Ginkgo biloba
Also sold as: Ginkgo · Ginkgo biloba leaf extract · EGb 761
A leaf extract studied mainly for cognitive symptoms in dementia and mild cognitive impairment. Standardized extract findings do not make leaf tea a memory enhancer or establish dementia prevention.
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Research
- Focus: No robust memory-enhancement benefit in healthy adults. Selected EGb 761 dementia/MCI trials show symptomatic signals, which are a different population and purpose.
- Anxiety: Neuropsychiatric symptom signals occur mainly in dementia/MCI trials; they do not establish general anxiety treatment in healthy adults.
REALITY CHECK // Ginkgo is sold for everyday memory, but large trials did not prevent dementia and healthy-adult enhancement is not robust. Some EGb 761 dementia meta-analyses report symptomatic benefit while the older Cochrane review was skeptical; the dossier lacks the full conclusion of the 2026 Cochrane update, so it cannot settle that conflict here. Seeds and unstandardized tea are not equivalent to purified leaf extract.
Levels: how we grade evidence. Grey = evidence of no benefit; amber = evidence it makes this goal worse.
Ratings are self-reported by a self-selected group of users: how it felt, not proof that it works.
Check your bottle
Compare what your label says with what was used in trials. This is a trial range, not a personal prescription.
Enter the amount from your label to see the result.
How it was studied
UPPER LIMIT // No numerical EFSA or NIH UL is established in this dossier. The 120-240 mg/day studied range is not an intake ceiling or proof that all preparations are interchangeable.
Summary
The strongest practical distinction is treatment versus prevention: some standardized-extract dementia meta-analyses are positive, while large prevention trials were null. Healthy-adult cognitive enhancement, isolated tinnitus and intermittent claudication lack convincing benefit. Bleeding and seizure precautions matter.
Mechanism
Flavone glycosides and terpene lactones have antioxidant and vascular hypotheses; ginkgolide B antagonizes platelet-activating factor. Ginkgotoxin, concentrated in seeds, antagonizes vitamin B6 and can provoke seizures. These mechanisms do not establish clinical prevention or cognitive enhancement.
Typical studied dose
Most standardized leaf-extract studies used 120-240 mg/day, with positive dementia studies commonly using EGb 761 at 240 mg/day over weeks to months, often at least 22 weeks. GEM used 240 mg/day for about six years without preventing dementia; GuidAge likewise found no Alzheimer-prevention benefit over five years.
Upper limit
No numerical EFSA or NIH UL is established in this dossier. The 120-240 mg/day studied range is not an intake ceiling or proof that all preparations are interchangeable.
Popular stacks with Ginkgo biloba
Not enough stack data yet. A combination with Ginkgo biloba appears here once 5 people rate the same set.
Forms and label traps
| Form on label | Active content | Studied range / day | Absorption & GI tolerance | Verdict |
|---|---|---|---|---|
| EGb 761 leaf extract: 24% flavone glycosides / 6% terpene lactones Best for: Matching a standardized leaf-extract label to the preparation studied in dementia/MCI. |
Extract weight · ~24% marker | 120–240 mg | Most positive dementia trials use this standardized extract; that does not imply prevention efficacy. Generally tolerated; occasional gastrointestinal symptoms or headache. |
Studied standard [REFERENCE // STUDIED_FORM] 24% displays the flavone-glycoside marker only; a separate 6% terpene-lactone specification also matters. Compare the FULL extract mass, never 24% of it, with 120-240 mg. |
| Other standardized 24/6 leaf extracts, including GBE50 Best for: Checking alternative extract specifications and product-specific evidence. |
Extract weight · ~24% marker | no comparable trial range | Some clinical evidence exists, but matching percentages alone does not establish EGb 761 bioequivalence. Similar gastrointestinal precautions; manufacturing purity varies. |
Caution [CAUTION // CHECK_BASIS] No extract-specific numerical trial range was recoverable for this entry. Zero means unavailable, not an effective zero dose. Preserve the separate 24%/6% markers. |
| Whole-leaf powder or leaf tea Best for: Identifying a label that cannot be matched to the standardized-extract trials. |
Unstandardized: active content unknown | no comparable trial range | Variable flavone/terpene content; no established equivalence to EGb 761. Variable; incompletely purified products may contain more ginkgolic acids. |
Caution [CAUTION // CHECK_BASIS] Unknown marker content is zero in this display, not absence of phytochemicals. No trial-dose conversion is justified. |
| Ginkgo seeds / nuts Best for: Recognizing an unsuitable supplement substitute. |
Unstandardized: active content unknown | no comparable trial range | Food seeds are not the purified medicinal leaf preparation. Larger amounts can cause toxicity and seizures through ginkgotoxin. |
Avoid / not comparable [AVOID // UNSUITABLE] Do not calculate a supplement dose from seeds. The zebrafish ginkgotoxin study is preclinical; the human seizure report provides a separate warning. |
Common label traps
- TRAP_01 // Everyday memory enhancer
Trials in healthy young and older adults do not show robust benefit. A dementia symptom result cannot be transferred to healthy students. - TRAP_02 // Prevents Alzheimer disease
GEM enrolled 3,069 participants and found no reduction in dementia with about six years of use; GuidAge also failed its prevention endpoint. - TRAP_03 // Treats any tinnitus
Cochrane reviews found no clear benefit for primary tinnitus. A symptom signal in dementia is a separate context. - TRAP_04 // Tea equals EGb 761
Leaf powder, tea and seeds do not reproduce the standardized 24/6 purified extract, including its ginkgolic-acid limit.
