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Background/Aim: Dementia and cognitive impairment are highly prevalent, and even mild stages are associated with a notable loss in health-related quality of life. Pharmacological treatment options include Ginkgo biloba L. leaf extracts (GBE), which have been assessed by the Committee on Herbal Medicinal Products (HMPC/EMA) as effective and safe based on evidence from clinical studies [1], [2].

So far, little is known about how GBE is used in routine care in the German population. GBE is available over the counter or can be prescribed by physicians. However, it remains unclear which factors are associated with physician involvement and whether this is related to treatment habits.

This may be clinically relevant, as physician involvement through prescription and/or recommendation could be associated with more appropriate drug utilization (e.g. adherence, trust in therapy) and thereby with effectiveness and safety.

Methods: We conducted a cross-sectional pharmacoepidemiological analysis of the German National Cohort (NAKO) baseline dataset (n=204,610). After data cleaning, the final sample comprised 199,813 participants. All persons who reported using GBE were included in our study (n=1,108; ATC codes N06DP01/N06DX02).

We analysed prescription status, age, sex, mode of intake, and duration of intake, as well as associations between these variables using binary and ordinal logistic regression models. Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) and p values were reported as appropriate.

Results: GBE users were predominantly female (60.1%, n=666), and their mean age was 58.5 years (SD 9.5). About half used GBE without a physician’s prescription or recommendation (51.3%, n=568), while roughly a third (29.8%; n=330) reported a physician’s recommendation. Only 18.6% (n=206) received a formal physician’s prescription.

Female GBE users were significantly less likely to receive a recommendation or formal physician’s prescription compared with male users (aOR=0.79, 95% CI 0.63–0.99; p=0.04). Greater physician involvement in GBE use tended to be more common among older users, although this association was not statistically significant.

Almost all GBE users took it regularly (91.5%; n=1,014), and the majority (65.4%; n=725) used it for more than three months. Prescription status was not significantly associated with intake mode. However, GBE utilization upon recommendation of a physician was significantly associated with longer intake duration compared with GBE use without physician involvement (aOR=1.35, 95% CI 1.05–1.75; p=0.02).

Discussion/Conclusion: Age did not appear to be a key factor in physician involvement in GBE use, whereas GBE was less likely to be recommended or prescribed by a physician among female than male users.

Notably, recommendation of GBE by a physician was associated with longer treatment duration, suggesting that medical guidance may support more consistent intake. Since formal prescriptions were relatively uncommon (<20%), adequate counselling in pharmacies and sufficient health literacy may be particularly important to support safe and effective self-medication.

In order to explore if there are factors that might influence whether GBE is formally prescribed, further studies are required investigating prescribing patterns in relation to potential determinants, such as symptom severity, socioeconomic factors, or insurance status.

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