What is the recommended dose of Ginkgo (Ginkgo biloba)?

Ginkgo Biloba Dosing Recommendation

For cognitive impairment and dementia, use 240 mg daily of standardized Ginkgo biloba extract (EGb761), divided into two or three doses, as this is the only dose convincingly demonstrated to improve cognition, neuropsychiatric symptoms, and daily activities. 1

Evidence-Based Dosing

Standard Dose for Cognitive Benefits

• 240 mg daily is the evidence-based dose that shows consistent efficacy for mild cognitive impairment and dementia 1, 2
• Lower doses (120-160 mg daily) have been studied but show less consistent benefits 3, 4
• The effect is clearly dose-dependent, with high daily doses (240 mg) required for convincing clinical improvement 1

Administration Schedule

• Divide the 240 mg total daily dose into two or three administrations (e.g., 120 mg twice daily or 80 mg three times daily) 5, 6
• Single doses of 120 mg or 240 mg show CNS effects with onset at 1 hour and duration up to 7 hours 5

Duration of Treatment

• Treatment duration in successful trials ranged from 12 to 52 weeks 2
• Clinical benefits for cognition appear at 12 weeks and are sustained through 24-52 weeks 4, 2
• The 240 mg daily dose shows significant improvement in cognitive scores (SKT) compared to placebo in meta-analysis 2

Clinical Context by Indication

For Dementia (Alzheimer's Disease and Vascular Dementia)

• 240 mg daily is the established dose showing statistically significant improvement in cognitive function 2
• Meta-analysis demonstrates standardized mean difference of -0.71 in SKT scores favoring Ginkgo at this dose 2

For Peripheral Arterial Disease/Intermittent Claudication

• 120-160 mg daily for 12-24 weeks showed modest improvement in pain-free walking distance (34 meters vs placebo) 3
• However, outcomes are of marginal clinical importance for this indication 3

For Mild Cognitive Impairment

• One study used 60 mg daily as part of a multi-nutrient combination, but this was not Ginkgo monotherapy 7
• Monotherapy studies support 240 mg daily for meaningful cognitive benefits 1

Critical Safety Considerations

Absolute Contraindications

• Do not combine with anticoagulants or antiplatelet medications (warfarin, aspirin, clopidogrel) due to ginkgolide B's antiplatelet effects 3, 8
• Avoid in patients with bleeding disorders or those at high bleeding risk 3, 8
• Do not use with SSRIs like escitalopram (Lexapro) due to increased bleeding risk 8

Drug Interactions

• Ginkgo inhibits cytochrome P450 enzymes, potentially altering metabolism of other medications 3
• Reported interactions with MAO inhibitors, alprazolam, haloperidol, and nifedipine 6
• Multiple major guidelines (American Academy of Neurology, American Academy of Family Physicians, Mayo Clinic) specifically warn against combining with coagulation-affecting medications 8

Adverse Events

• Overall adverse events are equivalent to placebo 1, 4
• Dropout rates due to side effects are actually lower with Ginkgo than placebo (OR 1.72, favoring Ginkgo) 2
• Fewer incidences of vertigo, tinnitus, angina pectoris, and headache compared to placebo 1

Common Pitfalls to Avoid

• Underdosing: Using 120 mg daily or less will likely produce inconsistent or marginal results 1
• Ignoring drug interactions: Always screen for anticoagulant/antiplatelet use before prescribing 3, 8
• Wrong extract: Ensure use of standardized EGb761 extract, as this is what clinical trials evaluated 6, 2
• Expecting immediate results: Benefits require at least 12 weeks of consistent use 4, 2