Home > reports from the field > Ginkgo biloba (Tavonin) for Raynaud’s Phenomenon, should one give it a try?

Ginkgo biloba (Tavonin) for Raynaud’s Phenomenon, should one give it a try?

Although some new treatments have become available for the treatment of Raynaoud’s Phenomenon (whether primary or secondary), it remains a condition that is quite frequently encountered by a rheumatologist in the outpatient-clinic. A condition from which patients suffer quite a lot, even (or should one say typically) also in seasons other then wintertime. Treatment with Ilomedin – a prostacyclin analog- infusions are known to be of benefit in a number of severe cases, although the exact optimal dosing regimen (how many (series of) consecutive infusion treatment days) is unknown. It is also an expensive treatment, and the same holds true for a somewhat newer kid-on-the-block bosentan (named Tracleer in the Netherlands) which essentially is put forward in severe cases in systemic sclerosis with formations of pitting scars resulting from digital ulcera.

However, even for this more advanced and expensive treatment options success rates of treatment differ quite a lot (e.g. “bosentan is not effective in systemic sclerosis-related Raynaud’s Phenomenon without pre-existing digital ulcers” is concluded in this 2009 study), in other words the one-fits-all of alternatively optimal flowchart of medications for the succesfull treatment of severe Raynaud’s Phenomenon in the end still comes down to classic trial and error (with rationale of course).

Upon my visit to the Karolinska Institute last autumn I spoke a dutch rheumatologist who pointed me at the use of Ginkgo biloba (called Tavonin in the Netherlands, it is actually an extract from the Ginkgo biloba, which is one of the oldest tree sorts on earth, also called the ‘Chinese nuts-tree’) for patients with Raynaud’s Phenomenon. In the Netherlands Ginkgo biloba is actually registered as a treatment modality for claudicatio intermittens. Apart from that some reports also advocate the use of Ginkgo biloba for it’s beneficial effects in Alzheimers Disease as far as short term memory concerns, personally as a rheumatologist I cannot judge that. I had never heard of it before, also it was not included in my education during my specialization to rheumatologist. I looked it up and, well, to stay on the safe side, it appeared that side effects are quite scarce (however DO NOTE THE SINGLE PRECAUTION WARNING: Ginkgo Biloba affects platelet activating factor, resulting in decreased clotting of the blood. This means one should be very careful when patients are on concomitant aspirin or coumarin (derivates) medication. Unexpected extensive blood loss / bleedings post-surgery have been reported). In general however, it doesn’t do patients significant harm, so…should I not give it a try in my own patient population, just like my dutch collegaus does?

I decided to give it a try and for what it’s worth I have know a n=2 series with 50% success rate 😉

The first patient told me she had stopped taking Tavonin, after first trying less then the recommended three dosages of 40mg a day. She did not feel well, and was rather shivering and shaky upon taking this medication. The second patient however, was really enthusiastic when she came back to the outpatient clinic, the benefit for her was evident and she, as opposed to the first patient, did not mention having noticed any side effects at all.

Today I decided to post this little blog post hoping for some replies from the field. Are you using Ginkgo biloba (Tavonin) for Raynaud’s Phenomenon in your own patient population, and if so, are you willing to share your experiences (both positive and negative) by replying here? I would welcome any input and comments.

Just before typing this blogpost I performed a very rough (and not that scientific) search on the web, to find out that the use of Ginkgo biloba (Tavonin) for Raynaud’s Phenomenon has already been reported in several papers quite some years ago (e.g. this one from 2002, n=22 RCT), but also that a recent (actually published March 2012) RCT (n=41 patients) performed in the Netherlands did not show a significant beneficial effect of Ginkgo biloba (Tavonin) for Raynaud’s Phenomenon. However the excellent safety profile was once more confirmed.

So, in my opinion, the conclusion for now should be: why not give it a try, since when you prescribe nifedipin (which seems a slightly better option in a 2009 Korean study) or other medication suggested so far it is also with the same trial and error and no guarantee of success, whilst the side effects of all other agents apart from Ginkgo biloba (Tavonin) for Raynaud’s Phenomenon are more likely to be worse. So when it is a matter of trial and error why not include Ginkgo biloba (Tavonin) somewhere at the top of the flowchart for available treatment options for Raynaud’s Phenomenon. Your government would probably not protest, because at the bottomline it is actually a quite cheap treatment option.

Let me know what you think of it please.

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