Memory Optimizer by Shaklee

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Alzheimer disease. It is unclear if oral bacopa is beneficial in patients with Alzheimer disease. Details: A small clinical study in patients with Alzheimer disease or mild cognitive impairment shows that taking bacopa 300 mg daily for 12 months does not improve measures of cognitive function or memory when compared with donepezil or baseline measures (109623).
• Attention deficit-hyperactivity disorder (ADHD). It is unclear if oral bacopa is beneficial in children with ADHD. Details: A small clinical study in boys 6-14 years of age with symptoms consistent with ADHD but without an official diagnosis shows that taking a specific bacopa supplement (KeenMind - CDRI 08, Flordis) for 14 weeks does not improve symptoms of ADHD but improves some cognitive outcomes including error-making, cognitive flexibility, executive functioning, and sleep when compared with placebo. Bacopa 160 mg was given once daily in those weighing 20-35 kg and twice daily in those over 35 kg (109625). However, another small, open-label study in children aged 6-12 years with ADHD shows that taking a different bacopa supplement (BacoMind, Natural Remedies), 225 mg daily for 6 months, improves symptoms such as restlessness, impulsivity, learning problems, and attention deficit when compared to baseline (97603). The validity of these findings is limited by the lack of blinding or comparator group.
• Back pain. Although there is interest in using oral bacopa for back pain, there is insufficient reliable information about the clinical effects of bacopa for this condition.
• Cognitive function. Bacopa seems to improve some measures of cognitive function, but data are conflicting. Details: A meta-analysis of 9 small clinical studies, along with more recent clinical research, shows that taking bacopa 300-600 mg daily for at least 12 weeks is not associated with improved measures of cognition including working memory, learning rate, recognition of pictures and words, reaction time, or attention when compared with placebo. However, subgroup analysis of this meta-analysis and another small clinical study show some evidence of improved reaction times, verbal learning, total recall, retention, memory, and information processing in healthy adults when compared with placebo (10058,17946,33287,97605,109624,111520). In children aged 6-8 years old, a very small clinical study shows that taking a syrup containing bacopa extract 350 mg three times daily for 3 months improves visual motor function and immediate memory when compared to baseline (33304). The validity of this finding is limited by the lack of a statistical comparison to the placebo group. Bacopa has also been studied in combination with other ingredients. A study in healthy adults aged 18-60 years shows that taking a single dose of a combination of bacopa 300 mg, American ginseng 100 mg, and coffee fruit extract 100 mg (Bacognize) improves some measures of working memory and attention by a small amount at 45 minutes when compared with placebo (103375). It is unclear if these effects are due to bacopa, other ingredients, or the combination. In contrast, a moderate-sized study in healthy, middle-aged adults shows that taking a combination product containing whole plant bacopa 7.5 grams, gingko biloba, and group B vitamins for 12 weeks does not improve measures of memory, attention, cognition, mood, or stress reactivity when compared with placebo. Subgroup analysis shows a possible benefit of bacopa supplementation on measures of attention in those with an optimal diet at baseline (111334).
• Cognitive impairment. It is unclear if oral bacopa is beneficial in patients with cognitive impairment. Details: A small clinical study in patients with mild cognitive impairment or Alzheimer disease shows that taking bacopa 300 mg daily for 12 months does not improve measures of cognitive function or memory when compared with donepezil or baseline (109623).
• Congestive heart failure (CHF). Although there is interest in using oral bacopa for CHF, there is insufficient reliable information about the clinical effects of bacopa for this condition.
• Depression. It is unclear if oral bacopa is beneficial in patients with depression. Details: Preliminary clinical research in adults with depression who have not responded to citalopram 40 mg daily shows that adding bacopa extract 300 mg twice daily for 4 weeks improves scores on depression rating scales when compared with citalopram alone (103378).
• Hypertension. Although there is interest in using oral bacopa for hypertension, there is insufficient reliable information about the clinical effects of bacopa for this condition.
• Insomnia. Although there is interest in using oral bacopa for insomnia, there is insufficient reliable information about the clinical effects of bacopa for this condition.
• Irritable bowel syndrome (IBS). Bacopa has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with diarrhea-predominant IBS shows that taking a combination of bacopa and bael (Aegel marmalos) reduces symptoms in 65% of patients, compared with 78% of patients taking clidinium bromide, chlordiazepoxide, and blond psyllium, and 33% taking placebo. Neither treatment is more effective than placebo for preventing relapses (10059).
• Parkinson disease. It is unclear if oral bacopa is beneficial in patients with Parkinson disease. Details: A very small study in older adults with Parkinson disease taking levodopa shows that taking a specific bacopa extract (Cognitus, Herbarium) 225 mg or 450 mg daily for 90 days does not improve Parkinsonian or systemic symptoms, motor activity, emotional function, or social outcomes when compared with placebo (111523). The validity of these findings is limited by a small sample size and lack of randomization.
• Rheumatoid arthritis (RA). Although there is interest in using oral bacopa for RA, there is insufficient reliable information about the clinical effects of bacopa for this condition.
• Sexual dysfunction. Although there is interest in using oral bacopa for sexual dysfunction, there is insufficient reliable information about the clinical effects of bacopa for this condition.
• Smoking cessation. Oral bacopa has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A moderate-sized clinical study in adults with a history of smoking 5 or more cigarettes daily for at least 3 years shows that using a specific combination product containing bacopa 100 mg, ashwagandha, Indian gooseberry, tribulus, albizia lebbeck, licorice, clove, ginger, cowhage, holy basil, turmeric (Smotect , Smotect India) twice daily for 3 months reduces the number of cigarettes smoked daily and alveolar carbon monoxide and carboxyhemoglobin levels but does not improve lung capacity when compared with placebo (112115). It is unclear if these effects are due to bacopa, other ingredients, or the combination. More evidence is needed to rate bacopa for these uses.

