Ginkgo Biloba

OBJECTIVES: This study aims to compare the outcomes of different pharmacotherapies for subjective tinnitus patients using a comprehensive network meta-analysis. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: PubMed, EMBASE, Web of Science and CINAHL Complete databases were searched from inception until 6 March 2025. ELIGIBILITY CRITERIA: Randomised controlled trials (RCTs) comparing pharmacotherapy treatment effects for subjective tinnitus patients were included with tinnitus severity as the primary outcome, and annoyance and tinnitus loudness as secondary outcomes. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently retrieved and screened full articles using a standardised and prepiloted Excel form. Network meta-analysis was conducted with heterogeneity, study risk of bias (ROB), risk of publication bias and certainty of evidence examined using I2, τ2, ROB2, funnel plots and Grading of Recommendations, Assessment, Development, and Evaluation assessments. RESULTS: Sixty full-text RCTs from 21 countries were included in the analysis with 22% low ROB, 58% some concerns and 20% high ROB. The heterogeneity parameter I2 was 0.67 (95% CI 0.33 to 0.84), 0 (95% CI 0 to 0.9) and 0.63 (95% CI 0 to 0.89) for the severity, annoyance and loudness network analysis, respectively. The only significant publication bias assessment by Egger's test was detected in the loudness network analysis (p<0.05). Ginkgo biloba with vitamin (standardised mean differences (SMD): -3.11, 95% CI (-4.15 to -2.06)), acamprosate (SMD: -0.88, 95% CI (-1.81 to -0.04)) and fluoxetine (SMD: -3.28, 95% CI (-4.23 to -2.34)) ranked first in severity, annoyance and loudness, respectively, compared with placebo. There are three significant inconsistent comparisons observed in the severity network and ranked with very low certainty of evidence by GRADE assessment. CONCLUSIONS: This meta-analysis found that antioxidant supplementation, such as Ginkgo biloba, and vitamins and gamma-aminobutyric acid agonists, represented by acamprosate, could be promising treatments for subjective tinnitus. Further trials with rigorous design and larger sample sizes are necessary to supplement the cur

The beneficial effects of Ginkgo biloba on cardio-metabolic markers have been reported. However, its effect on inflammation is not assessed in any meta-analysis. We performed a systematic review of randomized controlled trials evaluating the effects of Ginkgo biloba leaf extract (GBLE) on serum C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) levels. A systematic search was performed on four databases, including PubMed, Scopus, Web of Science, and Google Scholar, up to October 2021. After screening, 17 trials met our inclusion criteria. Trials were of 1-24 weeks of duration and included 1,104 participants. In the meta-analysis, the weighted mean differences (WMD) in change for serum CRP were -1.5 mg/L (95% CI: -2.16, -0.85, p < 0.001). Moreover, WMD for serum IL-6 and TNF-α were in favor of the GBLE compared to the placebo [(-16.86 pg/mL, 95% CI: -19.38, -14.34, p < 0.001); and (-4.19 pg/mL, 95%CI: -5.14, -3.23, p < 0.001), respectively]. Subgroup analysis showed that GBLE has a beneficial effect on serum CRP at the baseline levels≥3 mg/L and doses<500 mg/day. This meta-analysis showed that the GBLE could reduce serum inflammatory markers. Therefore, this medicinal herb might be a possible strategy for inflammation control. © 2022 John Wiley & Sons Ltd.

BACKGROUND: In recent years, the incidence rate of hypertensive nephropathy has been increasing quickly, which has been a major threat to people's health. Renin-angiotensin-aldosterone system blockers have certain curative effects. However, there are some patients having serious adverse reactions, and the benefit population is limited, so the treatment of hypertensive renal damage is necessary to have beneficial supplement. More and more clinical studies have shown that ginkgo leaf extract and dipyridamole injection (GDI) combined with antihypertensive drugs has achieved good results in the treatment of hypertensive renal damage. It is supposed to be a supplementary treatment in hypertensive nephropathy. OBJECTIVES: To systematically assess the efficacy and safety of GDI combined with antihypertensive drugs on hypertensive renal injury. METHODS: Seven databases including PubMed, Cochrane Library, Embase, Wanfang database, China biomedical literature service system (Sino Med), VIP Chinese Sci-tech journal database (VIP), and China national knowledge internet (CNKI) were retrieved to collect randomized controlled trials (RCTs) in the experimental group containing combined therapy of hypertensive nephropathy with GDI and antihypertensive drugs. The retrieval time was from the establishment of database to July 8, 2020. Two researchers independently selected literature, extracted data, and evaluated the risk of bias in the study. The methodological quality was evaluated with Cochrane handbook and meta-analysis was performed with Stata 14.0 software. RESULTS: Eight studies were included in this study which involved 556 patients. The meta-analyses indicated that, compared with using antihypertensive drugs alone, combined treatment of GDI with antihypertensive drugs can decrease 24-hour urinary total protein (weighted mean difference [WMD] -0.61, 95% confidence interval [CI]: -0.82, -0.39; k = 6, P ≤ .001), blood urea nitrogen (WMD -1.27, 95% CI: -2.45, -0.10; k = 6, P = .033, serum creatinine (WMD -29.50, 95% CI: -56.44, -2.56; number of estimates [k] = 6, P = .032). CONCLUSIONS: Our meta-analyses showed that GDI combined with antihypertensive drugs can improve the ren

OBJECTIVE: To assess the clinical efficacy and safety of ginkgo injections (GIs) combined with conventional treatment (CT) against angina pectoris (AP) due to coronary heart disease (CHD). METHODS: Randomized controlled trials (RCTs) that used GIs to treat AP were searched in SinoMed, PubMed, China National Knowledge Infrastructure Database, Chinese Scientific Journals Database, Wanfang Database, Embase and Cochrane Library until March 2017. The Cochrane"risk of bias"method was used to evaluate the methodological quality of RCTs. Data were analyzed using Stata v13.1 and WinBUGS v1.4.3. RESULTS: A total of 73 RCTs involving 7621 patients were included. A Bayesian network Meta-analysis of RCTs was undertaken, and the advantages of four types of GI-supplemented CT in AP treatment were determined. CONCLUSION: GI-assisted CT was more effective against AP than CT alone. However, based on the limitations of the study, additional high-quality RCTs are required to confirm our findings.

