SAFETY AND EFFICACY OF GINKGO (GINKGO BILOBA) DURING PREGNANCY AND LACTATION
Main Article Content
Keywords
Ginkgo, ginkgo biloba, pregnancy, lactation, breastfeeding, systematic review
Abstract
Background
There is a lack of basic knowledge on the part of both clinicians and patients as to the indications for use and safety of herbal medicines used in pregnancy and lactation. This is one article in a series that systematically reviews the evidence for commonly used herbs during pregnancy and lactation.
Objectives
To systematically review the literature for evidence on the use, safety, and pharmacology of ginkgo focusing on issues pertaining to pregnancy and lactation.
Methods
We searched 7 electronic databases and compiled data according to the grade of evidence found.
Results
There is some very weak scientific evidence from animal and in vitro studies that ginkgo leaf has anti-platelet activity, which may be of concern during labour as ginkgo use could prolong bleeding time. Low- level evidence based on expert opinion shows that ginkgo leaf may be an emmenagogue and have hormonal properties. The safety of ginkgo leaf during lactation is unknown. Patients and clinicians should be aware of past reports of ginkgo products being adulterated with colchicine.
Conclusions
Ginkgo should be used with caution during pregnancy, particularly around labour where its anti-platelet properties could prolong bleeding time. During lactation the safety of ginkgo leaf is unknown and should be avoided until high quality human studies are conducted to prove its safety.
References
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2. Blumenthal M. Market Report. HerbalGram 2000; 51:69.
3. Sierpina VS, Wollschlaeger B, Blumenthal M.Ginkgo biloba. American Family Physician 2003;68.
4. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant- induced sexual dysfunction. J Sex Marital Ther 1998; 24.
5. WHO. WHO monographs on selected medicinal plants Vol. 1. Ch. 16. Folium Ginkgo. Geneva, 1999.
6. Jellin JM, Batz F, Hitchens K. Natural medicines comprehensive database 3rd Edition. Stockton, CA: Therapeutic Research Faculty, 2002:1530.
7. Jan GS, Tong WN, Chan AM, Hui TW, Lo JW. Recovery from mivacurium block with or without anticholinesterase following continuous infusion in obstetric patients. Anaesthesia & Intensive Care 1996; 24:585-9.
8. Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol 1998; 55:1409 -15.
9. Newall CA, Anderson LA, Phillipson JD. Herbal medicines : a guide for health-care professionals. London, UK: Pharmaceutical Press, 1996:296.
10. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. New York, NY: John Wiley & Sons, 1996:649.
11. Schweizer J, Hautmann C. Comparison of two dosages of ginkgo biloba extract EGb 761 in patients with peripheral arterial occlusive disease Fontaine's stage IIb. A randomised, double- blind, multicentric clinical trial. Arzneimittelforschung 1999; 49:900- 4.
12. Ernst E. [Ginkgo biloba in treatment of intermittent claudication. A systematic research based on controlled studies in the literature]. Fortschr Med 1996; 114:85-7.
13. Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta- analysis of randomized trials. Am J Med 2000;108:276-81.
14. Kanowski S, Herrmann WM, Stephan K, Wierich W, Horr R. Proof of efficacy of the ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi- infarct dementia. Pharmacopsychiatry 1996; 29:47-56.
15. Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF. A placebo- controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group. JAMA 1997; 278:1327-32.
16. Kleijnen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. Br J Clin Pharmacol 1992; 34:352-8.
17. Haguenauer JP, Cantenot F, Koskas H, Pierart H. [Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter double- blind drug vs. placebo study]. Presse Med 1986; 15:1569- 72.
18. Hopfenmuller W. [Evidence for a therapeutic effect of Ginkgo biloba special extract. Meta- analysis of 11 clinical studies in patients with cerebrovascular insufficiency in old age]. Arzneimittelforschung 1994; 44:1005-13.
19. Meyer B. [Multicenter randomized double-blind drug vs. placebo study of the treatment of tinnitus with Ginkgo biloba extract]. Presse Med 1986; 15:1562-4.
20. Holstein N. [Ginkgo special extract EGb 761 in tinnitus therapy. An overview of results of completed clinical trials]. Fortschr Med Orig 2001; 118:157-64.