(Read more about BACOPA)

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. Clinical research in elderly adults with memory complaints shows that taking senega extract 300 mg daily for 8 weeks modestly improves some, but not all, measures of cognitive function when compared with placebo (96992).
• Memory. Preliminary clinical research in healthy adults shows that taking senega extract 300 mg daily for 4 weeks does not improve most measures of memory when compared with placebo. Immediate recall was improved by a small amount (96991). More evidence is needed to rate senega for these uses.

(Read more about SENEGA)

POSSIBLY EFFECTIVE

• Dementia. Oral vinpocetine, taken for up to 1 year, might improve cognitive function to a small degree in patients with dementia. Details: While some conflicting evidence exists (1784), several small clinical studies in patients with cognitive impairment due to various causes including dementia, Alzheimer disease, and vascular disease show that taking vinpocetine 5-20 mg three times daily for up to 1 year slightly to modestly improves cognitive function when compared with baseline scores or placebo (1787,1789,82151,82152,82153,82154,82179,82180)(82182,82183,92934,111333). However, most of these studies were published prior to 1990 and used diagnostic and evaluative criteria that limit the applicability of these results to current clinical practice (10221,10827,111333).

INSUFFICIENT RELIABLE EVIDENCE to RATE

• Age-related cognitive decline. Although there has been interest in using oral vinpocetine for age-related cognitive decline, there is insufficient reliable information about the clinical effects of vinpocetine for this purpose.
• Age-related macular degeneration (AMD). It is unclear if oral vinpocetine is beneficial in patients with AMD. Details: One small clinical study in patients with AMD shows that taking vinpocetine 10 mg daily for 2 months, in conjunction with conventional therapy, improves visual acuity and retinal function when compared with conventional therapy alone (82089).
• Chronic fatigue syndrome (CFS). Although there has been interest in using oral vinpocetine for CFS, there is insufficient reliable information about the clinical effects of vinpocetine for this purpose.
• Epilepsy. Although there has been interest in using oral and intravenous vinpocetine for epilepsy, there is insufficient reliable information about the clinical effects of vinpocetine for this purpose.
• Hearing loss. It is unclear if oral or intravenous vinpocetine is beneficial in patients with hearing loss. Details: One small clinical study in patients with acoustic trauma shows that intravenous administration of vinpocetine 10 mg twice daily for 10 days is less effective than nicergoline, an ergot derivative, for improving hearing loss (82147). Another small, open-label clinical study in patients with sensorineural hearing loss shows that taking vinpocetine 10 mg three times daily for 12 months improves some measures of hearing capacity, particularly in months 6-12, when compared to baseline (106845). The validity of these findings is limited by a lack of control group.
• Memory. Small clinical studies suggest that oral vinpocetine might slightly improve memory in healthy individuals. Details: Two very small clinical studies in healthy individuals show that taking vinpocetine 40 mg as a single dose or vinpocetine 10-40 mg three times daily for 2 days enhances some measures of memory when compared with placebo (1796,1797). Additionally, one small clinical study in healthy adults shows that taking a combination product containing vinpocetine 10 mg, ginkgo extract 40 mg, and other ingredients three times daily for 2 weeks improves short-term memory when compared with placebo (8544). It is unclear if these findings are due to vinpocetine, other ingredients, or the combination.
• Menopausal symptoms. Although there has been interest in using oral vinpocetine for menopausal symptoms, there is insufficient reliable information about the clinical effects of vinpocetine for this purpose.
• Motion sickness. Although there has been interest in using oral vinpocetine for motion sickness, there is insufficient reliable information about the clinical effects of vinpocetine for this purpose.
