Mother Tincture
Mother tincture of yohimbe bark, used in traditional phytotherapeutic practice.
Tincture
Prescription Drug (Yohimbine HCl) · Restricted Supplement in Many Countries
Biological Overview
Pausinystalia yohimbe is a large tree, 20 to 25 meters tall, native to the tropical forests of West-Central Africa (Gabon, Congo, Cameroon). It has oval, pointed leaves (30 x 10 cm) and white flowers with long filiform appendages at the tip of the petals. The trunk bark is the part used medicinally, and yohimbine, its principal active alkaloid, is also available as a synthetic prescription drug (yohimbine hydrochloride).
FamilyRubiaceae
Tree Height20–25 m
Indole Alkaloids1–6%
Key CompoundYohimbine
Botanical Classification
Taxonomy & Identification
- Latin Name
- Pausinystalia yohimbe (K. Schum.) Pierre
- Family
- Rubiaceae
- Common Names
- Yohimbe, Yohimbehe
- Parts Used
- Trunk bark
- Origin
- Gabon, Congo, Cameroon
- Habit
- Large tree, 20–25 m
Ethnobotany & Traditional Use
History & Tradition
The aphrodisiac properties of the bark were known to Pygmy peoples of the West-Central African rainforest. Traditionally, bark is stripped from the trunk in large strips, cut, and dried in the sun, and a decoction is then prepared from it as a beverage.
In the West, yohimbine — the bark's principal alkaloid — became a licensed prescription drug for erectile dysfunction well before the modern era of PDE5 inhibitors, and has since become one of the most extensively studied plant alkaloids in psychiatric research, used deliberately to probe noradrenergic function in panic disorder and post-traumatic stress disorder.
The Key Molecule
Yohimbine — Deep Dive
A selective alpha-2 adrenergic antagonist, yohimbine is both the compound behind yohimbe's documented effects and the reason for its serious risk profile.
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Selective Alpha-2 Antagonism
Yohimbine selectively inhibits presynaptic alpha-2 adrenolytic receptors, is sympatholytic, and produces vasodilation and hypotension — the core mechanism behind essentially every documented effect of the plant.
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Reliable Panic Induction
Intravenous yohimbine produced panic attacks meeting DSM-III criteria in 37 of 68 patients with panic disorder or agoraphobia, versus 1 of 20 healthy subjects. [7]
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Highly Variable Individual Metabolism
A patient's CYP2D6 enzyme phenotype can explain more than a 20-fold difference in blood yohimbine concentration after the same dose, helping account for unpredictable potency and toxicity between individuals. [19]
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Unreliable Label Content
Analytical testing of commercial yohimbe and yohimbine dietary supplements found actual yohimbine content frequently does not match what is stated on the label. [18]
Pharmaceutical Preparations
Parts Used & Available Forms
The trunk bark is the sole part used, available in traditional and pharmaceutical preparations.
Prescription Yohimbine HCl
Synthetic yohimbine hydrochloride, available by prescription and used in most controlled clinical trials.
Prescription Drug
Herbal Bark Products
Commercial "specialty" bark-derived supplements — the form most associated with unreliable labeling and severe adverse events.
Herbal Supplement
Clinical Dosimetry
Dosages
Documented dosing ranges — read alongside the label-reliability caution below before relying on any figure here for a commercial product.
⚠ Do Not Treat These Doses as Reliable for Commercial Products
Most yohimbe supplement products do not disclose their yohimbine content, and analytical testing has repeatedly found that actual content does not reliably match label claims. [18] Combined with large individual differences in metabolism via the CYP2D6 enzyme, [19] the same labeled dose can produce very different — and unpredictable — effects between products and between people.
Phytochemistry
Composition
Documented phytochemistry of the trunk bark, the sole part with a described composition in the primary source.
Indole Alkaloids (Yohimbanes)Yohimbine and its isomers: pseudo-yohimbine, allo-yohimbine
1–6%
HeteroyohimbanesAjmalicine
Present
Tetracyclic DerivativesCorynanthéine and related structures
Present
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Corporal Vasodilation
Vasodilation of the corpus cavernosum producing rapid erection, with increased duration, endurance and libido.
