in walking distance [1]. Tinnitus: mixed results; some European trials positive [1]. Anxiety: one small positive trial (EGb 761 480 mg/day) [1]. MODERATE
Insufficient
5 Safety, toxicity & adverse events
Absolute contraindications
✕ Active bleeding or hemorrhagic stroke
Relative
⚠ Concurrent anticoagulants/antiplatelets — PAF antagonism increases bleeding risk
⚠ Concurrent CYP2C19 substrates (omeprazole, clopidogrel) — ginkgo induces CYP2C19
⚠ Seizure disorders — ginkgotoxin (4-O-methylpyridoxine) in poorly purified extracts may lower seizure threshold
⚠ Surgery — discontinue 2 weeks before
⚠ Diabetes with concurrent antidiabetics — may alter glucose levels
🚩 Red flags
● Spontaneous bruising or bleeding in ginkgo user — stop immediately [1]
● Patient on warfarin with falling INR despite stable dose — ask about ginkgo (CYP effects variable) [3]
● Seizures after consuming large quantity of ginkgo seeds — ginkgotoxin poisoning; give IV pyridoxine [1]
6 Interactions
Drug interactions
Warfarin/DOACs/antiplatelet agents Major
Mechanism: PAF inhibition + antiplatelet effects. Additive bleeding risk. [1]
Effect: Spontaneous hemorrhage. Cases of subdural hematoma reported. [1]
Action: Avoid combination or monitor closely. Discontinue ginkgo 2 weeks before surgery [1].
NSAIDs (ibuprofen, aspirin) Moderate
Mechanism: Additive antiplatelet effects via PAF and COX pathways. [1]
Effect: Increased bleeding risk. [1]
Action: Monitor for signs of bleeding [1].
Supplement synergies
Bacopa monnieri · 300 mg bacopa (50% bacosides)
Different nootropic mechanisms (ginkgo: cerebral blood flow; bacopa: cholinergic). Commonly combined in cognitive stacks [1].
Different nootropic mechanisms (ginkgo: cerebral blood flow; bacopa: cholinergic). Commonly combined in cognitive stacks [1].
7 Regulatory
United States (FDA): Dietary supplement. No approved health claims [1].
Germany/France: EGb 761 is a prescription drug for cognitive disorders and peripheral arterial disease [3].
European Union: EMA: 'well-established use' for cognitive impairment and PAD [3].
South Korea/Japan: Available as dietary supplement and pharmaceutical.
8 References (3)
[1]National Institutes of Health, NCCIH. Ginkgo. Updated 2024. www.nccih.nih.gov REVIEW Accessed: 2026-05-29
[2]DeKosky ST, et al. Ginkgo biloba for prevention of dementia: a randomized controlled trial (GEM). JAMA. 2008;300(19):2253-2262. doi:10.1001/jama.2008.683 RCT Accessed: 2026-05-29
[3]Weinmann S, et al. Effects of Ginkgo biloba in dementia: systematic review and meta-analysis. BMC Geriatr. 2010;10:14. doi:10.1186/1471-2318-10-14 META-ANALYSIS Accessed: 2026-05-29
9 Related articles
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10 Cite this page
Vancouver: Pkhakadze G. Ginkgo Biloba — safety profile [Internet]. Tbilisi: PHIG; 2026 [cited 2026 Jun 02]. Available from: https://supplement.ge/ingredients/ginkgo-biloba/
APA 7th: Pkhakadze, G. (2026). Ginkgo Biloba — Safety profile. Public Health Institute of Georgia. https://supplement.ge/ingredients/ginkgo-biloba/
📋 Editorial information
Author: Prof. G. Pkhakadze, MD, MPH, PhD
Institution: Public Health Institute of Georgia (PHIG)
Affiliation: David Tvildiani Medical University (DTMU)
First published: January 2026
Last reviewed: 2026-05-29
Next review: December 2026
References: 3 cited sources
COI: SupplementIndex receives no funding from supplement manufacturers. All content independently authored by PHIG.
Process: Systematic literature review
📄 License & reuse
Published under Creative Commons Attribution 4.0 International (CC BY 4.0). You may share and adapt for any purpose with attribution.
Pkhakadze G. "Ginkgo Biloba — Safety Profile." SupplementIndex, PHIG, 2026. https://supplement.ge/ingredients/ginkgo-biloba/ CC BY 4.0.
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Educational and public health purposes. CC BY 4.0. Consult your healthcare provider before starting any supplement. Corrections: info@accreditation.ge. Publisher: PHIG