BACKGROUND: Antipsychotic (neuroleptic) medication is used extensively to treat people with chronic mental illnesses. Its use, however, is associated with adverse effects, including movement disorders such as tardive dyskinesia (TD) - a problem often seen as repetitive involuntary movements around the mouth and face. This review, one in a series examining the treatment of TD, covers miscellaneous treatments not covered elsewhere. OBJECTIVES: To determine whether drugs, hormone-, dietary-, or herb-supplements not covered in other Cochrane reviews on TD treatments, surgical interventions, electroconvulsive therapy, and mind-body therapies were effective and safe for people with antipsychotic-induced TD. SEARCH METHODS: We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials including trial registers (16 July 2015 and 26 April 2017), inspected references of all identified studies for further trials and contacted authors of trials for additional information. SELECTION CRITERIA: We included reports if they were randomised controlled trials (RCTs) dealing with people with antipsychotic-induced TD and schizophrenia or other chronic mental illnesses who remained on their antipsychotic medication and had been randomly allocated to the interventions listed above versus placebo, no intervention, or any other intervention. DATA COLLECTION AND ANALYSIS: We independently extracted data from these trials and we estimated risk ratios (RR) or mean differences (MD), with 95% confidence intervals (CIs). We assumed that people who left early had no improvement. We assessed risk of bias and created 'Summary of findings' tables using GRADE. MAIN RESULTS: We included 31 RCTs of 24 interventions with 1278 participants; 22 of these trials were newly included in this 2017 update. Five trials are awaiting classification and seven trials are ongoing. All participants were adults with chronic psychiatric disorders, mostly schizophrenia, and antipsychotic-induced TD. Studies were primarily of short (three to six6 weeks) duration with small samples size (10 to 157 participants), and most (61%) were published more than 20 years ago. The overall risk of bias in these studi

Systematic reviews and meta-analyses represent the uppermost ladders in the hierarchy of evidence. Systematic reviews/meta-analyses suggest preliminary or satisfactory clinical evidence for agnus castus (Vitex agnus castus) for premenstrual complaints, flaxseed (Linum usitatissimum) for hypertension, feverfew (Tanacetum partenium) for migraine prevention, ginger (Zingiber officinalis) for pregnancy-induced nausea, ginseng (Panax ginseng) for improving fasting glucose levels as well as phytoestrogens and St John's wort (Hypericum perforatum) for the relief of some symptoms in menopause. However, firm conclusions of efficacy cannot be generally drawn. On the other hand, inconclusive evidence of efficacy or contradictory results have been reported for Aloe vera in the treatment of psoriasis, cranberry (Vaccinium macrocarpon) in cystitis prevention, ginkgo (Ginkgo biloba) for tinnitus and intermittent claudication, echinacea (Echinacea spp.) for the prevention of common cold and pomegranate (Punica granatum) for the prevention/treatment of cardiovascular diseases. A critical evaluation of the clinical data regarding the adverse effects has shown that herbal remedies are generally better tolerated than synthetic medications. Nevertheless, potentially serious adverse events, including herb-drug interactions, have been described. This suggests the need to be vigilant when using herbal remedies, particularly in specific conditions, such as during pregnancy and in the paediatric population. Copyright © 2016 John Wiley & Sons, Ltd.

A number of health and lifestyle factors are thought to contribute to cognitive decline associated with age but cannot be easily modified by the individual patient. We identified 12 individually modifiable interventions that can be implemented during midlife or later with the potential to ameliorate cognitive aging. For ten of these, we used PubMed databases for a systematic review of long-duration (at least 6 months), randomized, controlled trials in midlife and older adults without dementia or mild cognitive impairment with objective measures of neuropsychological performance. Using network meta-analysis, we performed a quantitative synthesis for global cognition (primary outcome) and episodic memory (secondary outcome). Of 1038 publications identified by our search strategy, 24 eligible trials were included in the network meta-analysis. Results suggested that the Mediterranean diet supplemented by olive oil and tai chi exercise may improve global cognition, and the Mediterranean diet plus olive oil and soy isoflavone supplements may improve memory. Effect sizes were no more than small (standardized mean differences 0.11-0.22). Cognitive training may have cognitive benefit as well. Most individually modifiable risk factors have not yet been adequately studied. We conclude that some interventions that can be self-initiated by healthy midlife and older adults may ameliorate cognitive aging.

OBJECTIVE: We conducted a meta-analysis to examine whether Ginkgo biloba (G. biloba) enhances cognitive function in healthy individuals. METHODS: Scopus, Medline, Google Scholar databases and recent qualitative reviews were searched for studies examining the effects of G. biloba on cognitive function in healthy individuals. We identified randomised controlled trials containing data on memory (K = 13), executive function (K = 7) and attention (K = 8) from which effect sizes could be derived. The analyses provided measures of memory, executive function and attention in 1132, 534 and 910 participants, respectively. RESULTS: Effect sizes were non-significant and close to zero for memory (d = -0.04: 95%CI -0.17 to 0.07), executive function (d = -0.05: 95%CI -0.17 to 0.05) and attention (d = -0.08: 95%CI -0.21 to 0.02). Meta-regressions showed that effect sizes were not related to participant age, duration of the trial, daily dose, total dose or sample size. CONCLUSIONS: We report that G. biloba had no ascertainable positive effects on a range of targeted cognitive functions in healthy individuals.