• Stroke. Research on the use of intravenous vinpocetine to improve outcomes in patients recovering from ischemic stroke is mixed. It is unclear if oral vinpocetine is beneficial in these patients. Details: Some small clinical studies show that vinpocetine modestly reduces the residual effects of acute ischemic stroke (1785,10222,82087,82091,82120,82158,82159,82186). However, most clinical studies investigating the use of vinpocetine for stroke have been published in languages other than English and assessed intravenous formulations of vinpocetine not available in the US. One large clinical study shows that intravenous administration of vinpocetine 30 mg once daily for 7 days after an acute stroke, in addition to oral citicoline and aspirin or clopidogrel, seems to improve cerebral blood flow and measures of cognition, neurological function, and quality of life when compared with citicoline plus aspirin or clopidogrel (98226). A meta-analysis of 4 moderate-to-good quality clinical studies that included 837 adults with acute ischemic stroke, some of which are described above, shows that intravenous administration of vinpocetine in addition to standard care, followed by oral administration in some studies, reduces significant disability when compared with standard care. Vinpocetine also seems to improve cognition scores but does not reduce mortality (110744). The included studies used widely heterogeneous dosing regimens and excluded patients with severe strokes. However, a small clinical study not included in the meta-analysis shows that intravenous vinpocetine 20 mg followed by oral vinpocetine 10 mg three times daily for 3 months does not significantly improve neurophysical functioning post-stroke when compared with placebo (82074).
• Tinnitus. It is unclear if oral or intravenous vinpocetine is beneficial in patients with tinnitus. Details: A small observational study in patients with chronic unilateral or bilateral tinnitus has found that intravenous infusion of a specific vinpocetine product (Cavinton) 20 mg plus oral vinpocetine (Cavinton) 10 mg twice daily along with physiotherapy is associated with improved symptoms when compared to baseline (82099). However, a small clinical study in patients with tinnitus due to acoustic trauma shows that intravenous administration of vinpocetine (Cavinton) 10 mg twice daily appears to be less effective than nicergoline, an ergot derivative, for reducing tinnitus (82147).
• Urinary incontinence. It is unclear if oral vinpocetine is beneficial in patients with urinary incontinence. Details: One small, uncontrolled clinical study in patients with urinary incontinence shows that taking vinpocetine 10 mg three times daily for 2 weeks reduces daytime and nighttime frequency of urination when compared to baseline (82041). The validity of these findings is limited by a lack of control group. More evidence is needed to rate vinpocetine for these uses.

(Read more about VINPOCETINE)

POSSIBLY SAFE ...when used orally and appropriately, short-term. Bacopa has been used safely in clinical trials at a dose of up to 600 mg daily for up to 12 weeks (10058,10059,17946,97605).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately, short-term. Clinical research suggests bacopa extract might be safe to use at a dose of 225 mg daily for up to 6 months or 320 mg daily for up to 14 weeks in children aged 6-14 years (33304,97603,109625).

PREGNANCY AND LACTATION:
Insufficient reliable information available; avoid using.

(Read more about BACOPA)

POSSIBLY SAFE ...when used orally and appropriately, short-term (12). Senega extract has been used with apparent safety in clinical research at doses of 300 mg daily for 4-8 weeks (96991,96992).

POSSIBLY UNSAFE ...when used orally, long-term. Prolonged use can cause gastrointestinal irritation (12). There is insufficient reliable information available about the safety of senega when used topically.

PREGNANCY: LIKELY UNSAFE
when used orally; senega appears to have uterine and menstrual flow stimulant effects (12,19). There is insufficient reliable information available about the safety of the topical use of senega during pregnancy.

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about SENEGA)

POSSIBLY SAFE ...when used orally and appropriately for up to 12 months (1784,1788,82041,82074,82089,82091,82120,82121,82151,82152)(82153,82154,82179,82180,82182,82183,104522,106845,110744). ...when used intravenously and appropriately, short-term (82074,82099,82147,82158,82159,82186,110744).