21. Allain H, Raoul P, Lieury A, LeCoz F, Gandon JM, D'Arbigny P. Effect of two doses of Gingko biloba extract (EGb 761) on the dual- coding test in elderly subjects. Clin Ther 1993; 15:549-58.
22. Brautigam MR BF, Verleye G, et al. . Treatment of age-related memory complaints with Ginkgo biloba extract: a randomized double blind placebo-controlled study. Phytomed 1998;5(6):425- 434. 1998.
23. Semlitsch HV, Anderer P, Saletu B, Binder GA, Decker KA. Cognitive psychophysiology in nootropic drug research: effects of Ginkgo biloba on event-related pote ntials (P300) in age- associated memory impairment. Pharmacopsychiatry 1995; 28:134-42.
24. Mix JA, Crews WDJ. An examination of the efficacy of Ginkgo biloba extract EGb761 on the neuropsychologic functioning of cognitively intact older adults. J Altern Complement Med 2000; 6:219-29.
25. Rigney U, Kimber S, Hindmarch I. The effects of acute doses of standardized Ginkgo biloba extract on memory and psychomotor performance in volunteers. Phytother Res 1999; 13:408-15.
26. Kennedy DO, Scholey AB, Wesnes KA. The dose- dependent cognitive effects of acute administration of Ginkgo biloba to healthy young volunteers. Psychopharmacology (Berl) 2000; 151:416-23.
27. Roncin JP, Schwartz F, D'Arbigny P. EGb 761 in control of acute mountain sickness and vascular reactivity to cold exposure. Aviat Space Environ Med 1996; 67:445-52.
28. Tamborini A, Taurelle R. [Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome]. Rev Fr Gynecol Obstet 1993; 88:447- 57.
29. Lebuisson DA, Leroy L, Rigal G. [Treatment of senile macular degeneration with Ginkgo biloba extract. A preliminary double- blind drug vs. placebo study]. Presse Med 1986; 15:1556-8.
30. Paick JS, Lee JH. An experimental study of the effect of ginkgo bilob a extract on the human and rabbit corpus cavernosum tissue. J Urol 1996;156:1876-80.
31. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Ed Ther 1991; 17:53- 61.
32. Sikora R SM, Engelke B, et al. . Randomized placebo- controlled study on the effects of oral treatment with Gingko biloba extract in patients with erectile dysfunction. J Urology 1998;159(suppl 5):240. 1998.
33. Sikora R SM, Deutz FJ, et al. . Ginkgo biloba extract in the therapy of erectile dysfunction. J Urol 1989;141:188A. 1989.
34. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant- induced sexual dysfunction. J Sex Marital Ther 1998; 24:139 -43.
35. Hauns B, Haring B, Kohler S, Mross K, Robben- Bathe P, Unger C. Phase II study with 5- fluorouracil and ginkgo biloba extract (GBE 761 ONC) in patients with pancreatic cancer. Arzneimittelforschung 1999; 49:1030- 4.
36. Hauns B, Haring B, Kohler S, Mross K, Unger C. Phase II study of combined 5- fluorouracil/ Ginkgo biloba extract (GBE 761 ONC) therapy in 5-fluorouracil pretreated patients with advanced colorectal cancer. Phytother Res 2001; 15:34-8.
37. Brochet B, Orgogozo JM, Guinot P, Dartigues JF, Henry P, Loiseau P. [Pilot study of Ginkgolide B, a PAF-acether specific inhibitor in the treatment of acute outbreaks of multiple sclerosis]. Rev Neurol (Paris) 1992; 148:299-301.
38. Ranchon I, Gorrand JM, Cluzel J, Droy- Lefaix MT, Doly M. Functional protection of photoreceptors from light- induced damage by dimethylthiourea and Ginkgo biloba extract. Invest Ophthalmol Vis Sci 1999; 40:1191- 9.
39. Petty HR, Fernando M, Kindzelskii AL, et al. Identification of colchicine in placental blood from patients using herbal medicines. Chem Res Toxicol 2001; 14:1254-8.
40. Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract on pancreatic beta -cell function in response to glucose loading in normal glucose tolerant individuals. J Clin Pharmacol 2000; 40:647-54.
41. Kudolo GB, Dorsey S, Blodgett J. Effect of the ingestion of Ginkgo biloba extract on platelet aggregation and urinary prostanoid excretion in healthy and Type 2 diabetic subjects. Thromb Res 2002; 108:151-60.