OBJECTIVE: Conventional treatment for RP is limited due to side effects, and complementary and alternative medicines (CAM) are widely used by the population. Our objective was to find an effective and well-tolerated CAM for the treatment of RP. METHODS: Using MEDLINE, EMBASE and AMED, 20 randomized controlled trials (RCTs) were found and divided into nine treatment subcategories: acupuncture (n = 2 trials), anti-oxidants (n = 2), biofeedback (n = 5), essential fatty acids (n = 3), Ginkgo biloba (n = 1), L-arginine (n = 2), laser (n = 3), glucosaminoglycans (n = 1) and therapeutic gloves (n = 1). Trials in each subcategory were meta-analysed together. RESULTS: Several categories did not have enough trials to do a meta-analysis and most trials were negative, of poor quality and done prior to 1990. Biofeedback was negative for a change in frequency, duration and severity of RP attacks, and actually favoured control (sham biofeedback; P < 0.02). The therapeutic glove favoured active treatment (P < 0.00001). Laser resulted in one less RP attack on average over 2 weeks vs sham [weighted mean difference (WMD) 1.18; 95% CI 1.06, 1.29], and a change in severity of attacks (WMD 1.98; 95% CI 1.57, 2.39; P < 0.05). No significant differences were found in the nutritional supplements that were studied. CONCLUSIONS: There is a need for well-designed trials of CAM in RP. The literature is inconclusive except that biofeedback does not work for RP, therapeutic gloves may improve RP (but results may not be generalizable due to single trial site and no intent-to-treat analysis) and laser may be effective but the improvement may not be clinically relevant.

ImportanceDizziness/vertigo is a common symptom that can lead to falls and reduced confidence in daily activities. It can result from vestibular, non-vestibular, or unidentified etiologies. Effective treatments with minimal side effects are essential to improving patient outcomes.ObjectiveTo compare the efficacy and safety of Ginkgo biloba extract EGb 761® with Betahistine in patients with dizziness/vertigo of unclear etiology.Study DesignRandomized, double-blind, controlled trial conducted from October 2022 to August 2023.SettingEar, Nose, and Throat Outpatient Department at Burapha Hospital.ParticipantsEighty-six individuals aged ≥20 with dizziness/vertigo lasting >1 month without a specific etiology.InterventionPatients were randomized to EGb 761® (120 mg/day) or Betahistine (36 mg/day) with matched placebos for 12 weeks, assessed at weeks 2, 6, and 12.Main Outcome MeasuresPrimary outcome: change in dizziness severity as assessed by the 11-Point Box Scale and Dizziness Handicap Inventory (DHI) scores. Secondary outcomes: safety.ResultsRepeated-measures ANOVA showed significant improvement over time in both groups (P < .001), with no group × time interaction, indicating comparable efficacy. For DHI, Betahistine showed a transient advantage at week 2 (P < .01, Cohen's d = 0.96), but no significant difference between treatments was observed at week 12. Both treatments were well tolerated, with only mild gastrointestinal side effects.ConclusionEGb 761® and Betahistine demonstrated comparable efficacy and good safety in treating dizziness or vertigo of unclear etiology. Clinical improvement was most evident within the first 2 weeks of therapy.RelevanceEGb 761® is a safe and effective alternative to Betahistine with comparable efficacy and good tolerability.

Objective: To evaluate the effect of an electronic balance aid in balance rehabilitation training for patients with acute peripheral vestibular injury by comparing the outcomes of medication-only treatment and medication combined with vestibular rehabilitation using an electronic balance aid. Methods: This was a randomized controlled trial. The study subjects included 98 patients (40 males and 58 females, aged 25-69 years) diagnosed with idiopathic sudden sensorineural hearing loss (ISSNHL) with vertigo or vestibular neuritis, who were treated in the Department of Otorhinolaryngology-Head and Neck Surgery of Tianjin First Central Hospital from November 2022 to November 2023. All patients were randomly divided into the experimental group and the control group at a 1∶1 ratio using the sealed envelope method. Control group (conventional drug treatment): Patients received medication treatment for 2 weeks, including betahistine mesilate tablets, vitamin B1 tablets, methylcobalamin tablets, ginkgo biloba tablets, diphenhydramine hydrochloride injection (within 3 days of onset), metoclopramide hydrochloride injection, and glucocorticoids. Experimental group (conventional drug treatment+device training): On the basis of the same medication treatment as the control group, patients received vestibular rehabilitation training using an electronic balance aid (20 minutes per session, once a day,≥5 days per week, for a total of 2 weeks). SPSS software was used to compare the total scores of the Dizziness Handicap Inventory (DHI), the total scores of the Sensory Organization Test (SOT), and sensory analysis indicators between the two groups before and after treatment. Results: After treatment, vertigo symptoms significantly improved in both groups. DHI: The total DHI score in the control group decreased from 77.9±1.8 before treatment to 20.2±2.3 after treatment (P<0.001). In the experimental group, the total DHI score decreased from 73.5±2.1 before treatment to 8.6±0.9 after treatment (P<0.001). The difference in total DHI scores between the two groups after treatment was statistically significant, with the experimental group showing a lower score (t=-4.616, P<0.001). The impr

