Common Names
- Yohimbe bark
- Yohimbine hydrochloride
- Johimbe
- Aphrodine
- Corynine
- Quebrachine
For Patients & Caregivers
How It Works
Yohimbe is not recommended for treating erectile dysfunction (ED).
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. Although widely used to treat erectile dysfunction before the approval of newer drugs, current guidelines do not recommend its use. In addition, yohimbine can cause many side effects, interact with many drugs, and is not recommended for individuals with certain of medical conditions.
Purported Uses
- To improve athletic performance
No scientific evidence supports this use. - To help dizzy spells and “head rush”
A study in a small group of patients with nerve disorders suffering from these symptoms found that yohimbine improved symptoms. - To treat sexual dysfunction
Several research bodies concluded that proof supporting yohimbine was based on weak evidence. Yohimbine is not currently recommended to improve sexual dysfunction. - As a stimulant
Although yohimbine stimulates the nervous system, no clinical data support its use as a stimulant. Instead, there are many reports of negative side-effects due to blood pressure effects as well as a number of drugs with which yohimbine can interact. - To increase salivation
A small study showed that yohimbine could increase saliva flow compared with another drug. However, no further studies were ever done to confirm effectiveness and safety. - To lose weight
There are no clinical data to support this use. Instead, there are many reports of negative side-effects due to blood pressure effects as well as a number of drugs with which yohimbine can interact.
Patient Warnings
Yohimbine can interact with numerous drugs and cause serious adverse effects. Do not use if you have high blood pressure, heart disease, arrhythmias, Parkinson’s disease, seizure disorders, kidney, thyroid, or liver disease, sexual organ inflammatory disorders, ulcers, or psychiatric disorders. Do not take with antidepressant medications or with foods containing high amounts of tyramine (such as cheese, red wine, liver), or with decongestants, diet aids, or phenylpropanolamine-containing products.
Do Not Take If
- You take antianxiety agents: May reduce their effectiveness.
- You take antidepressants: May increase side effects.
- You take blood pressure medications: May lessen their effects.
- You take drugs that are substrates of CYP2D6: May effect how these drugs are metabolized.
- You take bupropion: Coingestion can result in toxic effects.
- You take opioids: May cause withdrawal and anxiety symptoms.
- You are pregnant or nursing: May cause serious side effects.
- You have cardiovascular disease, liver disease, or kidney disease: May cause serious side effects.
- You have high blood pressure: Yohimbine can raise your blood pressure even more.
- You have psychiatric conditions including posttraumatic stress disorder, anxiety, bipolar disorder, depression, mania, schizophrenia: Yohimbine may make your condition worse.
- You have an enlarged prostate or sex organ inflammation: Yohimbine may make your condition worse.
Side Effects
-
High blood pressure, anxiety, nervousness, nausea, dizziness, rapid heartbeat, irregular heartbeat, sleeplessness, urinary problems, diarrhea, psychiatric symptoms
Case reports
- Two unrelated deaths caused by yohimbine overdose that could not be explained by any other condition.
- Severe pain and persistent erection in a 42-year-old man with complex medical history after taking yohimbe extract. A surgical procedure was necessary.
- Acute neurotoxic effects including malaise, vomiting, loss of consciousness, and repeated seizures in a 39-year-old body builder after taking a large amount of yohimbine. Symptoms improved 12 hours after treatment.
- Skin eruption, kidney failure, and lupus-like syndrome in a 42-year-old man following yohimbine treatment for impotence. Since the patient did not have these symptoms before treatment with yohimbine, doctors believed these symptoms were treatment-related.
For Healthcare Professionals
Clinical Summary
Yohimbe is derived from the bark of the yohimbe tree, an evergreen native to West Africa. It has been used as an aphrodisiac for several centuries. Marketed as a steroid substitute and for weight loss, yohimbe is also used with other supplements in formulas to enhance athletic performance.
