What is the use and dosage of Tebonin Forte (Ginkgo biloba extract) for cognitive function and circulation?

Tebonin Forte (Ginkgo Biloba Extract): Clinical Use and Dosing

Tebonin Forte (Ginkgo biloba extract) has insufficient evidence to support its use for cognitive impairment, dementia, or circulation disorders, and should generally be avoided in clinical practice. 1

Evidence Quality and Recommendations

Cognitive Function

• Major guidelines explicitly list ginkgo biloba as having insufficient evidence to form clinical recommendations for cognition in patients with cancer-related cognitive impairment 1
• The 2025 Canadian Stroke Best Practice Guidelines do not recommend ginkgo biloba for vascular cognitive impairment, notably absent from their evidence-based treatment algorithms 1
• Systematic reviews show no convincing evidence that ginkgo is effective for cognitive impairment or dementia, despite widespread use 2
• A large body of research demonstrates at best "quite modest" effects, with questionable clinical significance compared to proven treatments 3

Circulation and Peripheral Arterial Disease

• For intermittent claudication, meta-analyses show a weighted mean difference of only 34 meters in pain-free walking distance with 120-160mg daily for 12-24 weeks—outcomes described as "of marginal clinical importance" 4
• No single well-powered study has definitively established efficacy for peripheral vascular disease 4
• One small study (n=15) showed increased skin microcirculation with 25ml Tebonin infusion, but this lacks clinical validation 5

Standard Dosing (When Used Despite Limited Evidence)

Typical Doses in Clinical Trials

• 120-160mg daily for cognitive and vascular indications, administered for 12-24 weeks 4
• Tebonin Forte typically contains standardized extract (EGb 761) at various concentrations 6
• The specific 200mg dose has not been extensively studied but falls within commonly researched ranges 4

Critical Safety Concerns

Bleeding Risk

• Ginkgo biloba contains ginkgolide B which displaces platelet-activating factor, decreasing coagulation 7, 4
• Multiple major guidelines (American Academy of Neurology, American Academy of Family Physicians) specifically warn against combining ginkgo with anticoagulants or antiplatelet medications 7
• Withdraw ginkgo two weeks before elective surgery due to bleeding risk 2

High-Risk Populations

• Patients with pre-existing bleeding disorders are at particularly high risk 7
• Those taking SSRIs (like Lexapro), warfarin, aspirin, or other anticoagulants should avoid concurrent use 7
• The American Academy of Family Physicians recommends avoiding concurrent use with medications affecting coagulation 7

Drug Interactions

• May alter drug pharmacokinetics through cytochrome P450 inhibition, potentially affecting metabolism of other medications 4
• Interactions with anticoagulants/antiplatelet drugs cannot be ruled out 2

Common Adverse Effects

• Minor side effects include stomach upset, headache, dizziness, constipation, forceful heartbeat, and allergic skin reactions 2
• Overall safety profile shows no excess side effects compared to placebo in controlled trials 2

Clinical Recommendation Algorithm

For patients requesting ginkgo biloba:

1. First-line approach: Recommend FDA-approved medications for cognitive enhancement rather than ginkgo biloba 7
2. If patient insists on use: Screen for bleeding disorders, review all medications for anticoagulant/antiplatelet effects, and document bleeding risk discussion 7
3. If concurrent use unavoidable: Consider more frequent monitoring of coagulation parameters 7
4. Surgical patients: Mandatory discontinuation two weeks preoperatively 2

The evidence does not support routine clinical use of Tebonin Forte for any indication given the marginal benefits and potential bleeding risks. 1, 4, 2