Objective:To analyze the clinical characteristics and prognostic factors of patients with acute low-frequency hearing loss（ALHL） and explore the potential role of migraine in its pathogenesis. Methods:A total of 56 ALHL patients treated at our outpatient clinic from June 2024 to January 2025 were randomly divided into two groups: a standardized treatment group and an anti-migraine treatment group. The standardized group received oral/intravenous steroids + oral/intravenous Ginkgo biloba extract, while the anti-migraine group received postauricular steroid injection/oral steroids + oral flunarizine for 2 weeks. Audiological, clinical, and psychological characteristics were collected, and statistical analysis was performed to assess clinical features and treatment outcomes, exploring the potential mechanism of migraine in ALHL. Results:The anti-migraine treatment group showed a significantly higher recovery rate than the standardized treatment group（92.86% vs 71.43%, P=0.036）. Among the anti-migraine group, 6 patients（21.43%） had a history of ALHL, 13（46.43%） had a confirmed migraine history, 26（92.86%） had anxiety, 26（92.86%） had depression, 5（17.86%） had irritable bowel syndrome, 21（75.00%） had sleep disorders, and 1（3.57%） experienced recurrence within 6 months. Conclusion:Anti-migraine therapy significantly improves the recovery rate in ALHL patients, suggesting that migraine may have a certain correlation with the pathogenesis of acute low-frequency hearing loss. Publisher: 目的：探讨急性低频听力下降（acute low-frequency hearing loss，ALHL）的临床特征及预后相关因素，并分析偏头痛在其发病中的可能作用机制。 方法：本研究纳入2024年6月至2025年1月期间在北京大学人民医院耳鼻咽喉头颈外科门诊就诊的56例ALHL患者，将其随机分为标准化治疗组（28例）和抗偏头痛治疗组（28例）。标准化治疗组接受口服/静脉激素+口服/静脉银杏叶提取物，抗偏头痛治疗组接受局部/口服激素+口服盐酸氟桂利嗪，疗程均为2周。同时收集患者的听力学、临床及心理特征资料，并对2组患者的临床特征及预后进行统计学分析。 结果：抗偏头痛治疗组患者的听力痊愈率显著高于仅采用标准化方案治疗组（92.86% vs 71.43%，P=0.036）。临床特征方面，抗偏头痛治疗组 28 例患者中，既往有ALHL病史者 6 例（21.43%），近 3 个月内伴头痛发作者 13 例（46.43%），合并焦虑者 26 例（92.86%），合并抑郁者 26 例（92.86%），伴肠易激综合征者5 例 （17.86%），伴睡眠障碍者 21 例（75.00%），半年内出现复发者 1 例（3.57%）。 结论：抗偏头痛治疗可显著提高ALHL患者的痊愈率，提示偏头痛可能与该病的发生相关。.

OBJECTIVE: This study aimed to evaluate whether adjunctive vitamin D supplementation enhances the efficacy of conventional therapy in treating sudden sensorineural hearing loss (SSNHL) in patients with vitamin D deficiency, and to assess both short-term and long-term clinical outcomes. METHODS: In this prospective randomized controlled trial, 101 SSNHL inpatients with vitamin D deficiency (serum 25-hydroxyvitamin D < 75 nmol/L) were enrolled at Yinchuan First People's Hospital (January-December 2024). Participants were randomized into a control group (n = 51, receiving conventional therapy: methylprednisolone and ginkgo biloba extract) and an experimental group (n = 50, conventional therapy + oral vitamin D3 [1500-2000 IU/day] for 10 days). Hearing and tinnitus outcomes were assessed via pure tone audiometry (PTA) and the Tinnitus Handicap Inventory (THI) at baseline, 10 days, and 3 months. RESULTS: Baseline characteristics were comparable between groups (all P > 0.05). At 10 days, the experimental group demonstrated significantly higher total effective rates for hearing recovery (82.0% vs. 52.9%, P < 0.001) and tinnitus improvement (83.3% vs. 71.1%, P = 0.007) compared to the control group. Mean PTA improvement was 29.3 dB HL vs. 14.2 dB HL (P < 0.001). At 3 months, the experimental group maintained significantly better outcomes, with a mean PTA improvement of 25.1 dB HL versus 12.5 dB HL in the control group (P < 0.001) and a greater reduction in THI scores (27.5 vs. 13.9, P < 0.001). The total effective rate for hearing remained superior in the experimental group (76.0% vs. 47.1%, P = 0.002). CONCLUSION: Vitamin D supplementation combined with conventional therapy significantly improves both short-term and sustained long-term hearing and tinnitus outcomes in SSNHL patients with vitamin D deficiency. These findings support its role as a safe and effective adjuvant treatment, warranting further validation through multicenter trials. © 2025. The Author(s).

The purpose of this research was to assess the impact of supplemental Ginkgo biloba extracts when administered in conjunction with vestibular rehabilitation training (VRT) to enhance patient outcomes in patients with vestibular neuritis (VN). A randomized controlled trial was conducted with 80 participants divided into two groups: Group A (Ginkgo biloba extracts+ VRT) and Group B (VRT only). It was established in the study that the integration of Ginkgo biloba extracts with VRT gave improved results, shorter treatment period, higher postural stability, and better quality of life than the group that received only VRT. Neuroprotective, anti-inflammatory and vasodilatory effects of Ginkgo biloba extracts were instrumental in helping compensate for the vestibular damage and therefore aid in recovery. This study has indicated that supplementing with Ginkgo biloba extracts alongside VRT is a better treatment approach when treating patients with 'persistent' VN.