PREGNANCY: POSSIBLY UNSAFE
when used orally. In June 2019, the US Food and Drug Administration (FDA) issued a statement of warning that those who are pregnant or who could become pregnant should avoid vinpocetine (95751). In rats, vinpocetine has been associated with an increased risk of miscarriage at a dose of 60 mg/kg daily and with reduced fetal weight and increased incidence of birth defects at a dose of 5-20 mg/kg. Based on pharmacokinetic analyses, a daily vinpocetine dose of 10 mg in humans is comparable to a daily dose of 5 mg/kg in rats (99701).

LACTATION:
Insufficient reliable information available; avoid using.

(Read more about VINPOCETINE)

ANTICHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use might decrease the effectiveness of both agents.  Details Bacopa seems to inhibit acetylcholinesterase and might increase acetylcholine levels, which could counteract the effects of anticholinergic drugs (17946). Similarly, anticholinergic drugs might counteract the cholinergic effects of bacopa.

CEVIMELINE (Evoxac) Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bacopa might increase the effects and adverse effects of cevimeline.  Details In one case, a 58-year-old female taking cevimeline long-term for Sjogren syndrome experienced hyperhidrosis, malaise, nausea, and tachycardia shortly after taking a single dose of bacopa. Symptoms resolved after two days. Cevimeline is metabolized by cytochrome P450 (CYP) 2D6 and CYP3A4, and researchers theorize that bacopa may have inhibited these isoenzymes (109627). However, it is unclear if bacopa causes clinically significant inhibition of either CYP2D6 or CYP3A4.

CHOLINERGIC DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, concurrent use of bacopa with other cholinergic drugs might have additive effects.  Details Bacopa seems to inhibit acetylcholinesterase and might increase acetylcholine levels (17946). Theoretically, this could result in additive cholinergic effects when used with cholinergic drugs.

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bacopa might increase the levels and adverse effects of CYP1A2 substrates.  Details Research on the effects of bacopa extracts on CYP1A2 enzymes is conflicting. Some in vitro evidence shows that bacopa extract can moderately and non-competitively inhibit CYP1A2, while other in vitro evidence suggests that any effect is unlikely to be clinically significant (97269,97606).

CYTOCHROME P450 2C19 (CYP2C19) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bacopa might increase the levels and adverse effects of CYP2C19 substrates.  Details In vitro evidence suggests that bacopa extract can moderately and non-competitively inhibit CYP2C19 enzymes (97606). It is not known whether this is clinically significant.

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bacopa might increase the levels and adverse effects of CYP2C9 substrates.  Details Research on the effect of bacopa extracts on CYP2C9 enzymes is conflicting. Some in vitro evidence suggests that bacopa extract can moderately and non-competitively inhibit CYP2C9, while other in vitro evidence suggests that any effect is unlikely to be clinically significant (97269,97606).

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, bacopa might increase the levels and adverse effects of CYP3A4 substrates.  Details Research on the effects of bacopa extracts on CYP3A4 enzymes is conflicting. Some in vitro evidence suggests that bacopa extract can moderately and competitively inhibit CYP3A4, while other in vitro evidence suggests that any effect is unlikely to be clinically significant (97269,97606).

THYROID HORMONE Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = D Theoretically, bacopa might have additive effects when used with thyroid hormone.  Details Animal research suggests that bacopa increases thyroxine (T4) levels in mice by about 40% (33286).

(Read more about BACOPA)

(Read more about SENEGA)

ANTICOAGULANT/ANTIPLATELET DRUGS Interaction Rating = Moderate Be cautious with this combination. Severity = High •  Occurrence = Possible •  Level of Evidence = B Vinpocetine might increase the risk of bleeding when taken with anticoagulant or antiplatelet drugs.  Details Clinical research shows that vinpocetine decreases red blood cell aggregation, as well as plasma and whole blood viscosity. This effect has been seen with intravenous vinpocetine 1 mg/kg and oral vinpocetine 30 mg daily (82101,82119). Vinpocetine also seems to have antiplatelet effects (1801,10061,82117).

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES Interaction Rating = Moderate Be cautious with this combination. Severity = Moderate •  Occurrence = Possible •  Level of Evidence = D Theoretically, vinpocetine might increase levels of drugs metabolized by CYP2C9.  Details In vitro research shows that vinpocetine weakly inhibits CYP2C9 (92933). However, this effect has not been reported in humans.

WARFARIN (Coumadin) Interaction Rating = Minor Be watchful with this combination. Severity = Mild •  Occurrence = Possible •  Level of Evidence = B Vinpocetine might modestly increase the risk of bleeding when taken with warfarin.  Details Clinical research shows that the combination of warfarin and vinpocetine leads to slight increases in prothrombin time and the area under the concentration curve for warfarin. However, these increases were small, and researchers suggest that this interaction is not likely to be clinically significant in most patients (10829).

