Ginkgo biloba: memory, circulation and drug interactions — what does the evidence say?

Ginkgo biloba is mainly used as a leaf preparation, especially a standardised dry extract. Raw leaf, powder and extract are not interchangeable. Most studies concern specific products rather than everything sold as ginkgo.

EMA separates powdered leaf, traditionally used for heavy legs or cold hands and feet linked to minor circulation problems, from certain dry extracts studied in cognitive impairment associated with dementia. Standardisation helps describe constituents and compare products; it does not guarantee an effect. Fresh seeds and crude plant material are not equivalent to a leaf extract. [1][2]

The 2026 Cochrane review included 82 studies and 10,613 participants. In mild cognitive impairment, ginkgo probably made little or no difference to global status, cognition or daily activities at six months. In dementia, small to moderate benefits were possible, but study results varied substantially. [3]

EMA recognises traditional use of powdered leaf for heavy legs or cold hands and feet after a doctor has excluded serious causes. This is based on long-standing use, with limited clinical evidence. Ginkgo is not a proven treatment for hypertension, heart disease or unexplained leg symptoms. [1][2]

Ginkgo may increase bleeding risk, particularly with warfarin. Extra caution is also needed with antiplatelet drugs and medicines that already increase bleeding risk. EMA advises stopping ginkgo preparations three to four days before surgery as a precaution. Never change prescribed treatment without medical or pharmacy advice. [1][4]

Safety data are insufficient in pregnancy and breastfeeding, so avoid use without professional advice. EMA notes that further seizures in people with epilepsy cannot be excluded. Children and adolescents should not use it without medical advice. [1][2]

Look for the botanical name, plant part, form, extraction ratio and stated standardised constituents. Be sceptical of claims that ginkgo prevents Alzheimer’s, «thins the blood» or restores memory. A studied standardised extract does not validate an unidentified powder or leaf.

Ginkgo is studied, but effects depend on preparation and population. Cognition evidence is limited or conflicting, while the European circulation indication is mainly traditional. Bleeding interactions, surgery, pregnancy, breastfeeding and epilepsy require professional advice.