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Alpha-2 Adrenergic Antagonism
Selective inhibitor of presynaptic alpha-2 adrenolytic receptors, sympatholytic in action.
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Dose-Dependent Blood Pressure Effect
Hypertensive at low doses and hypotensive at high doses, with peripheral vasodilator activity.
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Adipocyte Lipolysis Activation
Activates alpha-adrenergic receptors on adipocytes, reflecting increased lipolysis in laboratory studies. [9][11]
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Anxiogenic / Panic-Inducing
Reliably induces panic attacks meeting clinical diagnostic criteria in panic disorder patients; used deliberately as a pharmacological research probe. [6][7]
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PTSD Symptom Exacerbation
Exaggerated behavioral, cardiovascular and catecholamine responses documented in combat veterans with PTSD, including flashbacks. [8]
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Weight Loss — Inconclusive
Documented lipolytic activity has not translated into consistent clinical weight-loss results across randomized trials. [12][14]
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Erectile Dysfunction Efficacy
A meta-analysis of 7 randomized trials (419 patients) found evidence of efficacy for erectile dysfunction. [1]
Clinical Applications
Clinical Indications
Documented uses, including one the primary source itself flags as often negative and one that is a research tool rather than a treatment.
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Male Impotence
Primary Documented Indication
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Obesity
Flagged as Often Negative in Primary Source
- Weight loss: the primary source itself flags results as "often negative," consistent with a systematic review finding no reliable effect. [13]
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Research Tool
Not a Treatment Indication
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Not FDA-Approved OTC
Regulatory Status
- Illegal OTC marketing for ED: it is illegal in the United States to market an over-the-counter product containing yohimbine as an erectile dysfunction treatment without FDA approval. [20]
Pharmacodynamics
Mode of Action
The documented mechanisms behind yohimbine's vascular, sexual and neuropsychiatric effects.
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Presynaptic Alpha-2 Blockade
Yohimbine is a selective inhibitor of presynaptic alpha2-adrenolytic receptors, sympatholytic, vasodilator and hypotensive in its overall pharmacological profile.
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Genital Vasodilation & Sacral Excitability
Produces accentuated vasodilation in the genital organs and increases excitability of the genital organs in the sacral zone.
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CNS Noradrenergic Activation
Blockade of the alpha-2 adrenergic autoreceptor increases release of endogenous norepinephrine in the central nervous system, the mechanism behind its anxiogenic and panicogenic effects in susceptible individuals. [6]
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CYP2D6-Dependent Variable Metabolism
Individual CYP2D6 enzyme phenotype substantially alters yohimbine blood concentration after an identical dose, explaining much of the unpredictability in both effect and toxicity. [19]
Clinical Safety
Safety, Interactions & Precautions
Yohimbe carries a genuinely serious risk profile — this section should be read in full before use.
⚠ Absolute Contraindications
Do Not Combine or Use in These Situations
- MAOIs, tricyclic antidepressants & SNRIs: yohimbine can interact with monoamine oxidase inhibitors and with antidepressants that block norepinephrine reuptake (tricyclics, SNRIs such as venlafaxine and duloxetine) to cause an excessive, dangerous rise in blood pressure. A documented case report describes a hypertensive crisis following an herbal yohimbe product taken for impotence. [17][21]
- Renal insufficiency: contraindicated, per the primary source.
- Anxiety disorders, panic disorder & PTSD: yohimbine reliably induces panic attacks and exacerbates PTSD symptoms and flashbacks, including in uncontrolled, real-world settings. [6][7][8]
Adverse Effects
- Common: painful erections, priapism, nausea, sweating, tremors, changes in heart rhythm.
- Poison control data: a 7-year California Poison Control review found gastrointestinal distress (46%), tachycardia (43%), anxiety/agitation (33%) and hypertension (25%) as the most common adverse events. [15]
- Overdose: hypotension, tachycardia, seizures, paralysis and coma; deaths from overdose have been documented, including fatal case reports. [16]
Other Interactions & Regulatory Notes
- Other stimulants: combining yohimbine with caffeine, ephedrine or synephrine can further increase heart rate and cardiovascular risk.
