A 2016 systematic review of 5 studies using Bacopa monnieri in child and adolescent participants found that supplementation may improve behavioral and cognitive outcomes.^[23] However, two of the studies had no control group. More robust study designs are needed to determine the efficacy of Bacopa in children and adolescents. There was also a 2022 randomized controlled trial investigating the efficacy of Bacopa monnieri’s ability to reduce attention and hyperactivity in male children ages 6 to 14.^[24] No differences were noted for behavioral outcomes, but there were some improvements in the Bacopa group for certain cognitive outcomes, such as cognitive flexibility and processing speed. It is essential for parents to discuss supplements with a clinician before administering them to a child, as children can have different reactions to supplements than adults.

Although Bacopa monnieri is mainly viewed as a nootropic and adaptogen, it is also purported to be useful for a variety of health conditions, such as fevers,^[25] constipation, cough, seizures,^[26] infections/wounds,^[27] cancer,^[28] and general pain.^[29] None of these purported effects have been studied in human randomized controlled trials, and some have not even been studied in animal models. Consequently, there is not enough evidence to support the use of Bacopa for these conditions. There was also a small pilot trial that found Bacopa might improve emotional function in people with Parkinson’s disease, but more research is needed to confirm this effect.^[30]

Bacopa monnieri may interact with certain medications, including those commonly used for neurodegenerative and psychiatric conditions, although research in this area is limited. Because Bacopa monnieri may affect the serotonin, dopamine, and cholinergic systems, it is possible it could interact with pharmaceuticals that act on these systems. This includes anticholinergic medications, like those used to treat glaucoma and Alzheimer’s disease. Additionally, an in vitro study found that Bacopa monnieri inhibited the activity of certain cytochrome P450 enzymes (e.g., CYP3A4, CYP2C9, CYP2C19) and could therefore cause significant adverse reactions when taken alongside drugs that are metabolized by these enzymes, like clozapine, haloperidol, fluoxetine, and phenytoin.^[31] In a case study, a patient taking cevimeline (a cholinergic agonist that stimulates saliva production and is metabolized by P450 enzymes) experienced malaise, nausea, and tachycardia after taking a supplement containing Bacopa monnieri. The clinicians suspected cholinergic toxicity due to the herb-drug interaction. Symptoms resolved once the supplement was discontinued.^[32]

There is also rat research that found Bacopa could substantially increase thyroxine levels (T4), meaning it could interact with thyroid medications.^[33] Other possible interactions that have not yet been documented could also exist. This is why it is very important to speak with a clinician before taking Bacopa monnieri, especially when it will be used in combination with prescription medications.

In some trials, Bacopa monnieri was studied as a combination supplement, with the goal of enhanced therapeutic benefits. Bacopa monnieri has been used alongside a number of other herbs and vitamins, with mixed results. For example, a 4-week trial combining 300 mg of bacopa monnieri with 120 mg of ginkgo biloba found no improvements in any cognitive outcomes when compared to placebo, but the study was relatively short in duration and may not have used an optimal dose of ginkgo biloba.^[17] Conversely, a 2-month pilot study examining a nutraceutical containing 320 mg of Bacopa monnieri, 100 mg of L-theanine, 30 mg of saffron, 2 mg of copper, and some vitamins (9.5 mg of vitamin B6, 450 mcg of biotin, 400 mcg of folic acid, 33 mcg of vitamin B12, and 25 mcg of vitamin D), reported cognitive improvements with supplementation in participants with cognitive impairment.^[18]

Bacopa monnieri is also used in two polyherbal formulations. Protandim is combination supplement made up of ashwagandha, Bacopa extract, green tea extract, silymarin, and curcumin.^[19] Perment is a combination supplement made up of Bacopa monnieri, ashwagandha, butterfly pea, and Asparagus racemosus.^[20] There is little research on either of these polyherbal supplements. It is possible they provide more benefit than Bacopa on its own, but, without well-designed human trials, it is difficult to determine their clinical efficacy.

Bacopa monnieri may also work synergistically with rosemary. One in vitro study found that Bacopa monnieri in combination with rosemary (Rosmarinus officinalis) had stronger antioxidant effects than either supplement on its own.^[21] Similarly, a study using a rat model of Alzheimer’s disease found that oral administration of Bacopa monnieri and Rosmarinus officinalis could have neuroprotective effects.^[22] There is no human evidence to support these findings.

Keep in mind that although there is nothing inherently wrong with combination supplements, it is a challenge to deduce which components of these supplements are actually causing any beneficial effects. Thus, any benefits cannot be directly attributed to Bacopa monnieri.