The active component, an alkaloid called yohimbine, has been tested in clinical studies to treat sexual dysfunction in men and women (1) (2) (3) (4). It was prescribed as an oral treatment for erectile dysfunction (ED) prior to the approval of phosphodiesterase type 5 (PDE5) inhibitors. However, more recent analyses determined there is a lack of direct evidence regarding the efficacy and safety of oral yohimbine in nonorganic (psychogenic) ED, with no support for its use in organic ED (5) (6). In veterans with posttraumatic stress disorder, yohimbine increased acoustic startle reflex (7). A preliminary randomized trial suggests that it may be effective for improving presyncopal symptoms in patients with severe orthostatic hypotension (8). Other studies have noted its ability to attenuate pressor responses in patients with Parkinson’s disease and neurogenic orthostatic hypotension (9) (10). Preliminary studies of yohimbine on athletic performance (11) and xerostomia provide only limited additional information (12). Yohimbe products are among dietary supplements with the largest number of documented contraindications (13). They are also responsible for the most frequent toxic effects reported (14) and severe events requiring hospitalization (15).
Purported Uses
Mechanism of Action
Effects on erectile dysfunction may result from the inhibition of presynaptic-α1-adrenoceptor activity in cavernous smooth muscle cells as well as its impact on nitric oxide (NO) and cGMP formation involving endothelium and endothelial NO synthase (eNOS) activity, which is testosterone-dependent (6) (17). Yohimbe also has dilatory effect on genital blood vessels, enhanced genital tissue sensation, and increased reflex excitability in the sacral region (4).
The active constituents are indole alkaloids, including yohimbine (16), which possesses endothelin-like actions and affects NO production in renal circulation (18), and exerts anxiogenic effects through the noradrenergic pathway, which activates the HPA stress axis (19). As an α2-adrenoreceptor antagonist, yohimbine enhances norepinephrine release, increases parasympathomimetic activity, and reduces sympathetic activity (15) (20) (21). Blocking of α2-adrenoreceptors also results in increased blood supply to cavernous body tissue and increased plasma levels of noradrenaline by increasing its release from the sympathetic nervous system (4) (21). In patients with orthostatic hypotension, yohimbine produces a pressor effect by engaging residual sympathetic tone (8).
Warnings
Yohimbine can potentially interact with numerous drugs causing severe adverse effects. Do not use if you have high blood pressure, heart disease, arrhythmias, Parkinson’s disease, seizure disorders, kidney, thyroid, or liver disease, sexual organ inflammatory disorders, ulcers, or psychiatric disorders. Do not take with antidepressant medications or with foods containing high amounts of tyramine (such as cheese, red wine, liver), or with decongestants, diet aids, or phenylpropanolamine-containing products.
Contraindications
Adverse Reactions
Hypertension, anxiety, nervousness, nausea, dizziness, tachycardia, palpitations, insomnia, urinary frequency, diarrhea, manic symptoms (1) (6) (15).
Case reports
Fatalities following accidental yohimbine overdose: Medical examiners attributed 2 unrelated fatalities to accidental acute yohimbine intoxication, due to substantial yohimbine blood concentrations (7,400 and 5,400 ng/mL) and in the absence of other significant positive findings for both cases (23).
Acute neurotoxic effects: Malaise, vomiting, loss of consciousness, and repeated seizures in a 39-year-old body builder following ingestion of yohimbine 5g. Glasgow Coma Score indicated the need for orotracheal intubation. Symptoms subsided 12 h posttreatment with furosemide, labetalol, clonidine, and urapidil as well as gastrointestinal decontamination (24).
Erythrodermic skin eruption, progressive renal failure, and lupus-like syndrome: In a 42-year-old black man following treatment with yohimbine. Patient was admitted and received aggressive hydration, Eucerin cream with 1% hydrocortisone cream for the entire body and betamethasone valerate 0.1 % cream for hands. Patient was discharged after 2 weeks with symptom resolution, although he was readmitted 4 months later for additional clinical presentations (25).
Severe priapism: In a 42-year-old man with complex medical history after ingestion of yohimbe extract. Treatment involved insertion of a proximal cavernosal spongiosum shunt (26).
Herb-Drug Interactions
- Antianxiety agents: Yohimbine may reduce their therapeutic effects (27).
- Antidepressants: Yohimbine may augment side effects (28).
- Antihypertensives: Yohimbine may diminish their effects (8).
- Bupropion: Coingestion with yohimbe resulted in toxic effects (14).
- CYP2D6 substrate drugs: Yohimbine inhibits CYP2D6 and may therefore affect the intracellular concentration of drugs metabolized by these enzymes (29).
- Opioids: May induce withdrawal and anxiety symptoms (30).