Abstract
Background: Patients taking multiple medications are at particular risk of cognitive impairment, especially when anticholinergic drugs are involved. Standardised Ginkgo biloba L. leaf extracts (GBE) are a well-established treatment option for cognitive symptoms, but evidence on GBE in combination with concomitant medication remains limited. In this study, we investigated patient-reported outcomes from the pharmacoepidemiologic database PhytoVIS regarding GBE utilization for cognitive impairment in relation to co-medication. Methods: In a study cohort of 191 patients, we examined associations between co-medication and treatment patterns, perceived effectiveness and tolerability of GBE using descriptive statistics and non-parametric bivariate analyses. Anticholinergic burden was assessed using the German Anticholinergic Burden Scale (GABS). Retrospective case reports were prepared for all patients with significant adverse events (SAE) and patients with critical GABS scores. Results: Overall, 64.9% of patients used co-medication, most commonly cardiovascular drugs (47.5%), antidiabetic and analgesics/anti-inflammatory drugs (8.8% each). While there was no association with treatment duration or intake frequency, a higher number of co-medications was linked to lower GBE doses (p=0.03). Three patients reported SAEs during GBE intake, however overall perceived effectiveness and tolerability of GBE remained high irrespective of co-medication. Four GBE users had critical GABS scores (>2); all reported remission of cognitive symptoms. Conclusion: Although more co-medications were associated with lower GBE doses, perceived effectiveness and tolerability remained favourable. However, the findings highlight the importance of monitoring herbal medicinal products in self-medication, particularly in patients with co-medication, while also suggesting that GBE may support the management of cognitive impairment associated with anticholinergic therapies.