What is the dermatologic preoperative evaluation and management of ginkgo?

Updated: Mar 16, 2020
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Dirk M Elston, MD  more...
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Of the 38% of Americans using herbal medications in the past 2 years, 22% of them were ginkgo users. Ginkgo has been used for cognitive disorders, peripheral vascular disease, age-related macular degeneration, vertigo, tinnitus, erectile dysfunction, and altitude sickness. Studies suggest that ginkgo may stabilize or improve cognitive performance in patients with Alzheimer disease and multi-infarct dementia.

Ginkgo appears to alter vasoregulation, to act as an antioxidant, to modulate neurotransmitter and receptor activity, and to inhibit platelet-activating factor. Of these effects, the inhibition of platelet-activating factor raises the greatest concern for the perioperative period because platelet function may be altered. Clinical trials with small numbers of patients have not demonstrated complications from bleeding; however, 4 cases of spontaneous intracranial bleeding, 1 case of spontaneous hyphema, and 1 case of postoperative bleeding after laparoscopic cholecystectomy have been attributed to ginkgo use.

Studies have shown that the component of ginkgo, ginkgolgic acid, may lead to dermatological problems similar to those resulting from poison ivy and poison oak. This is due to the fact of the acid being structurally similar to the Toxicodendron species, the species including poison ivy and poison oak. Other cases show a correlation with ginkgo usage and seizures in patients with previously controlled epilepsy.

Terpenoids are the compounds believed to be responsible for the pharmacologic effects of ginkgo. They are highly bioavailable when orally administered. The elimination half-lives of the terpenoids after oral administration are 3-10 hours. Based on the pharmacokinetic data and the risk of bleeding, particularly in the surgical population, patients should discontinue taking ginkgo at least 36 hours prior to surgery.

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