The short answer
Not known in people, but an animal study gives reason for care. Rats given a standardised brahmi (Bacopa monnieri) extract for a week had about four times as much carbamazepine in their blood overall as rats given none. In lab tests, the same kind of extract slowed several of the liver enzymes that clear medicines.
We found no study that tested brahmi with carbamazepine, phenytoin, valproate or levetiracetam in people. Carbamazepine and phenytoin have a narrow therapeutic index, so small changes in blood level can matter. If you take an epilepsy medicine, tell your prescribing doctor before you start brahmi, and ask whether your drug level should be checked.
Carbamazepine is sold in India as Tegrital CR, divalproex (a form of valproate) as Dicorate ER, and levetiracetam as Levera.
At a glance
| What was seen | How it may work | Direction | Evidence |
|---|---|---|---|
| Carbamazepine exposure about 4 times higher in rats[1] | Lower CYP3A and gut P-glycoprotein activity in rats | More carbamazepine in the blood | Animal |
| Extract slowed CYP2C19, CYP2C9, CYP1A2 and CYP3A4[2] | Enzyme inhibition by the whole extract; purified bacosides had little effect | Could raise levels of drugs these enzymes clear | In vitro |
| Phenytoin still protected mice against seizures[3] | Not established | No loss of anticonvulsant effect in one mouse model | Animal |
No listing is not a clearance. A missing interaction here never means a combination is safe.
The evidence, study by study
Rat study, 2013 Animal
Male rats were given a standardised alcoholic extract of Bacopa monnieri, of a kind sold for memory, for one week before carbamazepine. Total carbamazepine exposure (AUC) rose about fourfold and the peak level 1.8-fold, compared with rats given no extract. The extract lowered CYP3A and gut P-glycoprotein, two systems that break down drugs or pump them back out of the gut. Rat results show why the question matters, but they cannot give a figure for people.[1]
Laboratory study, 2014 In vitro
Human liver enzymes made in the lab were exposed to a standardised Bacopa extract. The whole extract slowed CYP2C19, CYP2C9, CYP1A2 and CYP3A4, while the purified bacosides, its best-known compounds, had almost no effect. Lab findings like this show a possible route for an interaction. They do not show that one happens in people.[2]
Mouse study, 2000 Animal
Mice were given phenytoin for 14 days, with a Bacopa extract added for the last seven. The extract eased the memory problems that phenytoin caused, and phenytoin still protected against seizures in the test. This was one mouse experiment, and it tells us nothing about seizure control or drug levels in people with epilepsy.[3]
What your doctor may watch for
- Seizure control, and any new dizziness or unsteadiness.[4]
- Your drug level, if your doctor thinks it should be checked. The phenytoin label itself says herbal supplements can alter phenytoin levels.[4]
- Carbamazepine, like phenytoin, is classed by the US FDA as a narrow therapeutic index drug.[5]
What to tell your prescribing doctor
You can read this out, or show them this page:
“I am taking, or planning to take, brahmi (name of product, the Latin name on the pack, dose) along with my epilepsy medicine. In rats, a brahmi extract raised carbamazepine levels about fourfold. Should my drug level be checked, and which symptoms should I report to you?”
Withheld until review
Questions people ask
Related
Brahmi and sedatives or sleeping pills
Not tested in people. In lab tests brahmi slowed enzymes that clear some sedatives, so the effect on drowsiness is unknown.
InteractionPippali, black pepper and carbamazepine
Piperine from pepper raised carbamazepine levels in two small human studies. The studies used isolated piperine, not pippali powder.
FormulationBrahmi Ghrita
A medicated ghee of brahmi and ten herbs, used for memory and epilepsy. One small study in older adults; it contains danti, a scheduled poison.
InteractionBrahmi and antidepressants or anxiety medicines
No study has tested brahmi with SSRIs. Two adverse-event reports involve other antidepressants, and other medicines may explain them.
Sources
- Singh R, Panduri J, Kumar D, Kumar D, Chandsana H, Ramakrishna R, Bhatta RS. Evaluation of memory enhancing clinically available standardized extract of Bacopa monniera on P-glycoprotein and cytochrome P450 3A in Sprague-Dawley rats. PLoS One. 2013;8:e72517. PMID 24015255.
- Ramasamy S, Kiew LV, Chung LY. Inhibition of human cytochrome P450 enzymes by Bacopa monnieri standardized extract and constituents. Molecules. 2014;19:2588-2601. PMID 24566323.
- Vohora D, Pal SN, Pillai KK. Protection from phenytoin-induced cognitive deficit by Bacopa monniera, a reputed Indian nootropic plant. J Ethnopharmacol. 2000;71:383-390. PMID 10940574.
- Phenytoin sodium extended-release capsules, US prescribing information (DailyMed, Major Pharmaceuticals).
- US FDA. Draft guidance on carbamazepine (chewable tablets), August 2022. Classifies carbamazepine as a narrow therapeutic index drug.
- US FDA. Draft guidance on phenytoin sodium (extended-release capsules), December 2014. "FDA has concluded that phenytoin is a narrow therapeutic index (NTI) drug."
- Walker EA, Pellegrini MV. Bacopa monnieri. StatPearls. Updated 17 March 2023.
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bacopa monnieri. Updated 24 April 2024.
Updated 4 November 2026
Taking brahmi with other medicines? A vaidya can check your full list.
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