Other outcomes studied
Outside the five leaderboard goals. Same evidence levels as above.
- DEMENTIA SYMPTOMS / STANDARDIZED EXTRACT Limited · benefit
Several EGb 761 meta-analyses report better cognition/activities of daily living, often at 240 mg/day. The 2009 Cochrane review judged evidence inconsistent; this is a conflict, not proof of universal efficacy.
PMID 25114079 PMID 25506211 PMID 19160216 - MILD COGNITIVE IMPAIRMENT Limited · benefit
Small trials suggest episodic-memory or neuropsychiatric improvements in people with MCI. Better test scores do not establish prevention of dementia.
PMID 22704410 PMID 24633934 - DEMENTIA PREVENTION Strong · no benefit
GEM (3,069 participants, about six years), GuidAge (five years) and a smaller prevention trial did not show the claimed protection. Treatment signals do not reverse these prevention results.
PMID 19017911 PMID 22959217 PMID 18305231 - PRIMARY TINNITUS Limited · no benefit
Cochrane reviews and a placebo-controlled trial found no clear clinically established benefit for isolated primary tinnitus; certainty is limited.
PMID 36383762 PMID 23543524 PMID 15142066 - TINNITUS / DIZZINESS IN DEMENTIA Limited · benefit
A meta-analysis of dementia trials found neurosensory symptom signals. This does not establish treatment for primary tinnitus in otherwise healthy adults.
PMID 29942120 - INTERMITTENT CLAUDICATION Limited · no benefit
The newer Cochrane synthesis found no clinically important walking-distance benefit; it weakens the small positive signal in the older meta-analysis.
PMID 23744597 PMID 11014719 - VERTIGO / VASCULAR DIZZINESS Limited · benefit
Selected trials report improvement or noninferiority to betahistine, with heterogeneous vestibular or vascular populations. This does not validate every cause of dizziness.
PMID 41487075 PMID 35294126 - SUDDEN SENSORINEURAL HEARING LOSS Limited · benefit
One trial in 106 outpatients reported improvement. A single study is insufficient for a consumer protocol; sudden hearing loss requires urgent medical assessment.
PMID 11548897 - AGE-RELATED EYE DISEASE No established evidence
Narrative reviews and small older clinical data do not establish a reliable disease-modifying benefit. This label means unestablished benefit, not a definitive negative large RCT.
PMID 31266069 PMID 40947728 PMID 25306732
Reader questions
Should the label say 120 or 240 mg?
The dossier trial range is 120-240 mg/day of standardized extract; dementia trials commonly used 240 mg. That cannot select treatment for an individual or make prevention effective.
Does ordinary leaf tea work as well?
Equivalence is unproven. EGb 761 specifies 24% flavone glycosides, 6% terpene lactones and less than 5 ppm ginkgolic acids; a tea or powder may not.
Is ginkgo carcinogenic?
The dossier describes liver tumors in a high-dose mouse gavage bioassay and an IARC possible-carcinogen classification. Human relevance at supplement exposure remains uncertain, and the underlying regulatory documents were not independently checked in this translation. This is not proof of human cancer risk at a standard label dose.
Can I combine it with an SSRI or blood thinner?
Have the prescriber review the entire regimen. Bleeding is the main practical concern, especially when SSRIs and anticoagulants overlap; controlled warfarin data do not consistently show INR changes.
Morning or evening?
The supplied clinical sections do not establish a superior time of day. Extract identity, the clinical indication and medication review matter more than an unsupported timing rule.
Stack interactions
- Danger Warfarin, aspirin, clopidogrel and other blood thinners [CAUTION // CLINICAL_REVIEW]
Bleeding is a precaution supported by case reports and platelet mechanisms; controlled INR studies are often negative. Do not represent the interaction as a certain INR increase. Include surgery and other bleeding risks in the review.