42. Brinker F. The toxicology of botanical medicines. Sandy, Oregon: Eclectic Medical Publications. 2000:296.
43. Kressmann S, Muller WE, Blume HH. Pharmaceutical quality of different Ginkgo biloba brands. J Pharm Pharmacol 2002; 54:661-9.
44. Hecker H, Johannisson R, Koch E, Siegers CP. In vitro evaluation of the cytotoxic potential of alkylphenols from Ginkgo biloba L. Toxicology
2002; 177:167-77.
45. http://www.naturalstandard.com.
46. Campos-Toimil M, Lugnier C, Droy-Lefaix MT, Takeda K. Inhibition of type 4 phosphodiesterase by rolipram and Ginkgo biloba extract (EGb 761) decreases agonist-induced rises in internal calcium in human endothelial cells. Arterioscler Thromb Vasc Biol 2000; 20:E34-40.
47. Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil 2000; 81:668-78.
48. Chen X, Salwinski S, Lee TJ. Extracts of Ginkgo biloba and ginsenosides exert cerebral vasorelaxation via a nitric oxide pathway. Clin Exp Pharmacol Physiol 1997; 24:958-9.
49. Kudolo G. Ingestion of Ginkgo biloba extract significantly inhibits collagen- induced platelet aggregation and thromboxane A2 synthesis. Alt Ther 2001; 7:105.
50. Logani S, Chen MC, Tran T, Le T, Raffa RB. Actions of Ginkgo Biloba related to potential utility for the treatment of conditions involving cerebral hypoxia. Life Sci 2000; 67:1389- 96.
51. Bastianetto S, Ramassamy C, Dore S, Christen Y, Poirier J, Quirion R. The Ginkgo biloba extract (EGb 761) protects hippocampal neurons against cell death induced by beta-amyloid. Eur J Neurosci 2000; 12:1882-90.
52. Marcilhac A, Dakine N, Bourhim N, et al. Effect of chronic administration of Ginkgo biloba extract or Ginkgolide on the hypothalamic- pituitary-adrenal axis in the rat. Life Sci 1998; 62:2329-40.
53. Amri H, Ogwuegbu SO, Boujrad N, Drieu K, Papadopoulos V. In vivo regulation of peripheral- type benzodiazepine receptor and glucocorticoidsynthesis by Ginkgo biloba extract EGb 761 and isolated ginkgolides. Endocrinology 1996; 137:5707-18.
54. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000; 7:273-82.
55. Galluzzi S, Zanetti O, Binetti G, Trabucchi M, Frisoni GB. Coma in a patient with Alzheimer's disease taking low dose trazodone and gingko biloba. J Neurol Neurosurg Psychiatry 2000; 68:679-80.
56. Spinella M, Eaton LA. Hypomania induced by herbal and pharmaceutical psychotropic medicines following mild traumatic brain injury. Brain Inj 2002; 16:359-67.
57. Fowler JS, Wang GJ, Volkow ND, et al. Evidence that gingko biloba extract does not inhibit MAO A and B in living human brain. Life Sci 2000; 66:PL 141-6.
58. White HL, Scates PW, Cooper BR. Extracts of Ginkgo biloba leaves inhibit monoamine oxidase. Life Sci 1996; 58:1315-21.
59. Porsolt RD, Roux S, Drieu K. Evaluation of a ginkgo biloba extract (EGb 761) in functional tests for monoamine oxidase inhibition. Arzneimittelforschung 2000; 50:232- 5.
60. Granger AS. Ginkgo biloba precipitating epileptic seizures. Age Ageing 2001; 30:523-5.
61. Gregory PJ. Seizure associated with Ginkgo biloba? Ann Intern Med 2001; 134:344.
62. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements. A 5- year toxicological study (1991-1995). Drug Saf 1997; 17:342-56.
63. Matthews MKJ. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998; 50:1933-4.
2. Blumenthal M. Market Report. HerbalGram 2000; 51:69.
3. Sierpina VS, Wollschlaeger B, Blumenthal M.Ginkgo biloba. American Family Physician 2003;68.
4. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant- induced sexual dysfunction. J Sex Marital Ther 1998; 24.
