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Ginkgo Biloba

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Melissa Beers

on 8 October 2014

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Transcript of Ginkgo Biloba

Ginkgo Biloba
History
Ginkgo is a "living fossil"; has not changed in 200 million years
Used in communities all over the world; eastern Asia for 4000 years, central Asia for 1000, Europe for 300 years, spread to Americas 200 years ago.
Historical Indications
Ginkgo Biloba


Ginkgo biloba
for Prevention of Dementia: A Randomized Controlled Trial
Scientific Name: Ginkgo biloba
Common Names: Maidenhair Tree, Japanese Silver Apricot, Fossil Tree
Originated in southeastern China, spread through the majority of Asia through Buddhism and Confucianism
Symbol of yin and yang; longevity and prosperity
Assessed prevention of Dementia & Alzheimer Disease
5 academic medical centers across United States
75 years or older with normal cognition or Mild Cognitive Impairment
Placebo vs. 240 mg dose
Follow up every 6 months for 6 years
Fun Fact
Six ginkgo trees in Hiroshima, Japan, survived the August 6, 1945 atomic bomb blast. All six were within 1-2 miles of the epicenter.
This temple in Japan was rebuilt around the surviving Ginkgo
This tree grew from a clipping from a Tokyo temple tree that is believed to date back to the 12th century. The sapling was planted in the 1600s in Hiroshima
Asthma and bronchitis- 2600 BC
Home remedy for tinnitus, headache, vertigo, mood swings, Lyme disease, depression, Raynaud syndrome, PMS, glaucoma, and decreased libido due to the use of SSRIs
Only significant clinical evidence: improve cognitive function of dementia and Alzheimer's patients
Proposed Mechanisms of Action
Results:
120 mg twice daily
NOT
effective in preventing overall incidence of Dementia or Alzheimer Disease


However...
Further Investigation is needed.
Dietary Uses
Nuts very common in Chinese cuisine, especially dishes served at religious celebrations
Believed to be a potent aphrodisiac
Flesh of the seed is toxic, especially for children and elderly with as little as 10 seeds
Gingkotoxin (4-O-methylpyridoxine) is heat stable
Potential hypersensitivity to the shell, so wearing gloves while handling is recommended
Objectives
Development of Dementia
Cost & Forms
Describe
the history and cultural significance of the ginkgo tree
Explain
the mechanism of action of gingko supplements and its therapeutic effects
Evaluate
the clinical significance of ginkgo for the treatment of cognitive impairment
Prepare
pharmacists to counsel patients on safe and effective uses of ginkgo
$ (<25)
Dry Extract
Oral
Target Up & Up
$8.59

Alan James Group
$19.39
Fruehauf, H. Ginkgo: Cultural Background and Medicinal Usage in China. The Journal of Chinese Medicine. March 1998. Accessed October 1, 2014.
Walgreens Corp
$8.99
Kwant, C. A-bombed Ginkgo trees in Hiroshima, Japan. The Ginkgo Pages. Accessed October 2, 2014.
Dosing
Cohn, R. Gingko: The Life Story of the Oldest Tree on Earth: An interview with Botanist Peter Crane. Environment 360. May 01, 2013. Accessed October 2, 2014.
Extract of Ginkgo biloba (EGb) 761
40 mg, three times a day
80 mg, twice daily
24% flavonoid glycosides
6% terepenoids
Ginkgo Biloba with...
Drugs
NSAIDS (eg. aspirin) and anticoagulants (eg. warfarin)
increase risk of spontaneous bleeding
Other herbs known to increase bleeding (eg. garlic, ginger, ginseng)
Antidepressants
due to potential risk of precipitating serotonin syndrome
References
Food
None known
Diseases
Diabetes
may interfere with glucose management
Seizures
causes imbalance in neurotransmitter GABA
side effect of toxin
Bleeding disorders
Other Precautions
Stroop's Clinical Assessment of Cognition
Pregnancy
can cause early labor or extra bleeding during labor
Breast-Feeding
not enough is known
Children
the seed in general
Surgery
may cause extra bleeding
stop at least 2 weeks before
Dosage Adherence
Side Effects
Possible
Serious
Melissa Beers, Claire Schendel, and Catie Travis
Diarrhea
Dizziness
Gas
Headache
Nausea
Stomach upset
Severe allergic reactions
Fainting
Pounding in the chest
Skin redness
Trouble speaking
Unusual bruising or bleeding
Weakness
Effects of Ginkgo Biloba supplementation
in Alzheimer's disease patients
receiving cholinesterase inhibitors:
Data from the ICTUS Study
Assessed treatment in combination therapies
12 European countries, 29 medical centers
Alzheimer's Patients-Acetylcholinesterase inhibitors
Supplementation with Ginkgo
Follow up testing at 6 months & 1 year
Counseling Points
Herbal medicines are OTC, so normally no safety cap
Store at room temperature, away from heat, moisture light - do not store in bathroom
Generally considered safe to take with other Alzheimer's medications
Differences in Cognitive Assessments at 1 Year

