Ginkgo Biloba Dosing
The recommended dose of Ginkgo biloba extract (EGb 761) is 120-160 mg daily, typically divided into 2-3 doses, based on clinical trial evidence for cardiovascular and cognitive applications. 1
Standard Dosing Regimens
Clinical trials have established the following evidence-based dosing:
- 120-160 mg daily is the most commonly studied and recommended dose for peripheral arterial disease and intermittent claudication, administered for 12-24 weeks 1
- 240 mg daily has been used in some studies and showed more consistent CNS effects with earlier onset (1 hour) and longer duration (7 hours) compared to lower doses 2
- The traditional dosing pattern is 3 × 40 mg (total 120 mg daily), though this is based more on empirical data than formal dose-finding studies 3
Specific Clinical Applications
For cognitive impairment and dementia:
- Studies have used 60 mg of ginkgo biloba as part of combination supplements 4
- Dosing ranges from 80 to 720 mg/day have been reported in trials lasting 2 weeks to 2 years, though optimal dosing remains unclear 5
For cardiovascular effects:
- 120-160 mg daily is the established range for peripheral arterial disease 1
- This dose showed a weighted mean difference in pain-free walking distance of 34 meters compared to placebo 1
Important Safety Considerations
Bleeding risk is the primary concern with ginkgo biloba:
- Avoid concurrent use with anticoagulants, antiplatelet drugs, or SSRIs like Lexapro due to ginkgolide B's anticoagulant effects 6
- Multiple guidelines from the American Academy of Neurology and American Academy of Family Physicians specifically warn against combining ginkgo with medications affecting coagulation 6
- Patients with pre-existing bleeding disorders are at particularly high risk 6
Pharmacological Basis
The standardized extract (EGb 761) contains:
- Approximately 24% flavone glycosides (quercetin, kaempferol, isorhamnetin) 3
- 6% terpene lactones (2.8-3.4% ginkgolides A, B, C; 2.6-3.2% bilobalide) 3
- Ginkgolide B specifically displaces platelet-activating factor from binding sites, decreasing coagulation 1
Clinical Efficacy Limitations
The evidence for ginkgo biloba remains modest:
- For intermittent claudication, outcomes are likely to be of marginal clinical importance despite statistical significance 1
- No single well-powered study has definitively established efficacy, though meta-analyses suggest modest benefit 1
- A 2020 Lancet guideline noted that one small study (n=15) showed benefit for cisplatin-induced ototoxicity, but methodological concerns and insufficient replication prevented formal recommendations 4