Comment in Diabetes Metab J. 2026 Mar;50(2):414-415. doi: 10.4093/dmj.2025.0817. BACKGRUOUND: We conducted a prospective, randomized study to evaluate the combination of cilostazol (CTZ) and extract of Ginkgo biloba (EGb) and compare it with aspirin for the prevention of atherosclerosis progression in patients with type 2 diabetes mellitus (T2DM). METHODS: One hundred five patients with T2DM and increased carotid intima-media thickness (IMT) were randomly assigned to receive either CTZ 200 mg plus EGb 160 mg once daily or aspirin (ASA) 100 mg/day for 12 months. The primary endpoint was the change in maximum carotid IMT. RESULTS: The mean age and body mass index were 61.6±8.4 years and 25.2±3.1 kg/m2 in the CTZ/EGb group and 61.6±7.6 years and 24.5±3.3 kg/m2 in the ASA group, respectively. CTZ/EGb treatment reduced the maximum IMT in the bulb area (from 1.435±0.690 to 1.346±0.688 mm on the right; from 1.359±0.528 to 1.299±0.528 mm on the left), whereas ASA treatment did not, resulting in significant between-group differences (P<0.05). No significant differences were observed in the common carotid and internal carotid arteries. The CTZ/EGb group showed a reduction in triglycerides and an increase in high-density lipoprotein cholesterol levels. Additionally, aspartate and alanine aminotransferase levels decreased only in the CTZ/EGb group. There were no significant differences in Mini-Mental State Examination (MMSE) score changes or adverse events (ClinicalTrials.gov number: NCT05906199). CONCLUSION: Twelve months of CTZ/EGb combination therapy significantly attenuated the progression of carotid atherosclerosis compared with aspirin in patients with T2DM.

This prospective study compared the therapeutic efficacy of Ginaton alone, Ginaton combined with glucocorticoids, or Ginaton with mouse nerve growth factor (mNGF) in patients with sudden sensorineural hearing loss (SSNHL). Between January 2014 and June 2015, 101 SSNHL patients, with treatment initiated 3-10 days post onset, were randomly assigned to receive 1 of 3 2-week regimens: Ginaton alone (n = 33), Ginaton + glucocorticoid (n = 34), or Ginaton + mNGF (n = 34). Primary outcome was overall hearing improvement. Effectiveness rates were 78.79% (95% confidence interval [CI] 61.8%-89.9%) for Ginaton, 79.41% (95% CI 62.9%-90.1%) for Ginaton + glucocorticoid, and 88.24% (95% CI 72.5%-95.8%) for Ginaton + mNGF; these differences were not statistically significant (P > .05). All 3 groups showed significant post-treatment reductions in whole blood viscosity (high, medium, low shear rates; all P < .01), low-density lipoprotein cholesterol (all P < .01), and triglycerides (all P < .01). The neutrophil-to-lymphocyte ratio, an inflammatory marker, significantly decreased in the Ginaton + glucocorticoid (P < .05) and Ginaton + mNGF groups (P < .01). While all regimens demonstrated positive effects on hearing and surrogate markers, and Ginaton + mNGF showed a numerically higher hearing improvement rate, no statistically superior regimen for overall hearing was identified. This study suggests these approaches improve inner ear blood rheology and inflammation. However, larger, placebo-controlled trials are crucial to confirm efficacy and elucidate the distinct pharmacological contributions of each component, considering the study's sample size and open-label design. © 2025, The American College of Clinical Pharmacology.

Objective:This study aimed to evaluate the therapeutic effect of intratympanic injection of ganglioside in patients with refractory sudden deafness. Methods:A total of 120 patients with sudden deafness, aged 18-65 years, whose onset was within 11-42 days, failed to respond to conventional treatment, and had an average hearing threshold（500-4 000 Hz）>60 dB were selected. They were prospectively and randomly divided into a control group of 61 cases and an experimental group of 59 cases. The control group was treated according to the recommended protocol of the Chinese Medical Association（postauricular injection of methylprednisolone）, while the experimental group was treated with intratympanic injection of monosialotetrahexosylganglioside sodium+postauricular injection of methylprednisolone. Both groups were simultaneously administered oral ginkgo biloba extract and citicoline tablets. Hearing was re-examined two weeks after the completion of treatment, and the therapeutic effects of the two different treatment methods were compared and analyzed. Results:The effective rate was 29.51% in the control group and 54.24% in the experimental group（P<0.01）. The average hearing threshold improved by 11.57 dB HL in the control group and 22.50 dB HL in the experimental group（P<0.05）. Conclusion:The combination of postauricular injection of methylprednisolone and intratympanic injection of ganglioside is more effective than postauricular injection of methylprednisolone alone in the treatment of refractory sudden deafness. The earlier the treatment, the better the therapeutic effect. Publisher: 目的：本研究旨在评价鼓室注射神经节苷脂在难治性突聋患者中的疗效。 方法：入选发病在11～42 d、经常规治疗无效、平均听阈（500～4 000 Hz）>60 dB的突发性聋、年龄18～65岁的患者120例，前瞻性平行随机分为对照组61例和试验组59例，对照组按照中华医学会推荐方案（耳后注射甲泼尼龙）治疗，试验组鼓室注射单唾液酸四己糖神经节苷脂钠+耳后注射甲泼尼龙治疗，2组同时口服银杏提取物和胞磷胆碱片。治疗结束2周后复查听力，对2种不同治疗方法的疗效进行比较分析。 结果：对照组有效率为29.51％，试验组有效率为54.24％（P<0.01）。对照组平均听阈改善了11.57 dB HL，试验组平均听阈改善22.50 dB HL（P<0.05）。 结论：耳后注射甲泼尼龙联合鼓室注射神经节苷脂较单纯耳后注射甲泼尼龙治疗难治性突发性聋疗效好，并且治疗越早，疗效更佳。. A Randomized Controlled Study on the Clinical Efficacy of Ginkgo Biloba Combined with Nicorandil in Patients with HFmrEF. Gao X(1), Liu F(1), Han X(1), Tang S(1), Shen D(1), Zhang J(1), Liu C(1). Author