Combination vs. Conventional Therapy
Results: Combination therapy did not significantly improve therapeutic outcomes overall. However, further studies are needed.
Recommendations
Clinical Cognitive Assessment
Mini Mental State Examination (MMSE)
Alzheimer Disease Assessment Scale-Cognitive subscale (ADAS-cog)
Activities of Daily Living (ADL)
Addenbrookes cognitive examination III (ACE-III)
Fruehauf, H. Ginkgo: Cultural Background and Medicinal Usage in China. The Journal of Chinese Medicine. March 1998. Accessed October 1, 2014. http://www.classicalchinesemedicine.org/2010/03/ginkgo-cultural-background-and-medicinal-usage-in-china/
Ginkgo. MedlinePlus. Natural Medicines Comprehensive Database. Last reviewed July 7, 2014. Accessed September 30, 2014. http://www.nlm.nih.gov/medlineplus/druginfo/natural/333.html
Drugs and Supplements- Ginkgo (Ginkgo biloba). Mayo Foundation for Education and Research. 2014. Accessed October 2, 2014. http://www.mayoclinic.org/drugs-supplements/ginkgo/dosing/hrb-20059541
Kwant, C. A-bombed Ginkgo trees in Hiroshima, Japan. The Ginkgo Pages. Accessed October 2, 2014.
http://kwanten.home.xs4all.nl/hiroshima.htm
Cohn, R. Gingko: The Life Story of the Oldest Tree on Earth: An interview with Botanist Peter Crane. Environment 360. May 01, 2013. Accessed October 2, 2014. http://e360.yale.edu/feature/peter_crane_history_of_ginkgo_earths_oldest_tree/2646/
Cohn, R. Gingko: The Life Story of the Oldest Tree on Earth: An interview with Botanist Peter Crane. Environment 360. May 01, 2013. Accessed October 2, 2014. http://e360.yale.edu/feature/peter_crane_history_of_ginkgo_earths_oldest_tree/2646/
Ginkgo bilboa. Facts & Comparisons eAnswers. Last reviewed September 2014. Accessed October 2, 2014. http://online.factsandcomparisons.com.libproxy.lib.unc.edu/MonoDisp.aspx?monoid=fandc-np5141&book=NP&fromtop=true&search=392843%7c5&isStemmed=True&asbooks=
What are the most common mechanisms of action proposed for Ginkgo? Pharmacology Weekly. Pharmacology & Therapeutics Database. Last reviewed 2014. Accessed October 2, 2014. http://www.pharmacologyweekly.com/articles/ginkgo-biloba-mechanism-of-action-moa
Saper, R. Clinical use of ginkgo biloba. UpToDate. Last reviewed September 2014. Accessed October 2, 2014. http://www.uptodate.com.libproxy.lib.unc.edu/contents/clinical-use-of-ginkgo-biloba?source=search_result&search=ginkgo+biloba&selectedTitle=1~59
Adali, N. Canevelli, M. Canetet, C. Cesari, M. Kelaiditi, E. Ousset, P. Effects of Gingko biloba supplementation in Alzheimer's disease patients receiving cholinesterase inhibitors: Data from the ICTUS study. Phytomedicine : international journal of phytotherapy and phytopharmacology. 2014; 21: 888-892.
Dekosky, S. T., J. D. Williamson, A. L. Fitzpatrick, R. A. Kronmal, D. G. Ives, J. A. Saxton, O. L. Lopez, G. Burke, M. C. Carlson, L. P. Fried, L. H. Kuller, J. A. Robbins, R. P. Tracy, N. F. Woolard, L. Dunn, B. E. Snitz, R. L. Nahin, C. D. Furberg. "Ginkgo Biloba for Prevention of Dementia: A Randomized Controlled Trial." JAMA: The Journal of the American Medical Association 300.19 (2008): 2253-262.
Overall, we would not recommend ginkgo biloba for prevention or singular treatment of dementia.
Ginkgo extract taken at recommended doses is not harmful, but has not been proven to be helpful.
More studies are needed and are currently being conducted.
What are the most common mechanisms of action proposed for Ginkgo? Pharmacology Weekly. Pharmacology & Therapeutics Database. Last reviewed 2014. Accessed October 2, 2014.
Clinical Trial 1:
Saper, R. Clinical use of ginkgo biloba. UpToDate. Last reviewed September 2014. Accessed October 2, 2014.
Saper, R. Clinical use of ginkgo biloba. UpToDate. Last reviewed September 2014. Accessed October 2, 2014.
Ginkgo. MedlinePlus. Natural Medicines Comprehensive Database. Last reviewed July 7, 2014. Accessed September 30, 2014.
Clinical Trial 2:
Ginkgo. MedlinePlus. Natural Medicines Comprehensive Database. Last reviewed July 7, 2014. Accessed September 30, 2014.
Ginkgo. MedlinePlus. Natural Medicines Comprehensive Database. Last reviewed July 7, 2014. Accessed September 30, 2014.
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