Health Care Professional Information

Scientific Name
Pausinystalia yohimbe
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Brand Name

Yohimbe Bark, yohimbine hydrochloride, Johimbe, aphrodine, corynine, quebrachine

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Clinical Summary

Derived from the bark of yohimbe tree native to West Africa. It has been used as an aphrodisiac for several centuries. Marketed as a steroid substitute, yohimbe is also used with other supplements in formulas to enhance athletic performance. The active component, an alkaloid called yohimbine, was tested in clinical studies to treat sexual dysfunction in men and women (5). Oral administration is well tolerated, but long-term toxic effects have not been studied. Yohimbine stimulates the central nervous system and also acts as a monoamine oxidase inhibitor and calcium channel blocker. Thus, it can potentially interact with numerous drugs causing severe adverse effects.
Although yohimbine was shown effective in treating erectile dysfunction in some studies (2) (3) (4) (5), side effects including nervous excitation, tremors, high blood pressure, nausea, and vomiting have been reported.

A one-year prospective study of dietary supplement-related poison control center calls in 2006 showed that clinically significant toxic effects were most frequently reported with yohimbe-containing products (10).

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Purported Uses
  • Athletic performance
  • Sedation
  • Sexual dysfunction
  • Sexual performance
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Constituents
  • 6% Indole Alkaloids (including yohimbine)
  • Tannins
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Mechanism of Action

Yohimbine is an alpha2-adrenoreceptor antagonist. It blocks the presynaptic alpha2-adrenergic receptors, increases parasympathomimetic activity, and reduces sympathetic activity (12) (13). Blocking of alpha2-adrenoreceptors results in increased blood supply to cavernous body tissue. It also increases the plasma levels of noradrenaline by increasing noradrenaline release from the sympathetic nervous system. Aphrodisiac activity of yohimbine may be caused by its dilatory effect on genital blood vessels and the enhancement of sensation to genital tissue, and an increased reflex excitability in the sacral region (4).
Preliminary findings also report that yohimbine possesses endothelin-like actions and affects nitric oxide (NO) production in renal circulation (14).

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Pharmacokinetics

Yohimbine has a rapid onset due to its highly lipophilic property which assists its absorption and crossing of the blood-brain barrier in a short period of time. Peak plasma levels were observed within 10 to 45 minutes of oral administration. The average oral bioavailability is 33% (ranging from 7% to 87%). It is rapidly eliminated with a half-life of 0.58 hr following oral intake (7). Less than 1% of administered yohimbine is excreted unchanged in urine.

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Contraindications

Yohimbe is contraindicated in patients with schizophrenia, depression, anxiety, blood pressure, kidney disease, pregnancy, liver disease, angina pectoris, and heart disease (1).

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Adverse Reactions

Reported (Oral):

  • Yohimbine may cause anxiety or nervousness, nausea, dizziness, insomnia, urinary frequency, manic symptoms, and increase in blood pressure (5).
  • According to a case study reported in 1993, a forty-two-year-old man developed skin eruption, renal failure, and lupus-like syndrome following treatment with three 5.4 mg tablets of yohimbine for impotence (6). Since the patient did not have any symptoms of lupus before treatment with yohimbine, researchers believe the lupus was induced by yohimbine.
  • Acute neurotoxic effects including malaise, vomiting, loss of consciousness, and repeated seizures have been reported in a 39-year-old body builder following ingestion of 5g of yohimbine. The symptoms subsided twelve hours later following treatment (9).
  • A case of severe priapism was reported after ingestion of yohimbe extract. Treatment involved insertion of a proximal cavernosal spongiosum shunt (11).
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Herb-Drug Interactions
  • Buproprion: Coingestion with yohimbe resulted in toxic effects (10).
  • Methamphetamine: Coadministration with yohimbe resulted in toxic effects (10).
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Literature Summary and Critique

Ernst, E., and Pittler, M. H. Yohimbine for erectile dysfunction: A systematic review and meta-analysis of randomized clinical trials. J. Urol 1998;159(2):433-436.
This review included seven clinical trials that were performed to determine the therapeutic efficacy of yohimbine for erectile dysfunction. The trials indicate yohimbine is clinically effective compared to placebo and the benefits seem to outweigh the risks. There were very few adverse reactions reported. Researchers suggest that yohimbine can be used as a primary intervention in the treatment of erectile dysfunction.

