The dietary supplement of Ginkgo biloba: a comprehensive review of its potential interactions based on pre-clinical and clinical evidences

This review present Gingko biloba (GB) interactions, based on clinical and pre-clinical presentations. Literature was retrieved using databases; ScienceDirect, PubMed, Google scholar, Web of Science, Scopus etc. 14/45 interactions were found with clinical presentations. More interactions (80%) were reported with drugs followed by herbs (11.1%), and nutraceuticals (6.7%) with major mechanisms of interaction observed as; inhibition of Cytochrome metabolizing enzymes (44.4%) and platelet-activating factor (PAF) i.e. 15.6%. Major clinical features were; increased bleeding (eye, parietal), hematomas (subdural), and seizures as well as increased blood pressure, priapism, loss of infection/antiviral failure, and coma. Drugs with major interactions belonged to anti-platelet/anti-coagulant and NSAIDs. Synergistic effects were observed for GB vs herbs (except cannabis which showed rhabdomyolysis), foods, and nutraceuticals (except pyridoxine where neurotoxicity was seen). GB use should be monitored and the patient may seek proper advice from a healthcare professional.

The safety and efficacy of botanicals with nootropic effects

: Recent estimates for the global brain health supplement category, i.e. nootropic market size, will grow to nearly $5.8 billion by 2023. Overall, nearly one-quarter (23%) of adults currently take a supplement to maintain or improve brain health or delay and reverse dementia. Not surprisingly, the use of such supplements increases with age – more than one-third of the oldest generation (ages 74 and older) takes a supplement for brain health. This widespread use is being driven by a strong desire both in the younger and older generations to enhance cognitive performance and achieve healthy aging. The most prevalent botanicals currently dominating the nootropic marketplace include Gingko biloba, American ginseng, and Bacopa monnieri. However, other botanicals that affect stress, focus, attention, and sleep have also been procured by dietary supplement companies developing products for improving both, short and long-term brain health. This review focuses on efficacy data for neuroactive botanicals targeted at improving cognitive function, stress reduction, memory, mood, attention, concentration, focus, and alertness, including Bacopa monnieri, Ginkgo biloba, Holy basil, American ginseng, Gotu kola, Lemon balm, Common and Spanish sages and spearmint. Botanicals are discussed in terms of available clinical efficacy data and current safety profiles. Data gaps are highlighted for both efficacy and safety to bring attention to unmet needs and future research.

Safety and Efficacy for the Combination of Alpha Lipoic Acid, Gingko Biloba, Vitamin C, Zinc, Magnesium, Vitamin B6, Methylcobalamin, Vitamin E and Chromium Picolinate for the Medical Management of Age Related Hearing Loss: Post Marketing Surveillance Study

Introduction: Age related hearing loss is defined as a bilateral, progressive, symmetrical age-related sensorineural hearing loss, which is most pronounced at the higher frequencies. It is considered that oxidative stress has a central role in the pathology of age-related hearing loss so, this study was conducted to test the efficacy and safety for the combination of antioxidants for the treatment of age-related hearing loss. Methodology: This was a multi-centric study conducted at 11 clinical trial sites. Out of total 176 enrolled, 160 trial subjects completed the study. For efficacy assessment, 2 parameters were used including hearing related quality of life score and score obtained from hearing impairment questionnaire on day 0 (visit 1), 45 (visit 2) and 90 (visit 3). Results: At visit 1, the mean hearing related quality of life score was 4.437 increased to 5.725 at visit 2 and further increased to 6.906 at visit 3. At visit 2 and 3, the increase in hearing related quality of life score was 29.028% and 55.645% respectively as compared to baseline. The score obtained from hearing impairment questionnaire was 25.581 at visit 1 reduced to 16.200 and further reduced to 9.943 at visit 3. Conclusion: The combination of Alpha lipoic acid, Gingko biloba, Vitamin C, Zinc, Magnesium, Vitamin B6, Methyl cobalamin, Vitamin E and Chromium Picolinate can be used for the medical management of age related hearing loss.

