Scientific Name: Yohimbe
Other Names: Johimbi, Pausinystalia yohimbe

Who is this for?

Uses

Due to its questionable effectiveness and potentially severe side effects, yohimbe is not recommended for general use. Its use should be supervised by a healthcare professional.

Yohimbine is an alkaloid contained in the herbal product, yohimbe. Because yohimbine is the most active component of yohimbe, the two names are often used interchangeably. They are not the same, however. Less than 10% of yohimbe is composed of yohimbine; the rest consists of other chemicals with lesser or unknown effects. Despite a long history of use, neither yohimbe nor yohimbine has been proven in well-controlled human studies to be effective for any medical condition.

Nevertheless, a prescription drug made from yohimbine has long been used in the United States to treat male erectile dysfunction (ED), which is the inability to have or maintain an erection of the penis long enough to have sexual relations. This condition may also be called sexual dysfunction or impotence. Yohimbine may be effective for ED because it appears to relax and widen blood vessels in the penis. The resulting increased blood flow may lead to an erection. In studies, yohimbe has also increased the amount and activity of sperm produced by laboratory animals. At the same time, yohimbine may excite parts of the brain involved with the desire for sex. Men who have ED as a result of diabetes or as a side effect from taking antidepressants known as serotonin reuptake inhibitors (SSRIs) may respond to yohimbine. Recently, however, more effective treatments--including prescription drugs with less apparent potential for side effects--have been approved for ED. Yohimbine may have similar stimulating effects for women, but it is not used often by women due to its generally poor results and relatively frequent side effects.

Because low doses of the alkaloid yohimbine (less than about 20 mg per day) may result in mild nervous stimulation and increased breathing capability, it has been used at times as a weight-reducing agent, an exercise-enhancer, and a treatment for narcolepsy, a disorder that causes sleepiness and uncontrollable attacks of sleeping during the daytime. Yohimbine may cause central nervous system stimulation, which could improve all three conditions. No scientific evidence proves that either yohimbine or yohimbe is effective for any of them, however; even though yohimbine continues to be included in non-prescription herbal combination products promoted for athletes and individuals who want to lose weight.

In higher doses (approximately 50 mg or more per day), yohimbine appears to block an enzyme called monoamine oxidase (MAO). It may also reduce blood levels of neurotransmitters--particularly dopamine and serotonin, which are all thought to play a role in maintaining emotional status. Neurotransmitters are chemicals that carry messages from nerve cells to other cells. Low levels of MAO usually help to relieve depression, while low levels of dopamine and serotonin may contribute to increased feelings of depression. These conflicting effects may worsen depression or interfere with other treatments for it. Yohimbine may have a role, however, in relieving the side effect of ED that may be associated with taking SSRIs. Some evidence from a recent study suggests that yohimbine may also cause SSRIs to reach their full effectiveness sooner than the several weeks they ordinarily need. Higher doses of yohimbine may also reduce blood pressure by blocking alpha receptors. Yohimbe used to be taken to control blood pressure, but newer drugs with more predictable results and fewer side effects have replaced it for this use.

Yohimbine may affect the way that the body eliminates excess water, which may worsen kidney conditions. Therefore, individuals with kidney diseases should avoid taking yohimbe and products made from it.

Men who have benign prostatic hyperplasia (BPH) should also avoid yohimbe and yohimbine due to the possibility that they may promote prostate enlargement and worsen the symptoms of BPH.

Yohimbe and yohimbine may affect the balance of neurotransmitters involved in maintaining emotional status. Therefore, individuals who have or who have had anxiety, depression, or mental illnesses should not take yohimbine.

Although yohimbe and yohimbine are not generally used by women, they may cause the uterus to relax, if taken by a female. Taking it while pregnant may result in a miscarriage. In addition, chemicals in yohimbe may damage a developing fetus. Therefore, pregnant women should avoid yohimbe and yohimbine.

Yohimbe and yohimbine may affect children more than adults. Since very small amounts of yohimbe have caused severe anxiety-like responses in children, it should not be given to children.

While small doses (up to about 20 mg per day) of yohimbine may increase blood pressure, larger doses (30 mg or more per day) may cause blood pressure to fall. These effects differ widely from individual to individual. Therefore, individuals with high or low blood pressure should avoid taking yohimbe and yohimbine.

Precautions

Whether chemicals in yohimbe enter breast milk is not known. Due to yohimbine's possible anxiety-inducing effect on infants, however, women who are breastfeeding should not use yohimbe or its derivatives.