PMID 18214851 PMID 11777363 - Danger Antiseizure medicines / seizure disorders [CAUTION // CLINICAL_REVIEW]
Seizure reports and seed ginkgotoxin justify caution. Seed poisoning and leaf-extract exposure differ; animal evidence does not quantify clinical incidence.
PMID 16499756 PMID 11742783 PMID 11240603 - Caution Narrow-therapeutic-index CYP substrates [CAUTION // CLINICAL_REVIEW]
Human EGb 761 cocktail and flurbiprofen studies suggest little effect at studied exposure, despite inhibitory/inductive laboratory findings. Ask the prescriber about vulnerable substrates rather than assuming a universal strong interaction.
PMID 22189672 PMID 16432273 PMID 35295338 - Caution High-dose antiplatelet supplement stacks [CAUTION // CLINICAL_REVIEW]
Fish oil, garlic, high-dose vitamin E and curcumin are common overlapping stacks in the dossier. Combined bleeding risk is precautionary and not quantified by a stack RCT.
Red flags: interactions and who should avoid it
Interactions
Anticoagulants, antiplatelet drugs and perioperative use warrant bleeding precautions: case reports and plausible platelet effects exist even though controlled warfarin studies often found no meaningful INR change. Epilepsy and antiseizure treatment require review. Standardized-extract human CYP studies suggest small effects, while in vitro and animal findings should not be overstated. SSRI combinations may compound bleeding risk, particularly with anticoagulants.
Avoid or ask a doctor first if
Avoid unsupervised use in pregnancy, breastfeeding, children, seizure disorders or bleeding disorders. Review blood thinners and planned surgery with the treating team; the dossier discusses stopping roughly 1-2 weeks before surgery, but the clinician determines the interval. Seeds are not a supplement substitute and can cause seizures. Poorly purified extracts may contain allergenic ginkgolic acids; standardized EGb 761 limits these to below 5 ppm.
Sources (PubMed, 31)
- Efficacy and adverse effects of ginkgo biloba for cognitive impairment and dementia: a systematic review and meta-analysis.
PMID 25114079 · 2015 · systematic review / meta-analysisMeta-analysis reports symptomatic cognitive/ADL benefit in impairment or dementia; not prevention or healthy-adult enhancement.
- Efficacy and tolerability of Ginkgo biloba extract EGb 761® in dementia: a systematic review and meta-analysis of randomized placebo-controlled trials.
PMID 25506211 · 2014 · systematic review / meta-analysisEGb 761 dementia meta-analysis: symptomatic benefit signal with standardized extract.
- Ginkgo biloba for cognitive impairment and dementia.
PMID 19160216 · 2009 · systematic review / meta-analysisOlder Cochrane synthesis judged dementia/impairment evidence inconsistent or unreliable, contrasting positive extract-specific meta-analyses.
- [Effects of Ginkgo biloba extract in improving episodic memory of patients with mild cognitive impairment: a randomized controlled trial].
PMID 22704410 · 2012 · randomized controlled trialSelected MCI population: episodic-memory outcome, not dementia prevention.
- 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.
PMID 24633934 · 2014 · randomized controlled trialMCI with neuropsychiatric symptoms: selected-population clinical signal.
- Ginkgo biloba for prevention of dementia: a randomized controlled trial.
PMID 19017911 · 2008 · randomized controlled trialGEM prevention RCT: 3,069 participants, 240 mg/day, approximately six years; no dementia prevention.
- Long-term use of standardised Ginkgo biloba extract for the prevention of Alzheimer's disease (GuidAge): a randomised placebo-controlled trial.
PMID 22959217 · 2012 · randomized controlled trialGuidAge: no reduction in progression to Alzheimer disease over five years.
- A randomized placebo-controlled trial of Ginkgo biloba for the prevention of cognitive decline.
PMID 18305231 · 2008 · randomized controlled trialPrevention-of-cognitive-decline trial: no intention-to-treat benefit in the dossier.
- Ginkgo for memory enhancement: a randomized controlled trial.
PMID 12186600 · 2002 · randomized controlled trialHealthy older adults: no memory-enhancement advantage over placebo.
- Ginkgo biloba: no robust effect on cognitive abilities or mood in healthy young or older adults.
PMID 16329161 · 2006 · randomized controlled trialNo robust cognitive or mood effect in healthy younger or older adults.
- Ginkgo biloba for tinnitus.
PMID 36383762 · 2022 · systematic review / meta-analysisCochrane tinnitus review: no clear established primary-tinnitus benefit.
- Ginkgo biloba for tinnitus.
PMID 23543524 · 2013 · systematic review / meta-analysisEarlier Cochrane tinnitus synthesis: uncertain/no convincing primary-tinnitus benefit.
