Health Care Professional Information
Brand Name
Yohimbe Bark, yohimbine hydrochloride, Johimbe, aphrodine, corynine, quebrachine
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).
Purported Uses
- Athletic performance
- Sedation
- Sexual dysfunction
- Sexual performance
Constituents
- 6% Indole Alkaloids (including yohimbine)
- Tannins
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).
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.
Contraindications
Yohimbe is contraindicated in patients with schizophrenia, depression, anxiety, blood pressure, kidney disease, pregnancy, liver disease, angina pectoris, and heart disease (1).
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).
Herb-Drug Interactions
- Buproprion: Coingestion with yohimbe resulted in toxic effects (10).
- Methamphetamine: Coadministration with yohimbe resulted in toxic effects (10).
Literature Summary and Critique
Dosage (Inside MSKCC Only)
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References
- Brinker, F. Herb Contraindications And Drug Interactions. Sandy, OR: Eclectic Medical Publications, 2001.
- 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.
- 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.
- Montorsi, F. et al. Effect of yohimbine-trazodone on psychogenic impotence: a randomized, double-blind, placebo-controlled study. Urology 44.5 (1994): 732-36.
- Riley, A. J. Yohimbine in the treatment of erectile disorder. Br J Clin Pract. 48.3 (1994): 133-36.
- Sandler, B. and P. Aronson. Yohimbine-induced cutaneous drug eruption, progressive renal failure, and lupus-like syndrome. Urology 41.4 (1993): 343-45.
- Guthrie SK, et al. Yohimbine bioavailability in humans. Eur J Clin Pharmacol. 1990;39(4):409-11.
- MICROMEDEX(R) Healthcare Series. 120. 2004. Thomson MICROMEDEX (accessed September 10, 2004).
- Giampreti A, Lonati D, Locatelli C, et al. Acute neurotoxicity after yohimbine ingestion by a body builder. Clin Toxicol (Phila). 2009 Jul 30.
- 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.
- Myers A, Barrueto F Jr. Refractory priapism associated with ingestion of yohimbe extract. J Med Toxicol. 2009 Dec;5(4):223-5.
- 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.
- 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.
- 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.
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.
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.
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.
Do Not Take If
- You take Buproprion (coingestion can result in toxic effects).
- You take Methamphetamine (coingestion can result in toxic effects).
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.
Last updated: September 26, 2012
abnormal (ab-NOR-mul)
Not normal. An abnormal lesion or growth may be cancer, premalignant (likely to become cancer), or benign (not cancer).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)acute (uh-KYOOT)
Symptoms or signs that begin and worsen quickly; not chronic.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)administration (ad-MIH-nih-STRAY-shun)
In medicine, the act of giving a treatment, such as a drug, to a patient. It can also refer to the way it is given, the dose, or how often it is given.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)alkaloid (AL-kuh-loyd)
A member of a large group of substances found in plants and in some fungi. Alkaloids contain nitrogen and can be made in the laboratory. Nicotine, caffeine, codeine, and vincristine are alkaloids. Some alkaloids, such as vincristine, are used to treat cancer.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)anxiety (ang-ZY-eh-tee)
Feelings of fear, dread, and uneasiness that may occur as a reaction to stress. A person with anxiety may sweat, feel restless and tense, and have a rapid heart beat. Extreme anxiety that happens often over time may be a sign of an anxiety disorder.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)blood (blud)
A tissue with red blood cells, white blood cells, platelets, and other substances suspended in fluid called plasma. Blood takes oxygen and nutrients to the tissues, and carries away wastes.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)blood pressure (blud PREH-sher)
The force of circulating blood on the walls of the arteries. Blood pressure is taken using two measurements: systolic (measured when the heart beats, when blood pressure is at its highest) and diastolic (measured between heart beats, when blood pressure is at its lowest). Blood pressure is written with the systolic blood pressure first, followed by the diastolic blood pressure (for example 120/80).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)calcium (KAL-see-um)
A mineral needed for healthy teeth, bones, and other body tissues. It is the most common mineral in the body. A deposit of calcium in body tissues, such as breast tissue, may be a sign of disease.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)central nervous system (SEN-trul NER-vus SIS-tem)
The brain and spinal cord. Also called CNS.
