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Bacopa monnieri (often called brahmi) is a botanical frequently used in Ayurvedic medicine. The main indications for using Bacopa in Ayurvedic medicine are memory improvement, insomnia, epilepsy, and as an anxiolytic. Many clinical studies have demonstrated improvements in verbal learning, delayed word recall, memory acquisition, and anxiety reduction with using Bacopa. It has been described as a calming cognitive enhancer. The triterpenoid saponins are believed to be responsible for most of the herb's pharmacological actions. Bacopa has a high therapeutic index and is generally well-tolerated. The most common side effects are gastrointestinal, including increased stool frequency, nausea, and abdominal cramps. This activity reviews the indications, contraindications, activity, adverse events, and other key elements of the clinical use of the herb Bacopa monnieri in the care of patients with declining cognitive performance and anxiety. Objectives: Evaluate the clinical indications for the use of the botanical Bacopa monnieri. Assess possible mechanisms of action for Bacopa monnieri. Identify adverse effects and contraindications for the use of Bacopa monnieri. Summarize the clinical studies on the effectiveness of Bacopa monnieri in improving cognitive performance, verbal learning, delayed word recall, memory acquisition, and decreasing anxiety. Access free multiple choice questions on this topic.

There has been no human toxicity demonstrated with the use of Bacopa monniera in humans. One study evaluated the effects of large doses (30, 60, 300, and 1,500 mg/kg) administered to Sprague-Dawley rats over a period of 270 days and did not produce any significant toxicity.[45]

Individuals should communicate to their primary care provider when taking Bacopa monniera. The provider may need to discuss this with a pharmacist regarding other medications the patient is taking. Bacopa has cholinergic properties and may increase the chance of side effects with cholinergic drugs (acetylcholine, methacholine, bethanechol) due to an additive effect. Bacopa may also decrease the effectiveness of anticholinergic medications such as atropine or belladonna alkaloids. Bacopa is known to cause non-competitive inhibition of several cytochrome P450 enzymes (1A2 (CYP1A2), 2C19 (CYP2C19), 2C9 (CYP2C9), 3A4 (CYP3A4)).[41] This may cause an increased accumulation of medications broken down by this enzyme and a decreased formation rate of active breakdown products. This may alter the effects and side effects of these medications. T4 concentration was increased with the use of Bacopa extract. Consuming Bacopa concomitantly with thyroid hormone may result in too much thyroid hormone and increase the potential for adverse effects.[42]