Yohimbe bark extract (Pausinystalia yohimbe Pierre ex Beille Rubiaceae)

Yohimbe bark extract (Pausinystalia yohimbe Pierre ex Beille Rubiaceae)

Background

The terms yohimbine , yohimbine hydrochloride , and yohimbe bark extract are related but not interchangeable. Yohimbine is an active chemical (indole alkaloid) found in the bark of the Pausinystalia yohimbe tree. Yohimbine hydrochloride is a standardized form of yohimbine that is available as a prescription drug in the United States, and has been shown in human studies to be effective in the treatment of male impotence. Yohimbine hydrochloride has also been used for the treatment of sexual side effects caused by some antidepressants (SSRIs), female hyposexual disorder, as a blood pressure boosting agent in autonomic failure, xerostomia, and as a probe for noradrenergic activity.

Synonyms

Aphrodien, Corynanthe johimbi, Corynanthe yohimbi, corynine, johimbi, Pausinystalia johimbe, Pausinystalia yohimbe, quebrachine, Rubiaceae (family) , yohimbehe, yohimbehe cortex, yohimbeherinde, yohimbene, yohimbime, yohimbine.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidenceGrade*Erectile dysfunction (male impotence)
Yohimbine hydrochloride is a prescription drug that has been shown in multiple human trials to effectively treat male impotence. Although yohimbine is present in yohimbe bark extract, levels are variable and often very low. Yohimbe bark extract has not been shown to share the effects of yohimbine hydrochloride. Therefore, although yohimbe bark has been used traditionally to reduce male erectile dysfunction, there is not enough scientific evidence to form a firm conclusion in this area.

C

Libido (women)
Yohimbine has been proposed to increase female libido (sexual interest). There is only limited poor-quality research in this area, and more study is needed before a recommendation can be made.

C

Sexual side effects of selective serotonin reuptake inhibitor (SSRI) antidepressants
Yohimbine hydrochloride, a standardized form of yohimbine that is available as a prescription drug in the United States, has been suggested to treat sexual dysfunction due to SSRI antidepressants. However, research in this area is limited, and more study is needed before a recommendation can be made. In addition, yohimbe bark extract may not contain significant amounts of yohimbine, and therefore may not have these proposed effects.

C

Nervous system dysfunction (autonomic failure)
It is theorized that yohimbine may improve orthostatic hypotension (lowering of blood pressure with standing) or other symptoms of autonomic nervous system dysfunction. However, yohimbe bark extract may not contain significant amounts of yohimbine, and therefore may not have these proposed effects. More research is needed before a recommendation can be made.

C

Dry mouth (xerostomia)
Studies report that yohimbine is able to increase saliva in animals and in humans. Based on these few studies, yohimbine has been used for the treatment of dry mouth caused by medications, such as antidepressants. However, yohimbe bark extract may not contain significant amounts of yohimbine, and therefore may not have these effects. More research is needed before a recommendation can be made.

C

* Key to grades
A: Strong scientific evidence for this use;
B: Good scientific evidence for this use;
C: Unclear scientific evidence for this use;
D: Fair scientific evidence against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).

Uses based on tradition or theory
The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Alzheimer's disease, anesthetic, angina, aphrodisiac, clonidine overdose, cognition, coronary artery disease, cough, depression, diabetic complications, diabetic neuropathy, exhaustion, fevers, hallucinogenic, high cholesterol, insomnia, leprosy, low blood pressure, narcolepsy, obesity, panic disorder, Parkinson's disease, postural hypotension, pupil dilator, schizophrenia, syncope.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. There is no widely accepted standardization to regulate the production of yohimbe bark extract products, although yohimbine is believed to be the main ingredient of importance. A 1995 scientific analysis of 26 commercial yohimbe products reported that most products contained virtually no yohimbine.

A 2003 scientific analysis of twenty commercial aphrodisiac preparations found the amount of yohimbine measured and expressed as the maximal dose per day suggested on product labels ranged from 1.32 to 23.16 mg.

Adults (18 years and older)

Tea : A tea can be prepared by simmering 5 to 10 teaspoons of shaved yohimbe bark in 1 pint of water (with a further recommendation of adding 0.5 to 1.0 grams of vitamin C to the tea to make it more soluble). This traditional dose has not been tested in reliable human studies.

Tablets : The following doses are based on human trials of pharmaceutical standardized yohimbine hydrochloride (available by prescription in the United States). No reliable clinical studies are available for administration of yohimbe bark extract. For erectile dysfunction (male impotence), 15 to 42 milligrams of yohimbine hydrochloride daily in three divided doses (for example, 5.4 to 10 milligrams three times daily) has been studied. For libido in women, 5.4 milligrams three times daily of yohimbine hydrochloride has been studied. For sexual side effects caused by antidepressant drugs, 2.7 to 16.2 milligrams of yohimbine hydrochloride has been studied. For autonomic dysfunction/orthostatic hypotension, 5.4 to 12 milligrams of daily yohimbine has been studied. For dry mouth (xerostomia), 6 milligrams three times daily of yohimbine hydrochloride has been studied.

Children (younger than 18 years)

Yohimbe and yohimbine hydrochloride are not recommended for use in children.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

In theory, allergy/hypersensitivity to yohimbe, any of its constituents, or yohimbine-containing products may occur.

Side Effects and Warnings

Yohimbe bark extract is traditionally said to cause occasional skin flushing, piloeretion (body hair standing up), painful urination, genital pain, reduced appetite, agitation, dizziness, headache, irritability, nervousness, tremors, or insomnia.

