Drug & supplement interaction

Bacopa + Netupitant, Palonosetron (Oral)

Netupitant, Palonosetron (Oral) brand name: Akynzeo.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Bacopa has a moderate interaction with Netupitant, Palonosetron (Oral). Theoretically, bacopa might increase the levels and adverse effects of CYP3A4 substrates.

Read the full interaction report
SeverityModerate
LikelihoodPossible
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Bacopa and Netupitant, Palonosetron (Oral)

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Why this applies to Netupitant, Palonosetron (Oral)

Netupitant, Palonosetron (Oral) falls under CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES — the group Bacopa interacts with.

Theoretically, bacopa might increase the levels and adverse effects of CYP3A4 substrates.
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.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the gist with Akynzeo (netupitant plus palonosetron) and bacopa. The netupitant part is cleared by a liver enzyme called CYP3A4. In lab dish studies, bacopa might slow that enzyme down a bit, which could theoretically let netupitant linger longer in your body. If that happened, you might notice more of its usual side effects, like headache, constipation, fatigue, or mild weakness.

I want to be honest about the strength of this, though. The evidence here is shaky and comes only from test-tube and animal work, and even those studies disagree with each other. So this is more of a theoretical caution than a proven problem. Akynzeo is usually a short course around chemo, so the overlap is brief. Still, it's worth a quick mention to your oncology pharmacist or doctor before adding bacopa.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Kar A, Pandit S, Mukherjee K, Bahadur S, Mukherjee PK. Safety assessment of selected medicinal food plants used in Ayurveda through CYP450 enzyme inhibition study. J Sci Food Agric 2017;97(1):333-40. doi: 10.1002/jsfa.7739. PubMed
  2. Ramasamy S, Kiew LV, Chung LY. Inhibition of human cytochrome P450 enzymes by Bacopa monnieri standardized extract and constituents. Molecules 2014;19(2):2588-601. PubMed

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Bacopa Also Interacts With Other Medications

Bacopa has 916 moderate, 13 minor known drug interactions in our database — the Netupitant, Palonosetron (Oral) one above is one of them. If you take anything else, check it against the full list below.

Moderate 916 Minor 13 No known interaction 1,901 (incl. Netupitant, Palonosetron (Oral))
Taking anything else?

Check Another of Your Medications Against Bacopa

Covers the 2,830 medications we’ve checked against Bacopa. Pick one to open its full report.

Everything else you take

See Every Supplement That Interacts With Netupitant, Palonosetron (Oral)

This page covers Bacopa only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Netupitant, Palonosetron (Oral) page lists 158 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Grapefruit (major), Lithium (major), St. John's Wort (major) and 5-htp (moderate).

By severity: 4 major · 113 moderate · 41 minor.

From our pharmacist’s overview on the Netupitant, Palonosetron (Oral) page

“Getting Akynzeo (netupitant and palonosetron) to work is the difference between finishing a chemotherapy cycle comfortably and losing days to nausea, so this list warrants genuine care. Most of it involves a liver enzyme, CYP3A4, that clears netupitant.”

Reviewed by 2 · Jul 18, 2026

Open the Netupitant, Palonosetron (Oral) interaction page

One more smart check

Taking Bacopa as Part of a Dietary Supplement Product? Check It for Interactions

We hold 1,420 real supplement products containing Bacopa, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Bacopa. Your product may carry other ingredients that interact with Netupitant, Palonosetron (Oral) too, on top of Bacopa — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Bacopa and Netupitant, Palonosetron (Oral) Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Bacopa
Top 10%

#134 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Netupitant, Palonosetron (Oral)
Top 25%

#541 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Bacopa

What is Bacopa?

Bacopa
  • Memory and cognitive support
  • Anxiety and stress
  • ADHD symptoms
  • Age-related memory decline
  • General brain health

Bacopa is an Ayurvedic herb most often used for memory and thinking. Some small studies suggest it may modestly help memory when taken regularly for several weeks, but the evidence is limited and quality varies. It is generally well tolerated but can cause stomach upset, and it should be avoided in pregnancy and breastfeeding due to a lack of safety data.

Read the full Bacopa monograph & all interactions
Medication

About Netupitant and Palonosetron

What Is Netupitant and Palonosetron Used For?

Brand name: Akynzeo

Akynzeo capsules are used in adults to prevent both the short-term (acute) and longer-lasting (delayed) nausea and vomiting that can follow cancer chemotherapy — including, but not limited to, highly emetogenic (strongly nausea-causing) chemotherapy regimens. It is always taken together with the steroid dexamethasone.

Akynzeo capsules cover a broad range of chemotherapy regimens, including anthracycline plus cyclophosphamide-based regimens. Each ingredient targets a different stage: palonosetron addresses nausea and vomiting in the first 24 hours, while netupitant covers both the early and the delayed phase that can last several days after treatment.

See full Netupitant and Palonosetron drug information
Keep checking

Other Drugs & Bacopa

Browse every other medication we’ve checked against Bacopa — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
916Moderate
13Minor
1,900No known interaction
916 Moderate 13 Minor 1,900 No interaction
Moderate

916 interactions

Showing 60 of 916 moderate interactions — see all 916 on the Bacopa page.

Minor

13 interactions

No interaction 1,900 drugs checked — show the list

We also checked Bacopa against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 1,900 medications checked with no known interaction — see the full Bacopa list.

See the full Bacopa interactions page
See every supplement checked against Netupitant, Palonosetron (Oral), ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Bacopa monograph › Uses, safety, and every drug interaction in one place Netupitant, Palonosetron (Oral) supplement interactions › Every supplement checked against Netupitant, Palonosetron (Oral), ranked by severity Netupitant and Palonosetron drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Bacopa and Netupitant, Palonosetron (Oral) Together: Common Questions

Can you take Bacopa with Netupitant, Palonosetron (Oral)?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
How serious is the Bacopa and Netupitant, Palonosetron (Oral) interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Netupitant, Palonosetron (Oral) and Bacopa?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.