Post Marketing Surveillance Study to evaluate the Efficacy and Safety for the Combination of Alpha Lipoic Acid, Gingko Biloba, Vitamin C, Zinc, Magnesium, Vitamin B6, Methylcobalamin, Vitamin E and Chromium Picolinate in the Patients of Tinnitus

Introduction: Tinnitus is the false perception of sound. Normally it is considered to be developed due to oxidative stress to the inner ear. This study was conducted to test the efficacy and safety for the combination of Alpha lipoic acid, Gingko biloba, Vitamin C, Zinc, Magnesium, Vitamin B6, Methylcobalamin, Vitamin E and Chromium Picolinate in the patients of tinnitus. Method: The study was conducted on 165 patients out of which 142 completed the study. Efficacy was evaluated by tinnitus symptom score (TSS). Patients were asked to rate the TSS ranging from 0 to 10 where 0 means no symptom and 10 means maximum tolerable symptoms. Safety assessment was made by analysing the adverse events reported by the patient. Efficacy and safety evaluation was done on day 0, 10 and 22. Results: Patients had TSS 6.26 on baseline visit which was reduced to 4.50 at day 10 and was further reduced to 2.47 at day 22. Also, in the clinical trial duration of 22 days, only 5 episodes of the adverse drug reactions were reported by the patient and all of them were of non-serious in nature and mild in intensity. Conclusion: The fixed dose combination of Alpha lipoic acid 200 mg, Gingko biloba 120 mg, Vitamin C 30 mg, Zinc 12 mg, Magnesium 10 mg, Vitamin B6 3 mg, Methylcobalamin 1500 mcg, Vitamin E 10 IU and Chromium Picolinate 1.66 mg equivalent to elemental chromium 200 mcg was found to be efficacious and safe for the treatment of Tinnitus.

Efficacy and Safety for the Combination of Alpha Lipoic Acid, Gingko Biloba, Vitamin C, Zinc, Magnesium, Vitamin B6, Methylcobalamin, Vitamin E and Chromium Picolinate in the Patients of Sudden Sensorineural Hearing Loss and High Intensity Noise and Vibration Induced Hearing Loss: Post Marketing Surveillance Study

Introduction: Sudden sensorineural hearing loss (SSNHL) is defined as sensorineural hearing loss of 30 dB or more over 3 contiguous audiometric frequencies occurring over 72hrs. Conventionally the SSNHL is treated by corticosteroids but it is considered that, addition of antioxidants to the treatment can increase the percentage of patients with the complete recovery. So, this study was conducted to test the efficacy and safety for the combination of Alpha lipoic acid, Gingko biloba, Vitamin C, Zinc, Magnesium, Vitamin B6, Methylcobalamin, Vitamin E and Chromium Picolinate for the treatment of SSNHL and high Intensity noise and vibration induced hearing loss as a concomitant therapy in addition to the standard medical management. Methodology: Out of total 225 enrolled, 208 patients completed the study. Efficacy and safety evaluation was done on day 7 and 14 considering the baseline visit at day 0. Efficacy assessment was done by hearing Impairment questionnaire and hearing related quality of Life. Results: Mean score obtained from hearing impairment questionnaire at day 0 was 19.59 which was reduced to 12.56 at day 7 and was further reduced to 7.70 at day 14. On Visit 1 the mean hearing related quality of life score was 5.24 which was increased to 6.4 at day 7 and was found to be further increased to 7.41 at day 14. Conclusion: The investigational product was efficacious and safe for the treatment of SSNHL and high Intensity noise and vibration induced hearing loss when given as a concomitant therapy to the standard medical management.

Comparison of the efficacy between Ginkgo Biloba and Caroverine in the management of Idiopathic Tinnitus.

Aim: This Study of Tinnitus management conducted to compare the efficacy of two drugs namelycaroverine and gingko Biloba in Mahavir institute of medical sciences, Vikarabad over one year.Objective: To describe the results found in a group of people who have undergone treatment withcarvoverine, gingko Biloba,placebo. Method: Using Tchqs Score 90 adult subjects with the complaintof tinnitus and associated symptoms were analyzed with Proper History, Clinical Examination andPure Tone Audiometry and Thcq’s to determine the Degree of Annoyance of the Tinnitus and toAssess Tinnitus Impact on the Quality of Life before and after Treatment. Results: There was asignificant reduction in the degree of annoyance caused by Tinnitus, there was a significantreduction of tinnitus and there was a significant improvement in hearing thresholds, consequently,on the Quality of Life of the respondents after using the caroverine, gingko Biloba. Conclusion: Thisstudy allowed the Verification that the use of Caroverine, gingko bilobaand placebo for the Treatmentof Tinnitus and their Effect.