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(http://www.cancer.gov/dictionary)circulation (ser-kyoo-LAY-shun)
In the body, the flow of blood through the heart and blood vessels, and the flow of lymph through the lymph vessels.
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(http://www.cancer.gov/dictionary)clinical (KLIH-nih-kul)
Having to do with the examination and treatment of patients.
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(http://www.cancer.gov/dictionary)drug (drug)
Any substance, other than food, that is used to prevent, diagnose, treat or relieve symptoms of a disease or abnormal condition. Also refers to a substance that alters mood or body function, or that can be habit-forming or addictive, especially a narcotic.
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(http://www.cancer.gov/dictionary)dysfunction (dis-FUNK-shun)
A state of not functioning normally.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)efficacy (EH-fih-kuh-see)
Effectiveness. In medicine, the ability of an intervention (for example, a drug or surgery) to produce the desired beneficial effect.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)erectile dysfunction (eh-REK-tile dis-FUNK-shun)
An inability to have an erection of the penis adequate for sexual intercourse. Also called impotence.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)extract (EK-strakt)
In medicine, a preparation of a substance obtained from plants, animals, or bacteria and used as a drug or in drugs.
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(http://www.cancer.gov/dictionary)genital (JEH-nih-tul)
Refers to the genitalia (external and internal sex organs and glands).
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)high blood pressure (hy blud PREH-sher)
A blood pressure of 140/90 or higher. High blood pressure usually has no symptoms. It can harm the arteries and cause an increase in the risk of stroke, heart attack, kidney failure, and blindness. Also called hypertension.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)impotence (IM-puh-tents)
In medicine, refers to the inability to have an erection of the penis adequate for sexual intercourse. Also called erectile dysfunction.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)indole (IN-dole)
A type of chemical found in plants and in certain vegetables, such as broccoli, cabbage, and cauliflower. Indoles may promote good health and are being studied in the prevention of certain types of cancer, including breast cancer, prostate cancer, and colon cancer. An indole is a type of phytochemical.
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(http://www.cancer.gov/dictionary)ingestion (in-JES-chun)
Taking into the body by mouth.
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(http://www.cancer.gov/dictionary)insomnia (in-SOM-nee-uh)
Difficulty in going to sleep or getting enough sleep.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)intervention (IN-ter-VEN-shun)
In medicine, a treatment or action taken to prevent or treat disease, or improve health in other ways.
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(http://www.cancer.gov/dictionary)lupus (LOO-pus)
A chronic, inflammatory, connective tissue disease that can affect the joints and many organs, including the skin, heart, lungs, kidneys, and nervous system. It can cause many different symptoms; however, not everyone with lupus has all of the symptoms. Also called SLE and systemic lupus erythematosus.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)monoamine oxidase inhibitor (MAH-noh-uh-MEEN OK-sih-days in-HIH-bih-ter)
A type of drug used to treat depression. It stops the breakdown of certain chemicals in the brain that help improve a person’s mood. A monoamine oxidase inhibitor is a type of antidepressant. Also called MAO inhibitor.
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(http://www.cancer.gov/dictionary)nausea (NAW-zee-uh)
A feeling of sickness or discomfort in the stomach that may come with an urge to vomit. Nausea is a side effect of some types of cancer therapy.
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(http://www.cancer.gov/dictionary)nervous system (NER-vus SIS-tem)
The organized network of nerve tissue in the body. It includes the central nervous system (the brain and spinal cord), the peripheral nervous system (nerves that extend from the spinal cord to the rest of the body), and other nerve tissue.