42. Int Heart J. 2025;66(1):74-80. doi: 10.1536/ihj.24-316. A Randomized Controlled Study on the Clinical Efficacy of Ginkgo Biloba Combined with Nicorandil in Patients with HFmrEF. Gao X(1), Liu F(1), Han X(1), Tang S(1), Shen D(1), Zhang J(1), Liu C(1). Author information: (1)Department of Ger

OBJECTIVE: Ginkgo diterpene lactone meglumine (GDLM) could improve the functional outcome after acute ischemic stroke (AIS). This study aimed to investigate the efficacy of GDLM on the quality of life in patients with AIS in China. METHODS: This is a post hoc analysis of Efficacy and Safety of Ginkgo Diterpene Lactone Meglumine in Acute Ischemic Stroke trial. The quality of life was measured using the EuroQoL questionnaire, including EQ-5D and EQ visual analogue scale (EQ-VAS). The primary outcomes were changes in EQ-5D and EQ-VAS from baseline to day 14 and day 90 after randomization. RESULTS: A total of 3219 patients with completed data on outcomes were enrolled, with median age of 63 years (interquartile range, 55-70) and 2,067 (64.2%) men. GDLM was associated with a significant decrease in scores of ED-5Q components (from 0 [no problem] to 3[extreme problem]), the mean difference between GDLM and placebo group was -0.14 for mobility, -0.11 for usual activities and self-care, -0.09 for pain/discomfort, and -0.34 for anxiety/depression on day 14, respectively. Similar results were observed on day 90. Additionally, there was statistically significant difference of changes in EQ-VAS between the GDLM group and the placebo group from baseline to day 14 (mean difference, 1.70; 95% confidence interval [CI], 0.78-2.62; P = 0.0003) and to day 90 after randomization (mean difference, 3.29; 95% CI, 2.37-4.22; P < 0.001). CONCLUSIONS: In this analysis of Chinese patients with AIS, GDLM could improve the 14-day and 90-day quality of life compared with the placebo. TRIAL REGISTRATION: URL: https://www. CLINICALTRIALS: gov . Unique identifier: NCT02526225. Registration Date: 2016-02-01. © 2024. The Author(s).

Herbal medicines are widely used worldwide, often alongside prescription drugs, creating the potential for clinically significant herb-drug interactions. These interactions are frequently mediated by effects on drug-metabolizing enzymes (DMEs), particularly those of the cytochrome P450 (CYP450) family, as well as phase II conjugation pathways. This review examines current evidence on how selected herbal extracts influence key enzymes such as cytochrome P450 family 3 subfamily A member 4 (CYP3A4), cytochrome P450 family 2 subfamily D member 6 (CYP2D6), cytochrome P450 family 2 subfamily C member 9 (CYP2C9), and UDP-glucuronosyltransferases (UGTs), and highlights the implications for drug safety and efficacy. Major findings from the literature indicate that herbs like St. John's Wort, Ginkgo biloba, and turmeric can either inhibit or induce enzyme activity, leading to altered drug metabolism. However, results vary widely due to differences in extract composition, dosage, study design, and genetic factors among populations. It is important to note that there remains less clinical evidence as compared to in vitro or animal data, which makes it necessary to be careful when interpreting the results. In addition to pharmacokinetic interactions, this review discusses potential toxicity concerns and safety risks linked to the use of herbal medicinal products. It also outlines key challenges in effectively monitoring and regulating their safe use in clinical practice. Investigating, standardizing herbal product quality, improving study methodologies, and integrating pharmacogenomic data will be essential steps toward ensuring patient safety when combining herbal and conventional therapies.

Isoginkgetin is an edible biflavone from ginkgo biloba leaves with many bioactivities. In this work, the inhibition and synergistic effect of isoginkgetin with miglitol or acarbose on saccharomyces cerevisiae α-glucosidase (α-SCG) were tracked via various spectroscopic techniques and computer simulations. Compared with miglitol or acarbose, isoginkgetin displayed more remarkable inhibition effect on α-SCG. In the presence of isoginkgetin, miglitol and acarbose exhibited stronger inhibitory effect on α-SCG than miglitol and acarbose alone. Isoginkgetin exerted the synergistic inhibitory effect by significantly increasing the binding affinity of acarbose or miglitol with α-SCG, leading to larger structural changes in α-SCG. The best binding mode, the stability of the formed complex, and the contribution of key amino acids to the binding were deeply analyzed via dynamics simulation. Isoginkgetin can be used as a strong inhibitor of α-SCG and synergistic inhibitor of miglitol or acarbose.