Multiple adverse effects have been associated with the use of the drug yohimbine hydrochloride, although in recommended doses, it is usually tolerated. If adverse effects occur, discontinuing the drug will likely stop the effects. In theory, these same side effects may also occur with the use of yohimbe bark extract, which contains variable (usually low) amounts of yohimbine.

There are reports of rash, flushing, breathing difficulty, cough, runny nose, nausea, vomiting, increased salivation, diarrhea, increased frequency of urination, kidney failure, muscle aches, and a lupus-like syndrome with the use of yohimbine hydrochloride. Yohimbine has also been associated with tremulousness, insomnia, anxiety, irritability, and excitability. Yohimbine may precipitate panic attacks, anxiety, manic episodes or psychosis in patients with a history of mental illness.

In animal research, yohimbine has been associated with increased motor activity and seizures at higher doses. In humans, yohimbine may change the seizure threshold (the likelihood that a seizure will happen in some people), and may cause blood pressure/heart rate increases, fluid retention, chest discomfort and heart rhythm abnormalities. Higher doses may lower blood pressure. Yohimbine can enter the brain through the bloodstream. Yohimbine may increase the risk of bleeding by altering platelet function, and may dangerously reduce the number of white blood cells (agranulocytosis).

Symptoms of toxicity from yohimbine can include paralysis, dangerously low blood pressure, heart rhythm abnormalities, heart failure, and death. These same risks theoretically may also exist with yohimbe bark extract, depending on the concentration of yohimbine present and the amount ingested. Beta-blocker drugs such as metoprolol (Lopressor®, Toprol®) may be protective against yohimbine toxicity.

Pregnancy and Breastfeeding

Yohimbe should be avoided during pregnancy because it may relax the uterus and may be toxic to the fetus. Yohimbe should be avoided during breastfeeding, due to reports of deaths in children.

References

1. Bagheri H, Schmitt L, Berlan M, et al. A comparative study of the effects of yohimbine and anetholtrithione on salivary secretion in depressed patients treated with psychotropic drugs. Eur J Clin Pharmacol 1997;52(5):339-342.

2. Bagheri H, Schmitt L, Berlan M, et al. Effect of 3 weeks treatment with yohimbine on salivary secretion in healthy volunteers and in depressed patients treated with tricyclic antidepressants. Br J Clin Pharmacol 1992;34(6):555-558.

3. Balon R. Fluoxetine-induced sexual dysfunction and yohimbine. J Clin Psychiatry 1993;54(4):161-162.

4. Betz JM, White KD, der Marderosian AH. Gas chromatographic determination of yohimbine in commercial yohimbe products. J AOAC Int 1995;78(5):1189-1194.

5. Brodde OE, Anlauf M, Arroyo J, et al. Hypersensitivity of adrenergic receptors and blood-pressure response to oral yohimbine in orthostatic hypotension. N Engl J Med 1983;308 (17) :1033-1034.

6. Carey MP, Johnson BT. Effectiveness of yohimbine in the treatment of erectile disorder: four meta-analytic integrations. Arch Sex Behav 1996;25(4):341-360.

7. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol 1998;159(2):433-436.

8. Friesen K, Palatnick W, Tenenbein M. Benign course after massive ingestion of yohimbine. J Emerg Med 1993;11(3):287-288.

9. Hollander E, McCarley A. Yohimbine treatment of sexual side effects induced by serotonin reuptake blockers. J Clin Psychiatry 1992;53(6):207-209.

10. Jacobsen FM. Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry 1992;53(4):119-122.

11. Knoll LD, Benson RC, Jr., Bilhartz DL, et al. A randomized crossover study using yohimbine and isoxsuprine versus pentoxifylline in the management of vasculogenic impotence. J Urol 1996;155(1):144-146.

12. Kunelius P, Hakkinen J, Lukkarinen O. Is high-dose yohimbine hydrochloride effective in the treatment of mixed-type impotence? A prospective, randomized, controlled double-blind crossover study. Urology 1997;49(3):441-444.

13. Landis E, Shore E. Yohimbine-induced bronchospasm. Chest 1989;96(6):1424.

14. Montague DK, Barada JH, Belker AM, et al. Clinical guidelines panel on erectile dysfunction: summary report on the treatment of organic erectile dysfunction. The American Urological Association. J Urol 1996;156(6):2007-2011.

15. Morales A. Yohimbine in erectile dysfunction: the facts. Int J Impot Res 2000;12 Suppl 1:S70-S74.

16. Oliveto A, Sevarino K, McCance-Katz E, et al. Clonidine and yohimbine in opioid-dependent humans responding under a naloxone novel-response discrimination procedure. Behav Pharmacol 2003;14(2):97-109.

17. Price LH, Charney DS, Heninger GR. Three cases of manic symptoms following yohimbine administration. Am J Psychiatry 1984;141(10):1267-1268.

18. Rosen MI, Kosten TR, Kreek MJ. The effects of naltrexone maintenance on the response to yohimbine in healthy volunteers. Biol Psychiatry 1999;45(12):1636-1645.

19. Sandler B, Aronson P. Yohimbine-induced cutaneous drug eruption, progressive renal failure, and lupus-like syndrome. Urology 1993;41(4):343-345.

20. Vogt HJ, Brandl P, Kockott G, et al. Double-blind, placebo-controlled safety and efficacy trial with yohimbine hydrochloride in the treatment of nonorganic erectile dysfunction. Int J Impot Res 1997;9(3):155-161.

21. Zanolari B, Ndjoko K, Ioset JR, et al. Qualitative and quantitative determination of yohimbine in authentic yohimbe bark and in commercial aphrodisiacs by HPLC-UV-API/ MS methods. Phytochem Anal 2003;14(4):193-201.

January 01, 2004