Usage
Ginkgo Biloba + Methylcobalamin is prescribed to improve cognitive function, particularly in conditions like memory disorders, dementia (including Alzheimer’s disease), anxiety, depression, and dizziness (vertigo). It is also used to manage peripheral arterial disease. This combination acts as a nootropic agent and neuroprotective. It’s primarily classified as a nutritional supplement and a vasodilator.
The mechanism of action involves several pathways: Ginkgo Biloba improves blood circulation in the brain and acts as an antioxidant. Methylcobalamin (vitamin B12) plays a vital role in nerve cell maintenance and function.
Alternate Names
This combination does not have an official international nonproprietary name (INN). It is often referred to as Ginkgo-Methylcobalamin or Ginkgo-B12. Some brand names include Ginkoba M and Ginkocer.
How It Works
Pharmacodynamics:
Ginkgo Biloba exerts its effects primarily by improving blood flow, reducing blood viscosity, and acting as an antioxidant. This enhances oxygen and nutrient delivery to the brain and other tissues. Methylcobalamin is crucial for nerve cell myelination, neurotransmitter synthesis, and DNA synthesis.
Pharmacokinetics:
- Ginkgo Biloba: The absorption of Ginkgo Biloba components is complex and varies. It’s primarily metabolized in the liver and eliminated via renal and biliary routes.
- Methylcobalamin: Well-absorbed orally and via other routes like sublingual and intramuscular administration. It’s stored in the liver and eliminated renally.
Mode of Action: Ginkgo Biloba components, such as ginkgolides and bilobalide, are thought to inhibit platelet-activating factor (PAF), thus impacting platelet aggregation and blood viscosity. They also scavenge free radicals, providing antioxidant protection. Methylcobalamin acts as a coenzyme in various metabolic pathways, particularly those involved in nerve function. It’s essential for the synthesis of methionine, a key amino acid.
Receptor Binding/Enzyme Inhibition: Specific receptor interactions for Ginkgo Biloba components haven’t been fully elucidated. Its action on PAF represents a form of enzyme inhibition. Methylcobalamin’s action is linked to its role as a coenzyme for methionine synthase.
Elimination: Ginkgo Biloba components are eliminated via hepatic and renal pathways. Methylcobalamin is primarily excreted by the kidneys.
Dosage
Standard Dosage
Children: Not recommended for children without a doctor’s explicit prescription. Limited studies on children with autism spectrum disorder used 80-120mg/day of Ginkgo Biloba.
Special Cases:
- Elderly Patients: No specific dosage adjustments are explicitly stated, but caution and close monitoring are advised.
- Patients with Renal Impairment: Use with caution. Dosage adjustments might be necessary based on creatinine clearance.
- Patients with Hepatic Dysfunction: Use with caution as Ginkgo Biloba is metabolized in the liver.
- Patients with Comorbid Conditions: Caution is advised in patients with bleeding disorders, epilepsy, or those taking anticoagulants/antiplatelets. Diabetic patients should be closely monitored due to potential interactions with antidiabetic medications.
Clinical Use Cases
The use of Ginkgo Biloba + Methylcobalamin in settings like intubation, surgical procedures, mechanical ventilation, ICU, or emergency situations is not established, and dosage recommendations are not applicable.
Dosage Adjustments
Adjustments are made based on individual patient response, tolerability, and coexisting conditions, especially renal or hepatic impairment, bleeding disorders, and concomitant medications.
Side Effects
Common Side Effects:
Stomach upset, headache, dizziness, nausea, vomiting, diarrhea, skin rash, palpitations, and mouth irritation.
Rare but Serious Side Effects:
Easy bleeding/bruising, seizures, fainting, irregular heartbeat, vision problems, severe headache, weakness on one side of the body, restlessness, trouble speaking, muscle weakness, paralysis.
Long-Term Effects:
Potential for bleeding complications with long-term use, especially in patients with pre-existing bleeding disorders or those on anticoagulant therapy.
Adverse Drug Reactions (ADR):
Severe allergic reactions (anaphylaxis), spontaneous bleeding, seizures.
Contraindications
Hypersensitivity to Ginkgo Biloba or Methylcobalamin, active bleeding disorders, epilepsy. Pregnancy, breastfeeding.
Drug Interactions
Anticoagulants (warfarin, heparin, clopidogrel, ticlopidine), antiplatelets (aspirin), NSAIDs (ibuprofen, naproxen), anticonvulsants (phenytoin, gabapentin), antidepressants (trazodone), omeprazole, insulin, alcohol.
Pregnancy and Breastfeeding
Contraindicated during pregnancy and breastfeeding. Ginkgo Biloba might induce premature labor or bleeding. It’s excreted in breast milk.
Drug Profile Summary
- Mechanism of Action: Ginkgo Biloba improves cerebral blood flow and has antioxidant effects. Methylcobalamin is essential for nerve function and red blood cell formation.
- Side Effects: GI upset, headache, dizziness, skin rash, bleeding. Rarely: seizures, severe allergic reactions.
- Contraindications: Hypersensitivity, bleeding disorders, epilepsy, pregnancy, breastfeeding.
- Drug Interactions: Anticoagulants, antiplatelets, NSAIDs, anticonvulsants, certain antidepressants, alcohol.
- Pregnancy & Breastfeeding: Contraindicated.
- Dosage: Ginkgo Biloba 40-80 mg BID or TID (max 240mg/day), Methylcobalamin 750-1500mcg/day.
- Monitoring Parameters: Cognitive function, coagulation profile (if applicable), blood pressure.
Popular Combinations
Often used alone, but might be combined with other B vitamins or other supplements aimed at improving cognitive function.
Precautions
Screen for bleeding disorders, epilepsy, allergies, and drug interactions. Caution in pregnancy/breastfeeding, children, and elderly. Avoid alcohol. May impair mental alertness and affect driving ability.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Ginkgo Biloba + Methylcobalamin?
A: The standard dosage for adults is 40-80 mg of Ginkgo Biloba extract two or three times daily (maximum 240 mg/day) combined with 750-1500 mcg of Methylcobalamin daily. Not recommended for children.
Q2: What are the primary uses of this combination?
A: Improving cognitive function, particularly memory, in conditions such as dementia, Alzheimer’s, anxiety, depression, and dizziness.
Q3: Is this combination safe during pregnancy and breastfeeding?
A: No, it’s contraindicated. Ginkgo Biloba might cause bleeding and premature labor. It passes into breast milk.
Q4: What are the significant drug interactions to be aware of?
A: Anticoagulants, antiplatelets, NSAIDs, anticonvulsants, trazodone, omeprazole, and insulin.
Q5: What are the common side effects?
A: Stomach upset, headache, dizziness, skin rash, palpitations.
Q6: Are there any serious side effects?
A: Yes, though rare. These include severe bleeding, allergic reactions, and seizures.
Q7: What precautions should be taken before prescribing this combination?
A: Screen for bleeding disorders, allergies, epilepsy, and assess concomitant medications for potential interactions.
Q8: Can this combination be used in clinical settings like ICU or during surgery?
A: Its efficacy and safety haven’t been established in such settings, so it is not routinely used.
Q9: What is the role of Methylcobalamin in this combination?
A: Supports nerve health and function, complements the cognitive-enhancing effects of Ginkgo Biloba.
Q10: Are there any dietary restrictions while taking this medication?
A: Patients should limit alcohol consumption while taking this medication as it might exacerbate dizziness. No other specific dietary restrictions are noted.