5. WHO. WHO monographs on selected medicinal plants Vol. 1. Ch. 16. Folium Ginkgo. Geneva, 1999.
6. Jellin JM, Batz F, Hitchens K. Natural medicines comprehensive database 3rd Edition. Stockton, CA: Therapeutic Research Faculty, 2002:1530.
7. Jan GS, Tong WN, Chan AM, Hui TW, Lo JW. Recovery from mivacurium block with or without anticholinesterase following continuous infusion in obstetric patients. Anaesthesia & Intensive Care 1996; 24:585-9.
8. Oken BS, Storzbach DM, Kaye JA. The efficacy of Ginkgo biloba on cognitive function in Alzheimer disease. Arch Neurol 1998; 55:1409 -15.
9. Newall CA, Anderson LA, Phillipson JD. Herbal medicines : a guide for health-care professionals. London, UK: Pharmaceutical Press, 1996:296.
10. Leung AY, Foster S. Encyclopedia of Common Natural Ingredients Used in Food, Drugs and Cosmetics. New York, NY: John Wiley & Sons, 1996:649.
11. Schweizer J, Hautmann C. Comparison of two dosages of ginkgo biloba extract EGb 761 in patients with peripheral arterial occlusive disease Fontaine's stage IIb. A randomised, double- blind, multicentric clinical trial. Arzneimittelforschung 1999; 49:900- 4.
12. Ernst E. [Ginkgo biloba in treatment of intermittent claudication. A systematic research based on controlled studies in the literature]. Fortschr Med 1996; 114:85-7.
13. Pittler MH, Ernst E. Ginkgo biloba extract for the treatment of intermittent claudication: a meta- analysis of randomized trials. Am J Med 2000;108:276-81.
14. Kanowski S, Herrmann WM, Stephan K, Wierich W, Horr R. Proof of efficacy of the ginkgo biloba special extract EGb 761 in outpatients suffering from mild to moderate primary degenerative dementia of the Alzheimer type or multi- infarct dementia. Pharmacopsychiatry 1996; 29:47-56.
15. Le Bars PL, Katz MM, Berman N, Itil TM, Freedman AM, Schatzberg AF. A placebo- controlled, double-blind, randomized trial of an extract of Ginkgo biloba for dementia. North American EGb Study Group. JAMA 1997; 278:1327-32.
16. Kleijnen J, Knipschild P. Ginkgo biloba for cerebral insufficiency. Br J Clin Pharmacol 1992; 34:352-8.
17. Haguenauer JP, Cantenot F, Koskas H, Pierart H. [Treatment of equilibrium disorders with Ginkgo biloba extract. A multicenter double- blind drug vs. placebo study]. Presse Med 1986; 15:1569- 72.
18. Hopfenmuller W. [Evidence for a therapeutic effect of Ginkgo biloba special extract. Meta- analysis of 11 clinical studies in patients with cerebrovascular insufficiency in old age]. Arzneimittelforschung 1994; 44:1005-13.
19. Meyer B. [Multicenter randomized double-blind drug vs. placebo study of the treatment of tinnitus with Ginkgo biloba extract]. Presse Med 1986; 15:1562-4.
20. Holstein N. [Ginkgo special extract EGb 761 in tinnitus therapy. An overview of results of completed clinical trials]. Fortschr Med Orig 2001; 118:157-64.
21. Allain H, Raoul P, Lieury A, LeCoz F, Gandon JM, D'Arbigny P. Effect of two doses of Gingko biloba extract (EGb 761) on the dual- coding test in elderly subjects. Clin Ther 1993; 15:549-58.
22. Brautigam MR BF, Verleye G, et al. . Treatment of age-related memory complaints with Ginkgo biloba extract: a randomized double blind placebo-controlled study. Phytomed 1998;5(6):425- 434. 1998.
23. Semlitsch HV, Anderer P, Saletu B, Binder GA, Decker KA. Cognitive psychophysiology in nootropic drug research: effects of Ginkgo biloba on event-related pote ntials (P300) in age- associated memory impairment. Pharmacopsychiatry 1995; 28:134-42.
24. Mix JA, Crews WDJ. An examination of the efficacy of Ginkgo biloba extract EGb761 on the neuropsychologic functioning of cognitively intact older adults. J Altern Complement Med 2000; 6:219-29.
25. Rigney U, Kimber S, Hindmarch I. The effects of acute doses of standardized Ginkgo biloba extract on memory and psychomotor performance in volunteers. Phytother Res 1999; 13:408-15.