What side effects should I watch for?

Major Side Effects

Doses of yohimbine over about 40 mg per day may overly stimulate the central nervous system (CNS) resulting in anxiety, headache, insomnia, restlessness, or other symptoms. Rarely, death has been attributed to overdoses of yohimbe. Also reported have been:

• Changes in heart rhythm
• Difficult breathing
• Potentially dangerous drops in blood pressure
• Temporary muscle paralysis in the legs and feet

One reported case of priapism, a painful sustained erection, has been attributed to taking yohimbine.

Yohimbe and yohimbine may have an effect on neurotransmitters involved in maintaining emotional balance. General anxiety, manic episodes, psychoses, and other mental conditions reportedly have been triggered or worsened by taking yohimbe or yohimbine.

Inhaling or smoking powdered yohimbe bark has been reported to produce hallucinations.

Less Severe Side Effects

Low doses of yohimbine (under 20 mg per day) have resulted in:

• Abdominal pain
• Diarrhea
• Dizziness
• Drooling
• Elevated blood pressure
• Fast heart rate
• General weakness
• Increased urine production
• Nausea
• Nervousness
• Sweating
• Vomiting

What interactions should I watch for?

Prescription Drugs

Due to its effects on blood pressure, yohimbe and yohimbine are believed to interfere with the effects of drugs that lower blood pressure. Some blood pressure-lowering drugs are:

• ACE inhibitors such as captopril, enalapril, fosinopril, and lisinopril
• Beta blockers such as atenolol, metoprolol, and propranolol
• Calcium channel blockers such as amlodipine, nifedipine, and verapamil
• Diuretics such as Dyazide, furosemide, and hydrochlorothiazide

The risk of changes in blood pressure increases if yohimbe or yohimbine is taken at the same time as a tricyclic antidepressant such as amitriptyline, amoxapine, doxepin, or nortriptyline.

In one small study of laboratory animals, yohimbine increased the antidepressant effects of fluoxetine and venlafaxine. No similar effect has been reported in humans, but individuals who take both yohimbine and a prescription antidepressant may have more pronounced or prolonged antidepressant effects than expected.

Yohimbine may stimulate parts of the nervous system. If yohimbe or yohimbine is taken with prescription drugs that also cause nervous system stimulation, the risk of side effects such as anxiety, dizziness, fast heart beat, headache, insomnia, nausea, and restlessness may increase. A rapid, potentially dangerous spike in blood pressure known as a hypertensive crisis is also possible. Prescription drugs that may interact with yohimbe or yohimbine include:

• Alpha blockers such as doxazosin and terazosin
• Asthma drugs such as albuterol and metaproterenol
• clonidine (Catapres)
• guanabenz

Yohimbe and yohimbine are believed to affect levels of neurotransmitters, chemicals that carry messages from nerve cells to other cells. Antipsychotic drugs used to treat mental disorders such as schizophrenia also alter the levels of neurotransmitters. If yohimbe or yohimbine and antipsychotic drugs are taken at the same time, the effectiveness of the drug may be changed, so it is best to avoid using yohimbe or yohimbine while taking drugs such as:

• chlorpromazine
• fluphenazine
• prochlorperazine
• Risperdal
• Seroquel
• Zyprexa

Non-prescription Drugs

Non-prescription cough and cold remedies often contain pseudoephedrine (PSE) or phenylepherine, drugs which may increase the risk of side effects such as anxiety, dizziness, fast heart beat, headache, insomnia, nausea, and restlessness when they are taken with yohimbe or yohimbine.

Herbal Products

Yohimbe or yohimbine and certain other herbal products such as ephedra, guarana, and mate may cause blood pressure to rise. Ephedra is now banned from sale in the United States. It should not be taken for any reason. However, if ephedra or another blood-pressure raising herbal is taken at the same time as yohimbe or yohimbine, a sharp increase in blood pressure known as a hypertensive crisis may result. Symptoms of a hypertensive crisis may include confusion, difficulty breathing, intense headache, or numb or tingling fingers or toes.

Foods

Caffeine increases the central nervous system stimulation effect of yohimbe and yohimbine. The combination may cause excessive nervousness and irritability, along with other signs of over-stimulation. In addition, the risk of a hypertensive crisis increases when caffeine and yohimbe are taken together. Caffeinated beverages such as coffee, soft drinks, and tea should not be consumed when taking yohimbe or yohimbine.