(Read more about VINPOCETINE)

General ...Orally, bacopa is generally well tolerated.
Most Common Adverse Effects:
Orally: Abdominal cramps, diarrhea, dry mouth, headache, nausea.

Cardiovascular ...Orally, bacopa has been reported to cause palpitations (10058).

Gastrointestinal ...Orally, bacopa has been reported to cause abdominal cramps, abdominal pain, bloating, decreased appetite, diarrhea, dry mouth, excessive thirst, flatulence, indigestion, nausea, and increased stool frequency. Rates of adverse gastrointestinal events have ranged from 12% to 30% (10058,17946,33295,97605,109623,111520).

Musculoskeletal ...Orally, bacopa has been reported to cause arthralgia, muscle fatigue, and myopathy (10058,109623,111522). In one case, a 21-year-old male experienced progressive proximal weakness, muscle atrophy, weight loss, dark urine, and elevated serum markers of myopathy, with muscle biopsy showing immune-mediated necrotizing myopathy, after taking a supplement containing bacopa for 5 years (111522).

Neurologic/CNS ...Orally, bacopa has been reported to cause drowsiness, headache, insomnia, and vivid dreams (10058,10059,17946,109623).

Other ...Orally, bacopa has been reported to cause flu like symptoms and fatigue (10058,97605,111520).

(Read more about BACOPA)

General ...Orally, senega seems to be well tolerated. The most common adverse effects are gastrointestinal irritation, dyspepsia, diarrhea, queasiness, vomiting, and dizziness. These adverse effects are usually associated with large doses or prolonged use (2,4,8,18,96992).

Gastrointestinal ...Orally, senega can cause mild dyspepsia (96992). Prolonged use of senega can cause gastrointestinal irritation (2). Large doses of senega can cause diarrhea (8), queasiness (18), and vomiting (4).

Immunologic ...There is a case of IgE-mediated occupational asthma and rhinitis due to inhalation of senega powder (96987).

Neurologic/CNS ...Orally, large amounts of senega can cause dizziness (8).

(Read more about SENEGA)

General ...Orally and intravenously, vinpocetine seems to be well tolerated.
Most Common Adverse Effects:
Orally: Anxiety, dizziness, headache, flushing, gastric discomfort, sleep disturbances, and urticaria.
Serious Adverse Effects (Rare):
Orally: Agranulocytosis, arrhythmias, and seizures.
Intravenously: Arrhythmias.

Cardiovascular ...Orally, tachycardia, multifocal extra systoles, transient hypotension and hypertension, and palpitations have been reported with vinpocetine in clinical trials (1789,82118,82152,92936). One case of severe hypotension has been reported with oral vinpocetine (106845). Vinpocetine has also been reported to cause atrial fibrillation and ventricular arrhythmias, with the highest incidence occurring after intravenous or intramuscular administration (1789,82128,68753,82123).

Dermatologic ...Orally, vinpocetine has been reported to cause flushing, skin rash, and urticaria (82118,82120,82153,106845). Intravenously, vinpocetine has been associated with one report of allergic dermatitis (98226).

Gastrointestinal ...Orally, gastric discomfort, upper abdominal pain, nausea, diarrhea, constipation, vomiting, heartburn, difficulty swallowing, and dry mouth have been reported with vinpocetine (1787,1789,10061,10221,82120,82154,82155,92936,106845). Intravenously, diarrhea has been reported with vinpocetine (98226).

Hematologic ...Orally, vinpocetine has been associated with one case report of agranulocytosis (82156) and one case report of ecchymoma of the eyelid in a 60-year-old male 12 hours after a botulinum toxin injection. The patient had been taking vinpocetine 30 mg daily and aspirin 100 mg daily (112878).

Neurologic/CNS ...Orally, anxiety, drowsiness, headache, sleep disturbance, nervousness, excitation, hyperirritability, epileptiform convulsion, and vertigo have been reported with vinpocetine (1787,10221,68772,82118,82120,82151,82152,82154,92936,106845). Intravenously, dizziness has been reported with vinpocetine (98226).

Ocular/Otic ...Orally, vinpocetine has been associated with one case of eyelid edema (106845). Also, one case reports ecchymoma of the eyelid in a 60-year-old male 12 hours after a botulinum toxin injection. The patient had been taking vinpocetine 30 mg daily and aspirin 100 mg daily (112878).

Pulmonary/Respiratory ...Orally, vinpocetine has been associated with one case of severe dyspnea (106845).

(Read more about VINPOCETINE)