- Antihypertensive medications: yohimbine may inhibit the effect of antihypertensive drugs.
- Regulatory status: restricted or banned in a number of countries due to inaccurate labeling and potential for serious side effects; illegal to market OTC as an ED treatment in the US without FDA approval. [20]
Clinical Disclaimer: This monograph is for educational and professional reference only. It does not constitute medical advice, diagnosis, or treatment guidance. Yohimbe carries documented, serious risks. Always consult a qualified healthcare provider before use, particularly if you take any prescription medication, have cardiovascular disease, kidney disease, or a history of anxiety, panic disorder, or PTSD.
Common Questions
Frequently Asked Questions
What is yohimbe traditionally used for?
The aphrodisiac properties of the bark were known to Pygmy peoples of the West-Central African rainforest. The bark is stripped from the trunk in large strips, cut, dried in the sun, and traditionally prepared as a decoction.
Which part of the yohimbe plant is used medicinally?
The trunk bark is the part used.
What is yohimbine and how does it work?
Yohimbine is an indole alkaloid and the principal active compound in yohimbe bark. It is a selective antagonist of presynaptic alpha-2 adrenergic receptors, which increases the release of norepinephrine, produces peripheral vasodilation including in genital tissue, and has sympatholytic and hypotensive effects at higher doses.
Does yohimbine actually work for erectile dysfunction?
A systematic review and meta-analysis of seven randomized controlled trials (419 patients) found evidence of efficacy for erectile dysfunction. However, it is illegal in the United States to market an over-the-counter product containing yohimbine as a treatment for erectile dysfunction without FDA approval, and most commercial yohimbe supplements do not reliably disclose or match their actual yohimbine content.
Can yohimbine cause panic attacks?
Yes. Yohimbine reliably induces panic attacks meeting clinical diagnostic criteria in people with panic disorder, and is deliberately used in psychiatric research as a pharmacological challenge agent to study noradrenergic function in panic disorder and post-traumatic stress disorder. People with anxiety, panic disorder, or PTSD should avoid yohimbine.
Is yohimbine safe to combine with antidepressants?
No, not without medical supervision. Yohimbine can interact with monoamine oxidase inhibitors (MAOIs) and with antidepressants that inhibit norepinephrine reuptake, such as tricyclic antidepressants and SNRIs, to produce a dangerous, excessive rise in blood pressure. A documented case report describes a hypertensive crisis following an herbal yohimbe product used for impotence.
Does yohimbine help with weight loss?
The evidence is inconsistent. Yohimbine has documented lipid-mobilizing (lipolytic) activity in laboratory and short-term physiological studies, but randomized controlled trials on actual body weight and fat distribution have shown largely null or inconsistent results, and a systematic review concluded the evidence does not support its effectiveness for weight reduction.
Can I trust the yohimbine content listed on supplement labels?
Not necessarily. Most yohimbe supplement products do not disclose how much yohimbine they contain, and analytical testing of commercial products has found actual yohimbine content frequently does not match label claims, which contributes to unpredictable dosing and unpredictable risk of adverse effects.
Primary Literature
Bibliography
This monograph draws on the primary botanical source plus substantial additional peer-reviewed literature, given the brevity of the original entry — every added claim is linked to a verifiable, named source below.
↑1. Ernst E, Pittler MH. Yohimbine for erectile dysfunction: a systematic review and meta-analysis of randomized clinical trials. J Urol. 1998 Feb;159(2):433-6. PubMed PMID:9649257 →
↑2. Riley AJ, Goodman R, Kellett JM, et al. Double blind trial of yohimbine hydrochloride in the treatment of erection inadequacy. Sex Marital Ther. 1989;4(1):17-26.
↑3. Teloken C, Rhoden EL, Sogari P, et al. Therapeutic effects of high dose yohimbine hydrochloride on organic erectile dysfunction. J Urol. 1998 Jan;159(1):122-4.