Yohimbe and yohimbine may enhance the effects of alcohol, leading to a feeling of intoxication with only a small amount of alcohol comsumption.

Drugs that block the enzyme monoamine oxidase (MAO) may interact seriously with tyramine, a chemical in that helps maintain blood pressure levels in the body. Tyramine is found in many beverages and foods including beer, red wine, aged or smoked meats, certain cheeses, sauerkraut, and yeast. Since yohimbine is a mild MAO inhibitor, a dangerous rise in blood pressure may result if it is taken with any food or drink containing tyramines.

Some interactions between herbal products and medications can be more severe than others. The best way for you to avoid harmful interactions is to tell your doctor and/or pharmacist what medications you are currently taking, including any over-the-counter products, vitamins, and herbals. For specific information on how yohimbe and yohimbine interact with drugs, other herbals, and foods and the severity of those interactions, please use our Drug Interactions Checker to check for possible interactions.

Should I take it?

Yohimbe is the bark of an evergreen tree that grows wild along the coasts of west-central Africa. Because it is thick and soft, it is relatively easy to remove from the tree trunk and branches. While yohimbe bark may be harvested anytime during the year, its alkaloid content is highest during the rainy winter season, which is between May and September in the Southern Hemisphere. While stripping off the bark does not usually kill the trees, it gives insects the chance to burrow into the yohimbe trees. Eventually the effects of these insect will kill an affected tree. New trees grow relatively quickly, however, and they may start from the stumps of dead ones. Yohimbe trees also produce numerous seeds that look similar to maple tree seeds.

Residents of the areas where it grows have long used yohimbe for numerous medical purposes ranging from heart conditions to sleepiness. It has been smoked to produce hallucinations for recreational or religious reasons and it has been used to improve endurance for hunting. It is best known, however, as an aphrodisiac, a substance believed to increase sexual desire and performance.

Dosage and Administration

Neither herbal yohimbe nor yohimbine is recommended for use without the supervision of a health professional.

In clinical studies, a commonly used dose to treat ED was 6 mg of yohimbine taken three times a day. None of the studies lasted longer than 10 weeks, and the safety of yohimbine taken longer than 10 weeks is not known.

Summary

Yohimbine, an alkaloid in yohimbe, has been used as a treatment for erectile dysfunction (ED). Newer prescription drugs may offer better results with less chance of side effects, however.

Risks

Yohimbe and yohimbine may cause miscarriage or birth defects if taken by a pregnant woman. Because they may produce anxiety disorders in children, yohimbe and yohimbine should also be avoided by children and breast-feeding women. Individuals with benign prostate hyperplasia, high blood pressure, or kidney diseases should not take products made from yohimbe, which may worsen these conditions. Taking yohimbe or yohimbine may also trigger or aggravate mental conditions such as depression or schizophrenia.

Side Effects

Very large doses of yohimbine may result in possibly dangerous changes in blood pressure, breathing, or heart rate. Yohimbe and yohimbine have also been associated with diarrhea, headache, insomnia, nausea, restlessness, sweating, and a number of other side effects.

Interactions

Yohimbe and its derivatives may interfere with the effects of drugs to treat high blood pressure, depression, schizophrenia, and several other conditions. Taking yohimbe or yohimbine may increase the risk of side effects from drugs such as tricyclic antidepressants and pseudoephedrine; herbals such as guarana and mate; and foods such as caffeine. When a yohimbe product is taken at the same time as alcohol, intoxication may occur more rapidly. Foods and drinks containing an amino acid known as tyramine may raise blood pressure when they are consumed while yohimbe or yohimbine is being taken.

Last Revised April 21, 2008

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Note: The above information is not intended to replace the advice of your physician, pharmacist, or other healthcare professional. It is not meant to indicate that the use of the product is safe, appropriate, or effective for you.

In general, herbal products are not subject to review or approval by the U.S. Food and Drug Administration (FDA). They are not required to be standardized, meaning that the amounts of active ingredients or contaminants they contain may vary between brands or between different batches of the same brand. Not all of the risks, side effects, or interactions associated with the use of herbal products are known because few reliable studies of their use in humans have been done.

This information is provided for your education only. Please share this information with your healthcare provider and be sure that you talk to your doctor and pharmacist about all the prescription and non-prescription medicines you take before you begin to use any herbal product.

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