- Yohimbe bark
For Patients & Caregivers
Tell your healthcare providers about any dietary supplements you’re taking, such as herbs, vitamins, minerals, and natural or home remedies. This will help them manage your care and keep you safe.
What is it?
Yohimbe is not recommended for treating erectile dysfunction.
Yohimbe is a tree native to West Africa. Yohimbine, an alkaloid derived from the bark of the 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 prescription drugs, and is not recommended for individuals with certain medical conditions.
What are the potential uses and benefits?
- To improve athletic performance
Evidence is lacking to support this claim.
- 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, clinical data do not support its use.
- For weight loss
There are no data to support this use and yohimbe products are reported to have serious side effects and drug interactions.
What are the side effects?
High blood pressure, anxiety, nervousness, nausea, dizziness, rapid heartbeat, irregular heartbeat, heart muscle damage, sleeplessness, urinary problems, diarrhea, psychiatric symptoms
- 6 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.
- Palpitations and severe high blood pressure in a 49-year-old man who used an herbal supplement containing yohimbine.
- Toxic effects including malaise, vomiting, loss of consciousness, and repeated seizures in a 39-year-old bodybuilder after taking a large amount of yohimbine.
- Skin eruption, kidney failure, and lupus-like syndrome in a 42-year-old man following treatment with yohimbine for impotence.
What else do I need to know?
- 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, seizures, kidney, thyroid, or liver disease, sexual organ inflammatory disorders, ulcers, or psychiatric disorders.
- Do not take with antidepressants or foods high in tyramine such as cheese, red wine, and liver, or with decongestants, diet aids, or phenylpropanolamine-containing products.
- An analysis of 49 yohimbine supplement brands sold in the US showed that only 4% provided accurate information about the quantity of yohimbine and known adverse effects.
Do Not Take if:
- You take antianxiety agents: Yohimbine may reduce their effectiveness.
- You take antidepressants: Yohimbine may increase their side effects.
- You take blood pressure medications: Yohimbine may lessen their effects.
- You take CYP2D6 substrate drugs: Yohimbine may affect how these drugs are metabolized.
- You take bupropion: Coingestion with yohimbe products can result in toxic effects.
- You take opioids: Yohimbine may cause withdrawal and anxiety symptoms.
- You are pregnant or nursing: Yohimbine may cause serious side effects.
- You have cardiovascular, liver, or kidney disease: Yohimbine may cause serious side effects.
- You have high blood pressure: Yohimbine can raise blood pressure so taking it may compound the problem.
- You have psychiatric conditions including PTSD, 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.
For Healthcare Professionals
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. Yohimbe is marketed as a steroid substitute, to enhance athletic performance, and for weight loss and energy support.
The active component, an alkaloid called yohimbine, has been tested in clinical studies to treat sexual dysfunction (1) (2) (3) (4). It was prescribed as an oral treatment for erectile dysfunction prior to the approval of PDE5 inhibitors, but there is a lack of direct evidence on its efficacy and safety (5) (6).
Purported Uses and Benefits
- Athletic performance
- Sexual dysfunction
- Weight loss
Mechanism of Action
Effects on erectile dysfunction may result from inhibition of presynaptic-α1-adrenoceptor activity in cavernous smooth muscle cells and impact on NO and cGMP formation involving endothelium and endothelial NO synthase 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).
- 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.
- An analysis of 49 yohimbine supplement brands sold in the US showed that only 4% provided accurate information about the quantity of yohimbine and known adverse effects (32).
Severe poisoning and death: Attributed to quantified yohimbine concentrations in 6 cases, and in the absence of death from trauma, previous illness, or other common toxic components (23) (35).
Hypertensive urgency: In a 49-year-old man who presented to the emergency department with palpitations and severely elevated blood pressure that was not responding to treatment. The patient later admitted to using an herbal supplement containing yohimbine (36).
Acute neurotoxic effects: Malaise, vomiting, loss of consciousness, and repeated seizures in a 39-year-old bodybuilder following ingestion of yohimbine 5g and requiring orotracheal intubation and other treatment (24).
Erythrodermic skin eruption, renal failure, and lupus-like syndrome: In a 42-year-old black man following treatment with yohimbine. Patient required hospital admission and aggressive treatment as well as subsequent readmission (25).
Severe priapism: In a 42-year-old man with complex medical history after ingestion of yohimbe extract. Treatment required included a surgical procedure (26).
- 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 products 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: Yohimbine may induce withdrawal and anxiety symptoms (30).