Complementary Alternative Cardiovascular Medicine

Chapter 3 / Botanical Medicine and CVD 35
The dose typically used for the treatment of peripheral artery disease
is 120–160 mg/d of an extract standardized to 24% ginkgolides and 6%
terpenes. The German Commission E lists occasional GI upset, headache,
and allergic skin reactions as side effects of ginkgo and contraindicates
the herb in patients with a hypersensitivity to ginkgo preparations. The
leaf has a relatively low risk of toxicity when used appropriately. The
LD50 is 7.7 g/kg of standardized ginkgo extract when given orally to
mice. No evidence of chronic toxicity was noted when doses up to 500 mg/
kg/d were given to mice for a 27-wk period (48).
Concerns have been raised regarding the potential risk of bleeding in
patients who are taking gingko alone or in combination aspirin or warfarin.
Spontaneous ocular hymphema was noted in a patient who was
taking ginkgo and aspirin (49), intracerebral hemorrhage when ginkgo
was taken with warfarin for 2 mo (50), bilateral subdural hematoma in a
33-yr-old woman who had been taking 120 mg/d of ginkgo for 2 yr (51),
and subarachnoid hemorrhage in a 61-yr-old man with mildly prolonged
bleeding time who had been taking 120–160 mg/d ginkgo for 6 mo (52).
An additive effect on platelet inhibition was noted in normal and thrombosis-induced
rats when given a combination of ticlopidine (50 mg/kg/d)
and EGb 761 (40 mg/kg/d of a proprietary standardized extract of ginkgo
that contains 24% ginkgoflavones and 6% terpenes). Bleeding time was
prolonged by 150% (53), but this study used a ginkgo dose much higher
than the recommended therapeutic dose. Although the true risk of interaction
with warfarin or antiplatelet agents is not known (45), patients
should be monitored if taking these medications. However, given the tens
of millions of doses of ginkgo that have been consumed in Europe and the
United States, risk of hemorrhage is relatively small.
Walking is considered one of the best self-help treatments for peripheral
artery disease, but many people suffer extreme pain after walking
even for short periods. While we await more conclusive evidence on the
efficacy of ginkgo for this condition, practitioners may wish to do a trial
of this herb for 8 wk (if not contraindicated) in conjunction with a walking
program to see if ginkgo increases the distance the participants are able to
walk free of pain or discomfort.
GUGGUL (COMMIPHORA MUKUL)
Class 3 for Dyslipidemia
The guggul tree grows in dry areas of India, Pakistan, and Afghanistan,
where it has been used by indigenous medical practitioners to treat
obesity, rheumatic conditions, and other ailments. Since the 1960’s,
research has focused on its lipid-lowering activity, and today, it is commonly
used as a lipid-lowering agent in India. Although it is known that