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Dosage (Inside MSKCC Only)
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References
  1. Brinker, F. Herb Contraindications And Drug Interactions. Sandy, OR: Eclectic Medical Publications, 2001.
  2. Ernst, E. and M. H. Pittler. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol. 159.2 (1998): 433-36.
  3. Kunelius, P., J. Hakkinen, and O. Lukkarinen.Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type impotence? A prospective, randomized, controlled double-blind crossover study. Urology. 49.3 (1997): 441-44.
  4. Montorsi, F. et al. Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology 44.5 (1994): 732-36.
  5. Riley, A. J. Yohimbine in the treatment of erectile disorder. Br J Clin Pract. 48.3 (1994): 133-36.
  6. Sandler, B. and P. Aronson. Yohimbine-induced cutaneous drug eruption, progressive renal failure, and lupus-like syndrome. Urology 41.4 (1993): 343-45.
  7. Guthrie SK, et al. Yohimbine bioavailability in humans. Eur J Clin Pharmacol. 1990;39(4):409-11.
  8. MICROMEDEX(R) Healthcare Series. 120. 2004. Thomson MICROMEDEX (accessed September 10, 2004).
  9. Giampreti A, Lonati D, Locatelli C, et al. Acute neurotoxicity after yohimbine ingestion by a body builder. Clin Toxicol (Phila). 2009 Jul 30.
  10. Haller C, Kearney T, Bent S, et al. Dietary supplement adverse events: report of a one-year poison center surveillance project. J Med Toxicol. 2008 Jun;4(2):84-92.
  11. Myers A, Barrueto F Jr. Refractory priapism associated with ingestion of yohimbe extract. J Med Toxicol. 2009 Dec;5(4):223-5.
  12. Murburg MM, Villacres EC, Ko GN, and Veith RC. Effects of yohimbine on human sympathetic nervous system function. J Clin Endocrinol Metab. 1991;73: 861-865.
  13. Kirkeby HJ, Forman A, Sorensen S, and Andersson KE. Alpha-adrenoceptor function in isolated penile circumflex veins from potent and impotent men. J Urol. 1989;142:1369-1371.
  14. Ajayi AA, Newaz M, Hercule H, et al. Endothelin-like action of Pausinystalia yohimbe aqueous extract on vascular and renal regional hemodynamics in Sprague Dawley rats. Methods Find Exp Clin Pharmacol. 2003 Dec;25(10):817-22.
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Consumer Information

How It Works

Bottom Line: Yohimbe has been shown effective in treating erectile dysfunction.

Yohimbe is a tree native to West Africa. Yohimbine, an alkaloid derived from the bark of Yohimbe tree, has been used for many years as an aphrodisiac and in the treatment of erectile dysfunction. It can cause side effects including nervous excitation, tremors, high blood pressure, nausea, and vomiting.

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Purported Uses
  • To improve athletic performance
    No scientific evidence supports this use.
  • To improve sexual performance
    This use is not backed by clinical data.
  • To treat sexual dysfunction
    Yohimbe was shown in human studies to improve sexual dysfunction.
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Research Evidence

Treatment of erectile dysfunction:
In a recent review of several clinical trials, yohimbine was found to be effective compared to placebo in the treatment of erectile dysfunction.

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Do Not Take If
  • You take Buproprion (coingestion can result in toxic effects).
  • You take Methamphetamine (coingestion can result in toxic effects).
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Side Effects
  • Anxiety
  • Nausea
  • Dizziness
  • Insomnia
  • Manic Symptoms
  • High Blood Pressure
  • Reported (Oral): According to a case study reported in 1993, a forty-two-year-old man developed skin eruption, renal failure, and lupus-like syndrome following treatment with three 5.4 mg tablets of yohimbine for impotence. Since the patient did not have any symptoms of lupus before treatment with yohimbine, researchers believe the lupus was induced by yohimbine.
  • Acute neurotoxic effects including malaise, vomiting, loss of consciousness, and repeated seizures have been reported in a 39-year-old body builder following ingestion of 5g of yohimbine. The symptoms subsided twelve hours later following treatment.
  • A case of severe priapism (an abnormal often painful persistent erection) was reported after ingestion of yohimbe extract. Treatment involved insertion of a proximal cavernosal spongiosum shunt.
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Last updated: September 26, 2012
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