26. Kennedy DO, Scholey AB, Wesnes KA. The dose- dependent cognitive effects of acute administration of Ginkgo biloba to healthy young volunteers. Psychopharmacology (Berl) 2000; 151:416-23.
27. Roncin JP, Schwartz F, D'Arbigny P. EGb 761 in control of acute mountain sickness and vascular reactivity to cold exposure. Aviat Space Environ Med 1996; 67:445-52.
28. Tamborini A, Taurelle R. [Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome]. Rev Fr Gynecol Obstet 1993; 88:447- 57.
29. Lebuisson DA, Leroy L, Rigal G. [Treatment of senile macular degeneration with Ginkgo biloba extract. A preliminary double- blind drug vs. placebo study]. Presse Med 1986; 15:1556-8.
30. Paick JS, Lee JH. An experimental study of the effect of ginkgo bilob a extract on the human and rabbit corpus cavernosum tissue. J Urol 1996;156:1876-80.
31. Sohn M, Sikora R. Ginkgo biloba extract in the therapy of erectile dysfunction. J Sex Ed Ther 1991; 17:53- 61.
32. Sikora R SM, Engelke B, et al. . Randomized placebo- controlled study on the effects of oral treatment with Gingko biloba extract in patients with erectile dysfunction. J Urology 1998;159(suppl 5):240. 1998.
33. Sikora R SM, Deutz FJ, et al. . Ginkgo biloba extract in the therapy of erectile dysfunction. J Urol 1989;141:188A. 1989.
34. Cohen AJ, Bartlik B. Ginkgo biloba for antidepressant- induced sexual dysfunction. J Sex Marital Ther 1998; 24:139 -43.
35. Hauns B, Haring B, Kohler S, Mross K, Robben- Bathe P, Unger C. Phase II study with 5- fluorouracil and ginkgo biloba extract (GBE 761 ONC) in patients with pancreatic cancer. Arzneimittelforschung 1999; 49:1030- 4.
36. Hauns B, Haring B, Kohler S, Mross K, Unger C. Phase II study of combined 5- fluorouracil/ Ginkgo biloba extract (GBE 761 ONC) therapy in 5-fluorouracil pretreated patients with advanced colorectal cancer. Phytother Res 2001; 15:34-8.
37. Brochet B, Orgogozo JM, Guinot P, Dartigues JF, Henry P, Loiseau P. [Pilot study of Ginkgolide B, a PAF-acether specific inhibitor in the treatment of acute outbreaks of multiple sclerosis]. Rev Neurol (Paris) 1992; 148:299-301.
38. Ranchon I, Gorrand JM, Cluzel J, Droy- Lefaix MT, Doly M. Functional protection of photoreceptors from light- induced damage by dimethylthiourea and Ginkgo biloba extract. Invest Ophthalmol Vis Sci 1999; 40:1191- 9.
39. Petty HR, Fernando M, Kindzelskii AL, et al. Identification of colchicine in placental blood from patients using herbal medicines. Chem Res Toxicol 2001; 14:1254-8.
40. Kudolo GB. The effect of 3-month ingestion of Ginkgo biloba extract on pancreatic beta -cell function in response to glucose loading in normal glucose tolerant individuals. J Clin Pharmacol 2000; 40:647-54.
41. Kudolo GB, Dorsey S, Blodgett J. Effect of the ingestion of Ginkgo biloba extract on platelet aggregation and urinary prostanoid excretion in healthy and Type 2 diabetic subjects. Thromb Res 2002; 108:151-60.
42. Brinker F. The toxicology of botanical medicines. Sandy, Oregon: Eclectic Medical Publications. 2000:296.
43. Kressmann S, Muller WE, Blume HH. Pharmaceutical quality of different Ginkgo biloba brands. J Pharm Pharmacol 2002; 54:661-9.
44. Hecker H, Johannisson R, Koch E, Siegers CP. In vitro evaluation of the cytotoxic potential of alkylphenols from Ginkgo biloba L. Toxicology
2002; 177:167-77.
45. http://www.naturalstandard.com.
46. Campos-Toimil M, Lugnier C, Droy-Lefaix MT, Takeda K. Inhibition of type 4 phosphodiesterase by rolipram and Ginkgo biloba extract (EGb 761) decreases agonist-induced rises in internal calcium in human endothelial cells. Arterioscler Thromb Vasc Biol 2000; 20:E34-40.