This retrospective observational study was conducted to investigate the prevalence and clinical implications of drug interactions involving Ginkgo biloba extract on bleeding risk and coagulation profiles. Our analysis utilized data from patients admitted to Hai Phong International Hospital between January 2022 and December 2023. Inclusion criteria consisted of patients aged 18 years and above, those prescribed Ginkgo biloba extract alone or in combination with other medications, and the availability of complete medical records, including medication history, laboratory tests, and clinical outcomes. Out of 2,647 prescriptions meeting the inclusion criteria, 342 exhibited drug interactions with a prevalence rate of 12.94%. Notably, Ginkgo biloba extract frequent interacts with antiplatelets, anticoagulants, and nonsteroidal anti-inflammatory drugs, with Clopidogrel and Aspirin exhibiting the highest prevalence rates of 2.61% each. However, interactions with anticoagulants including direct oral anticoagulants and acenocoumarol, were not statistically significant in our analysis. Omeprazole was a frequently interacting drug (2.34%) of mild severity. Among the 747 patients analyzed for bleeding disorders, 31 (4.15%) exhibited bleeding symptoms. Correlation analysis indicated a strong association between clinical bleeding and abnormal coagulation results (OR, 1.75; p < 0.001). Moreover, significant correlations were found between Ginkgo biloba extract drug interactions and the bleeding risk (OR: 1.08, p < 0.001) and abnormal coagulation (OR: 1.49, p < 0.001). The severity of Ginkgo biloba extract drug interactions did not correlate with bleeding risk (OR: 1.01, p = 0.767) but influenced abnormal coagulation test results (OR: 0.813, p = 0.019). Specific medications, including clopidogrel, aspirin, celecoxib, loxoprofen, nifedipine, and omeprazole, were significantly associated with the risk of bleeding and abnormal coagulation (p < 0.05). Interactions with ticagrelor, etoricoxib, insulin, omeprazole, and domperidone were associated with abnormal coagulation tests without affecting the reported bleeding. These findings underscore the critical need of evaluating potential

BACKGROUND: The escalating use of complementary and alternative medicine (CAM) raises concerns, particularly among geriatric patients taking multiple medications. Notably, the doubled chance of major drug interactions between prescription and over-the-counter (OTC) drugs in older adults underscores the need for further research. This study aimed to evaluate clinically significant CAM and prescription medication interactions in a geriatric clinic, emphasizing the growing importance of understanding CAM implications in health care. METHODS: A 2-year cross-sectional study, approved by the Institutional Review Board, enrolled 420 participants aged 65 and older from a geriatric primary care clinic. Participants completed a survey, and pharmacy students conducted chart reviews to evaluate potential CAM products and prescription medication interactions. RESULTS: Among the 420 participants-who were predominantly White females and who were taking supplements, OTC medications, or both-15.6% experienced potential drug interactions. Ginkgo biloba, garlic, and calcium were common contributors to major, moderate, and minor interactions, respectively, among supplements. Meanwhile, ibuprofen was among the contributors to major and moderate interactions among OTC medications. Most supplements and OTC medications were disclosed to health care professionals. However, there was a lack of investigation by health care professionals regarding CAM use, emphasizing a discrepancy between patient-reported and physician-inquired CAM usage. CONCLUSION: This study highlighted the significant use of CAM and/or OTC medications, particularly among vulnerable older adults, revealing a concerning 15.6% rate of potential drug interactions. The findings emphasized the need for awareness among health care practitioners and standardized CAM surveys to enhance accuracy and patient safety.

Hypertension is a highly prevalent population-level disease that represents an important risk factor for several cardiovascular complications and occupies a leading position in mortality statistics. Antihypertensive therapy includes a wide variety of drugs. Additionally, the potential antihypertensive and cardioprotective effects of several phytotherapy products have been evaluated, as these could also be a valuable therapeutic option for the prevention, improvement or treatment of hypertension and its complications. The present review includes an evaluation of the cardioprotective and antihypertensive effects of garlic, Aloe vera, green tea, Ginkgo biloba, berberine, ginseng, Nigella sativa, Apium graveolens, thyme, cinnamon and ginger, and their possible interactions with antihypertensive drugs. A literature search was undertaken via the PubMed, Google Scholar, Embase and Cochrane databases. Research articles, systematic reviews and meta-analyses published between 2010 and 2023, in the English, Hungarian, and Romanian languages were selected.

BACKGROUND The use of herbal medicines (HMs) is increasing, which raises concerns of herb-drug interactions (HDIs). This questionnaire-based study aimed to evaluate knowledge of HMs and HDIs in 147 undergraduate nursing students in Riyadh, Saudi Arabia, between March 2022 to June 2022. MATERIAL AND METHODS An online cross-sectional study was conducted among 147 nursing undergraduates at King Saud University, Riyadh, Saudi Arabia from March 2022 to June 2022, using a self-administered 24-item questionnaire. The convenience sampling method was used to evaluate the knowledge of HMs and interactions of anticoagulants, anti-inflammatory drugs, antibiotics, and antiplatelet drugs with herbs like ginkgo biloba, St. John's wort, garlic, ginger, green tea, and chamomile tea. RESULTS The findings of this study reported that 74.8% of the undergraduates used HMs. With regard to HDIs, 20.4% of nursing undergraduates identified the interaction between gingko biloba and drugs like ibuprofen and warfarin, while 13.6% identified interactions between drugs like warfarin with green tea, ginger, and chamomile tea. Regarding general knowledge, 59% of the students (n=84) reported good knowledge of HMs. Previous history of HM use significantly affected the mean HM knowledge score (t=4.635; P=0.0001). CONCLUSIONS To summarize, Saudi nursing students showed a lack of understanding and knowledge of HDIs. Ability to identify specific HDIs, like ginkgo biloba interactions with warfarin and ibuprofen, and warfarin interactions with green tea and ginger, was limited. There is a need to introduce HM and HDI courses in the academic curriculum.

