Ginkgo biloba (DB01381): A Comprehensive Pharmacological and Clinical Review

Executive Summary

Ginkgo biloba (DrugBank ID: DB01381; CAS Number: 90045-36-6) is a phytopharmaceutical agent with a unique standing in both traditional and modern medicine. Derived from one of the world's oldest living tree species, its leaf extract has been investigated for a wide range of therapeutic applications, primarily centered on cognitive and circulatory disorders. The extract's pharmacological activity is attributed to a complex mixture of bioactive compounds, principally flavonoid glycosides and terpene lactones, which confer a multifaceted mechanism of action. These mechanisms include potent antioxidant effects, vasodilation and improvement of blood rheology, modulation of key neurotransmitter systems, and antagonism of Platelet-Activating Factor (PAF).

This comprehensive review synthesizes the current body of scientific evidence on Ginkgo biloba, critically examining its botanical origins, pharmacology, clinical efficacy, safety profile, and regulatory status. A central theme emerging from the analysis is the significant discrepancy between the highly standardized, pharmaceutical-grade extract used in credible clinical research (EGb 761) and the often-adulterated, unregulated products sold as dietary supplements, which complicates the translation of research findings into clinical practice.

The clinical evidence for Ginkgo biloba is marked by a significant paradox. While a large body of evidence from systematic reviews and meta-analyses suggests that the standardized extract EGb 761 at a dose of 240 mg/day may offer modest symptomatic benefit in stabilizing or slowing the decline in cognition and function in patients with established dementia or mild cognitive impairment, the most definitive large-scale trial to date—the Ginkgo Evaluation of Memory (GEM) Study—found it to be unequivocally ineffective for the primary prevention of dementia in older adults.