↑4. Jacobsen FM. Fluoxetine-induced sexual dysfunction and an open trial of yohimbine. J Clin Psychiatry. 1992 Apr;53(4):119-22.
↑5. Charney DS, Heninger GR, Redmond DE Jr. Yohimbine induced anxiety and increased noradrenergic function in humans: effects of diazepam and clonidine. Life Sci. 1983 Jul 4;33(1):19-29. PubMed PMID:6865647 →
↑6. Charney DS, Heninger GR. Noradrenergic function in panic anxiety. Effects of yohimbine in healthy subjects and patients with agoraphobia and panic disorder. Arch Gen Psychiatry. 1984 Aug;41(8):751-63. PubMed PMID:6742977 →
↑7. Charney DS, Woods SW, Goodman WK, Heninger GR. Neurobiological mechanisms of panic anxiety: biochemical and behavioral correlates of yohimbine-induced panic attacks. Am J Psychiatry. 1987 Aug;144(8):1030-6. PubMed PMID:3037926 →
↑8. Southwick SM, Morgan CA 3rd, Charney DS, High JR. Yohimbine use in a natural setting: effects on posttraumatic stress disorder. Biol Psychiatry. 1999 Aug 1;46(3):442-4. PubMed PMID:10435213 →
↑9. Galitzky J, Taouis M, Berlan M, Rivière D, Garrigues M, Lafontan M. Alpha 2-antagonist compounds and lipid mobilization: evidence for a lipid mobilizing effect of oral yohimbine in healthy male volunteers. Eur J Clin Invest. 1988 Dec;18(6):587-94.
↑10. Kucio C, Jonderko K, Piskorska D. Does yohimbine act as a slimming drug? Isr J Med Sci. 1991 Oct;27(10):550-6. PubMed PMID:1955308 →
↑11. Lafontan M, Berlan M, Galitzky J, Montastruc JL. Alpha-2 adrenoceptors in lipolysis: alpha 2 antagonists and lipid-mobilizing strategies. Am J Clin Nutr. 1992 Jan;55(1 Suppl):219S-227S. PubMed PMID:1345885 →
↑12. Sax L. Yohimbine does not affect fat distribution in men. Int J Obes. 1991 Aug;15(8):561-5.
↑13. Pittler MH, Ernst E. Dietary supplements for body-weight reduction: a systematic review. Am J Clin Nutr. 2004 Apr;79(4):529-36. PubMed PMID:15051593 →
↑14. Ostojic SM. Yohimbine: the effects on body composition and exercise performance in soccer players. Res Sports Med. 2006 Oct-Dec;14(4):289-99.
↑15. Kearney T, Tu N, Haller C. Adverse drug events associated with yohimbine-containing products: a retrospective review of the California Poison Control System reported cases. Ann Pharmacother. 2010 Jun;44(6):1022-9. PubMed PMID:20442348 →
↑16. Anderson C, Anderson D, Harre N, Wade N. Case study: two fatal case reports of acute yohimbine intoxication. J Anal Toxicol. 2013 Oct;37(8):611-4.
↑17. Ruck B, Shih RD, Marcus SM. Hypertensive crisis from herbal treatment of impotence. Am J Emerg Med. 1999;17(3):317-8.
↑18. Cohen PA, Wang YH, Maller G, DeSouza R, Khan IA. Pharmaceutical quantities of yohimbine found in dietary supplements in the USA. Drug Test Anal. 2016 Mar-Apr;8(3-4):357-69.
↑19. Mueller-Schoell A, Michelet R, Weinelt F, Kloft C, Mikus G. CYP2D6 phenotype explains reported yohimbine concentrations in four severe acute intoxications. Arch Toxicol. 2021 Aug;95(8):2861-2867. Full Text →
↑20. National Center for Complementary and Integrative Health (NCCIH), NIH. Yohimbe: Usefulness and Safety. Full Text →
↑22. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury — Yohimbine. Full Text →
↑23. Hostettmann K. Les aphrodisiaques naturels. Éd. Favre, 2000.