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(http://www.cancer.gov/dictionary)noradrenaline (NOR-uh-dreh-nuh-lin)
A chemical made by some nerve cells and in the adrenal gland. It can act as both a neurotransmitter (a chemical messenger used by nerve cells) and a hormone (a chemical that travels in the blood and controls the actions of other cells or organs). Noradrenaline is released from the adrenal gland in response to stress and low blood pressure. Also called norepinephrine.
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(http://www.cancer.gov/dictionary)oral (OR-ul)
By or having to do with the mouth.
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(http://www.cancer.gov/dictionary)oxide (OK-side)
A type of chemical substance that is a combination of oxygen and another substance. Oxides are found in essential oils.
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(http://www.cancer.gov/dictionary)placebo (pluh-SEE-boh)
An inactive substance or treatment that looks the same as, and is given the same way as, an active drug or treatment being tested. The effects of the active drug or treatment are compared to the effects of the placebo.
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(http://www.cancer.gov/dictionary)plasma (PLAZ-muh)
The clear, yellowish, fluid part of the blood that carries the blood cells. The proteins that form blood clots are in plasma.
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(http://www.cancer.gov/dictionary)prospective (pruh-SPEK-tiv)
In medicine, a study or clinical trial in which participants are identified and then followed forward in time.
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(http://www.cancer.gov/dictionary)proximal (PROK-sih-mul)
In medicine, refers to a part of the body that is closer to the center of the body than another part. For example, the knee is proximal to the toes. The opposite is distal.
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(http://www.cancer.gov/dictionary)renal failure (REE-nul FAYL-yer)
A condition in which the kidneys stop working and are not able to remove waste and extra water from the blood or keep body chemicals in balance. Acute or severe renal failure happens suddenly (for example, after an injury) and may be treated and cured. Chronic renal failure develops over many years, may be caused by conditions like high blood pressure or diabetes, and cannot be cured. Chronic renal failure may lead to total and long-lasting renal failure, called end-stage renal disease (ESRD). A person in ESRD needs dialysis (the process of cleaning the blood by passing it through a membrane or filter) or a kidney transplant. Also called kidney failure.
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(http://www.cancer.gov/dictionary)shunt (shunt)
In medicine, a passage that is made to allow blood or other fluid to move from one part of the body to another. For example, a surgeon may implant a tube to drain cerebrospinal fluid from the brain to the abdomen. A surgeon may also change normal blood flow by making a passage that leads from one blood vessel to another.
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(http://www.cancer.gov/dictionary)significant (sig-NIH-fih-kunt)
In statistics, describes a mathematical measure of difference between groups. The difference is said to be significant if it is greater than what might be expected to happen by chance alone. Also called statistically significant.
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(http://www.cancer.gov/dictionary)syndrome (SIN-drome)
A set of symptoms or conditions that occur together and suggest the presence of a certain disease or an increased chance of developing the disease.
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(http://www.cancer.gov/dictionary)therapeutic (THAYR-uh-PYOO-tik)
Having to do with treating disease and helping healing take place.
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(http://www.cancer.gov/dictionary)tissue (TIH-shoo)
A group or layer of cells that work together to perform a specific function.
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(http://www.cancer.gov/dictionary)toxic (TOK-sik)
Having to do with poison or something harmful to the body. Toxic substances usually cause unwanted side effects.
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(http://www.cancer.gov/dictionary)urinary (YOOR-ih-NAYR-ee)
Having to do with urine or the organs of the body that produce and get rid of urine.
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(http://www.cancer.gov/dictionary)urine (YOOR-in)
Fluid containing water and waste products. Urine is made by the kidneys, stored in the bladder, and leaves the body through the urethra.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)yohimbe (yoh-HIM-bay)
A tree native to West Africa. The bark is used as a supplement for bodybuilding and to enhance male sexual performance. It contains the chemical yohimbine, which is being studied in the treatment of sexual dysfunction. It may interact with certain drugs used to treat depression, high blood pressure, and high blood sugar. The scientific name is . Also called johimbe.
Source: The National Cancer Institute's Dictionary of Cancer Terms
(http://www.cancer.gov/dictionary)
