Herbal agents for cognitive disorders
ATC code: N06BX02 (Ginkgo biloba extract)
Brand names
Tanakan, Tebonin
A standardised extract from Ginkgo biloba leaves. Main components are flavonoids (ginkgo flavonglycosides) and terpene lactones (ginkgolides and bilobalide). The manufacturer claims vasodilation, antioxidant activity, neurotransmitter modulation, and platelet aggregation inhibition. The EGb 761 extract is the best-studied form. Used in Europe and sold over-the-counter in the US as a botanical supplement.
Not recommended
A 2013 Cochrane review showed a small increase in pain-free walking distance with ginkgo biloba, but clinical relevance is uncertain. Current ESC 2024 and AHA/ACC 2024 peripheral artery disease guidelines do not list ginkgo. The foundation is smoking cessation, a walking programme, statins, and antiplatelet therapy; cilostazol is added for inadequate response.
Not recommended
Online, ginkgo is promoted as a 'natural remedy for concentration and ADHD'. AAP 2019 and NICE NG87 do not include herbal preparations in ADHD treatment. First-line is psychostimulants (methylphenidate, lisdexamfetamine), atomoxetine, and behavioural therapy. Ginkgo in children increases bleeding risk and can interact with other drugs.
Not recommended
The 2009 Cochrane review 'Ginkgo biloba for cognitive impairment and dementia' reported inconsistent results with large effect dispersion and no clinically meaningful cognitive benefit in the most rigorous RCTs. The largest trial, GEM 2008 (3069 participants, 6 years follow-up), found no reduction in dementia risk with EGb 761 240 mg daily. AAN 2018 does not recommend ginkgo for mild cognitive impairment, and NICE NG97 does not mention it for dementia.
Not recommended
AUA 2018 and EAU 2023 list PDE-5 inhibitors (sildenafil, tadalafil, vardenafil) as first-line for erectile dysfunction. Ginkgo biloba is not included in clinical guidelines. Small studies in antidepressant-induced ED yielded mixed results, and no large independent RCTs exist.
Not recommended
In healthy individuals without objective cognitive impairment, international sources do not recommend ginkgo for 'memory enhancement'. Systematic reviews of subjective memory complaints show either no effect or small inconsistent effects in studies with risk of bias.
Not recommended
A 2013 Cochrane review of ginkgo for tinnitus concluded there was no clinically meaningful effect. AAO-HNS 2014 and NICE NG214 do not recommend the drug. The popular retail positioning of ginkgo 'for ear ringing' does not match evidence data.
Pregnancy safety is not established. Bleeding risk – not recommended.
Not recommended during breastfeeding.
Ginkgo biloba extract is evaluated for the following indications with varying evidence strength: Intermittent claudication in peripheral artery disease (evidence tier D), Subjective age-related memory complaints (marketed indication) (evidence tier F), Tinnitus (evidence tier F). See the full indication matrix with dosing and citations above on this page.
Common side effects of Ginkgo biloba extract (≥ 1 in 100): Headache, Dyspepsia, Allergic reactions. See the Safety section for uncommon and serious reactions.
Pregnancy safety is not established. Bleeding risk – not recommended.
Not recommended during breastfeeding.
Ginkgo biloba extract is contraindicated in: Hypersensitivity to any component; Concomitant anticoagulants without monitoring; History of haemorrhagic stroke; Pregnancy and breastfeeding. Full list in the Safety section.
biological activity does not depend on whether a component is natural or synthetic. Ginkgo genuinely affects coagulation and interacts with drugs. The claimed memory benefit is unconfirmed in large RCTs, whereas the bleeding risk is confirmed.