47. Diamond BJ, Shiflett SC, Feiwel N, et al. Ginkgo biloba extract: mechanisms and clinical indications. Arch Phys Med Rehabil 2000; 81:668-78.
48. Chen X, Salwinski S, Lee TJ. Extracts of Ginkgo biloba and ginsenosides exert cerebral vasorelaxation via a nitric oxide pathway. Clin Exp Pharmacol Physiol 1997; 24:958-9.
49. Kudolo G. Ingestion of Ginkgo biloba extract significantly inhibits collagen- induced platelet aggregation and thromboxane A2 synthesis. Alt Ther 2001; 7:105.
50. Logani S, Chen MC, Tran T, Le T, Raffa RB. Actions of Ginkgo Biloba related to potential utility for the treatment of conditions involving cerebral hypoxia. Life Sci 2000; 67:1389- 96.
51. Bastianetto S, Ramassamy C, Dore S, Christen Y, Poirier J, Quirion R. The Ginkgo biloba extract (EGb 761) protects hippocampal neurons against cell death induced by beta-amyloid. Eur J Neurosci 2000; 12:1882-90.
52. Marcilhac A, Dakine N, Bourhim N, et al. Effect of chronic administration of Ginkgo biloba extract or Ginkgolide on the hypothalamic- pituitary-adrenal axis in the rat. Life Sci 1998; 62:2329-40.
53. Amri H, Ogwuegbu SO, Boujrad N, Drieu K, Papadopoulos V. In vivo regulation of peripheral- type benzodiazepine receptor and glucocorticoidsynthesis by Ginkgo biloba extract EGb 761 and isolated ginkgolides. Endocrinology 1996; 137:5707-18.
54. Budzinski JW, Foster BC, Vandenhoek S, Arnason JT. An in vitro evaluation of human cytochrome P450 3A4 inhibition by selected commercial herbal extracts and tinctures. Phytomedicine 2000; 7:273-82.
55. Galluzzi S, Zanetti O, Binetti G, Trabucchi M, Frisoni GB. Coma in a patient with Alzheimer's disease taking low dose trazodone and gingko biloba. J Neurol Neurosurg Psychiatry 2000; 68:679-80.
56. Spinella M, Eaton LA. Hypomania induced by herbal and pharmaceutical psychotropic medicines following mild traumatic brain injury. Brain Inj 2002; 16:359-67.
57. Fowler JS, Wang GJ, Volkow ND, et al. Evidence that gingko biloba extract does not inhibit MAO A and B in living human brain. Life Sci 2000; 66:PL 141-6.
58. White HL, Scates PW, Cooper BR. Extracts of Ginkgo biloba leaves inhibit monoamine oxidase. Life Sci 1996; 58:1315-21.
59. Porsolt RD, Roux S, Drieu K. Evaluation of a ginkgo biloba extract (EGb 761) in functional tests for monoamine oxidase inhibition. Arzneimittelforschung 2000; 50:232- 5.
60. Granger AS. Ginkgo biloba precipitating epileptic seizures. Age Ageing 2001; 30:523-5.
61. Gregory PJ. Seizure associated with Ginkgo biloba? Ann Intern Med 2001; 134:344.
62. Shaw D, Leon C, Kolev S, Murray V. Traditional remedies and food supplements. A 5- year toxicological study (1991-1995). Drug Saf 1997; 17:342-56.
63. Matthews MKJ. Association of Ginkgo biloba with intracerebral hemorrhage. Neurology 1998; 50:1933-4.
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Dugoua, J.-J., Mills, E., Perri, D., & Koren, G. K. (2018). SAFETY AND EFFICACY OF GINKGO (GINKGO BILOBA) DURING PREGNANCY AND LACTATION. Journal of Population Therapeutics and Clinical Pharmacology, 13(3). https://mail.jptcp.com/index.php/jptcp/article/view/128
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How to Cite
Dugoua, J.-J., Mills, E., Perri, D., & Koren, G. K. (2018). SAFETY AND EFFICACY OF GINKGO (GINKGO BILOBA) DURING PREGNANCY AND LACTATION. Journal of Population Therapeutics and Clinical Pharmacology, 13(3). https://mail.jptcp.com/index.php/jptcp/article/view/128