- Ginkgo biloba does not benefit patients with tinnitus: a randomized placebo-controlled double-blind trial and meta-analysis of randomized trials.
PMID 15142066 · 2004 · systematic review / meta-analysisTinnitus placebo-controlled trial and meta-analysis with null findings.
- Ginkgo biloba extract EGb 761® alleviates neurosensory symptoms in patients with dementia: a meta-analysis of treatment effects on tinnitus and dizziness in randomized, placebo-controlled trials.
PMID 29942120 · 2018 · systematic review / meta-analysisNeurosensory symptom effects in dementia, not a general primary-tinnitus indication.
- Ginkgo biloba for intermittent claudication.
PMID 23744597 · 2013 · systematic review / meta-analysisUpdated Cochrane intermittent-claudication review: no clinically meaningful walking benefit.
- Ginkgo biloba extract for the treatment of intermittent claudication: a meta-analysis of randomized trials.
PMID 11014719 · 2000 · systematic review / meta-analysisOlder small positive claudication meta-analysis, weakened by the newer synthesis.
- Efficacy of EGb 761® and Betahistine in Treatment of Dizziness/Vertigo: A Randomized Double-Blind Controlled Trial.
PMID 41487075 · 2026 · randomized controlled trialEGb 761 versus betahistine dizziness/vertigo comparison; not proof for all causes.
- Effectiveness and safety of Ginkgo biloba extract (GBE50) in the treatment of dizziness caused by cerebral arteriosclerosis: a multi-center, double-blind, randomized controlled trial.
PMID 35294126 · 2022 · randomized controlled trialGBE50 RCT in dizziness attributed to cerebral arteriosclerosis.
- 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.
PMID 11548897 · 2001 · randomized controlled trialSingle sudden-hearing-loss trial in 106 outpatients, insufficient for a general consumer recommendation.
- Neuroprotective Potential of Ginkgo biloba in Retinal Diseases.
PMID 31266069 · 2019 · narrative reviewNarrative retinal-disease review; mechanistic/preliminary evidence rather than a large efficacy RCT.
- Phytochemicals in Ginkgo biloba for Age-Related Eye Disease - A Review.
PMID 40947728 · 2025 · narrative reviewAge-related eye-disease review; clinical efficacy remains uncertain.
- [Clinical efficacy of Vitrum Memory in patients with glaucoma and dry form of age-related macular degeneration].
PMID 25306732 · 2014 · clinical report / other studySmall/older clinical report involving a ginkgo-containing product in glaucoma and dry AMD.
- Generalized convulsions after consuming a large amount of gingko nuts.
PMID 11240603 · 2001 · clinical report / other studyHuman report of generalized convulsions after a large amount of ginkgo nuts.
- Zebrafish larvae exposed to ginkgotoxin exhibit seizure-like behavior that is relieved by pyridoxal-5'-phosphate, GABA and anti-epileptic drugs.
PMID 22736461 · 2012 · animal studyGinkgotoxin-associated seizure-like behavior in zebrafish; preclinical mechanism only.
- Potential interaction of Ginkgo biloba leaf with antiplatelet or anticoagulant drugs: what is the evidence?
PMID 18214851 · 2008 · narrative reviewReview of potential anticoagulant/antiplatelet interactions and their uncertain clinical magnitude.
- The risk-benefit profile of commonly used herbal therapies: Ginkgo, St. John's Wort, Ginseng, Echinacea, Saw Palmetto, and Kava.
PMID 11777363 · 2002 · systematic review / meta-analysisHerbal risk-benefit review supporting cautious drug/bleeding review.
- Ginkgo biloba use in nursing home elderly with epilepsy or seizure disorder.
PMID 16499756 · 2006 · observational studyObservational nursing-home epilepsy/seizure context.
- Ginkgo biloba precipitating epileptic seizures.
PMID 11742783 · 2001 · clinical report / other studyClinical seizure reports associated with ginkgo exposure.
- Effect of Ginkgo biloba special extract EGb 761® on human cytochrome P450 activity: a cocktail interaction study in healthy volunteers.
PMID 22189672 · 2012 · randomized controlled trialHuman cocktail interaction study: limited CYP effects at studied EGb 761 exposure.
- Ginkgo biloba does not alter clearance of flurbiprofen, a cytochrome P450-2C9 substrate.
PMID 16432273 · 2006 · randomized controlled trialFlurbiprofen clearance was not altered; constrains blanket CYP-interaction claims.
- Potent Inhibition of Human Cytochrome P450 3A4 by Biflavone Components from Ginkgo Biloba and Selaginella Tamariscina.
PMID 35295338 · 2022 · in vitro studyBiflavone CYP3A4 inhibition in vitro; not proof of a strong clinical interaction.
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