Physiologic changes due to aging, pregnancy, nutritional status, drug interactions, and can affect pharmacokinetics and pharmacodynamics of antiepileptic drugs. In this review article, the interactions between phenytoin and herbs recorded in the literature were summarized according to the Medline database (via PubMed). Our results revealed that, changes in phenytoin's bioavailability were reported for co-administration of herbs or herbal extracts. An increase in phenytoin blood levels was established with Piper nigrum, Mentat, and Lipidum sativum in in vitro and/or in vivo studies. In contrast, herbphenytoin interactions led to sub-therapeutic levels of phenytoin in other cases with herbs such as Cannabis, Ginkgo biloba, Morinda citrifolia, Nigella sativa, and Trigonella foenum graceum. In addition, the findings of other pharmcodynamic experiments showed that various herbs, including Zizyphus jujube, Terminalia chebula, Curcuma longa L, and Centella asiatica, improved the pharmacological impact of phenytoin. To reduce the patients' health risks, health professionals involved in their treatment are expected to be thoroughly educated about the interactions between phenytoin and medicinal plants.

BACKGROUND: Patient harm resulting from drug interactions between conventional and traditional or complementary medicines (CM) are avoidable. OBJECTIVE: To provide a clinical overview of a selection of CM interactions with drugs commonly used in Australian general practice or in the management of COVID-19. DISCUSSION: Many herb constituents are substrates for cytochrome P450 enzymes, and inducers and/or inhibitors of transporters such as P-glycoprotein. Hypericum perforatum (St John's Wort), Hydrastis canadensis (golden seal), Ginkgo biloba (ginkgo) and Allium sativum (garlic) are reported to interact with many drugs. Simultaneous administration of certain anti-viral drugs with zinc compounds and several herbs should also be avoided. Preventing and identifying unwanted CM-drug interactions in primary care requires vigilance, access to CM-drug interaction checkers and excellent communication skills. Potential risks from interactions should be balanced against the potential benefits of continuing the drug and/or CM and involve shared decision making.

Herb medicine has a long history of application and is still used worldwide. With the development of complementary and alternative medicine, the interaction between herb and drugs has attracted more and more attention. Herb-drug interactions (HDI) could cause decreased efficiency, increased toxicity, and affect the drug absorption and disposition processes due to the interference of their pharmacological or pharmacokinetic effects. Hence, the mechanisms and results of herb-pharmacokinetic interactions should be comprehensively summarized. Here, we have summarized the mechanisms of HDI and pharmacokinetic interactions in the last ten years based on searching on PubMed, Science Direct, and Web of Science with different keywords. Besides, the pharmacokinetic interactions were related to nine commonly used herbs and drugs, including Ginseng, Salvia miltiorrhiza, Ginkgo biloba, Garlic, Coptis chinensis, St. John's wort, Ginger, Licorice, Silythistle and Fructus Schisandrae. This review provides an overview of HDI to provide a reference for the rational and safe clinical use of herbs and drugs.

The predicted anti-oxidation is related to apoptosis, proliferation, lipid metabolism, cell differentiation, and immune response. There are some differences in the antioxidant capacity of the four typical components of ginkgo biloba extract (EGb) including ginkgo flavone (GF), ginkgolide (G), procyanidins (OPC), and organic acids (OA), and any two members of them can exhibit apparent synergistic effects. The order of DPPH scavenging ability was: OPC > GF > OA > G. The scavenging ability of procyanidins was close to that of VC; the scavenging capacity of ABTS was GF > OPC > OA > G. The GF:OPC (1:9) showed the best synergism in scavenging DPPH and ABTS radicals. The 193 kinds of small molecules reported in EGb were obtained by analyzing the properties of EGb. In order to construct a corresponding biological activity target set, molecular docking and the network pharmacology method were employed to build the molecular action mechanism network of a compound target, and the main biological functions and signaling pathways involved with their antioxidant activities were predicted. The results displayed that the top ten compounds which belonged to the two broad categories, ginkgo flavonoids and proanthocyanidins, could interact closely with several important target proteins (CASP3, SOD2, MAPK1, HSPA4, and NQO1). This would be expected to lay a theoretical foundation for the deep development of Ginkgo biloba extract.

CONTEXT: Ginkgo biloba Linn (Ginkgoaceae) [leaves extract (GBE)] is authorized for the treatment of sudden hearing loss (SHL); however, its clinical feasibility in SHL has not been thoroughly investigated. OBJECTIVE: To evaluate the efficacy and safety of adjuvant GBE in the treatment of SHL. MATERIALS AND METHODS: We used PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Wanfang, Chinese Scientific Journal Database, China Biomedical Database for literature research, starting from inception to 30 June 2022. The key terms: Ginkgo biloba extract, Sudden Sensorineural Deafness. This meta-analysis contained randomized controlled trials that compared the safety and efficacy of the combination of GBE and general treatments (GT) with GT alone for SHL. The extracted data were analyzed using Revman5.4 software with risk ratio (RR), 95% confidence intervals (CI) and mean difference (MD). RESULTS: Our meta-analysis included 27 articles with a total of 2623 patients. The results revealed that the effects of GBE adjuvant therapy was superior than GT (total effective rate: RR = 1.22, 95% CI: 1.18-1.26, p < 0.00001), the pure tone hearing threshold (MD = 12.29, 95% CI: 11.74-12.85, p < 0.00001) and hemorheology indexes (whole blood high shear viscosity: MD = 1.46, 95% CI: 0.47-2.44, p = 0.004) after treatment were significantly improved compared to non-treatment, while there was no significant difference as for hematocrit (red blood cells) (MD = 4.15, 95% CI: -7.15-15.45, p = 0.47). CONCLUSION: The efficacy of GBE + GT for the treatment of SHL may be more promising than GT alone.