Yohimbe

What it is

Yohimbe is the bark of a West African evergreen tree, Pausinystalia johimbe, whose main active alkaloid is yohimbine. Extracts are sold in hundreds of US dietary supplements, although the bark is banned in a number of other countries. Chemical analysis shows that much of the yohimbine in these products is not accompanied by the companion bark alkaloids rauwolscine and corynanthine, which points to highly processed or synthetic material rather than whole bark. Yohimbine itself also exists as a prescription drug in some countries.

What the research says

The evidence is contested rather than settled. A 2022 systematic review and meta-analysis of eight randomised trials found yohimbine improved erectile function versus placebo, but the same analysis found no significant effect on sexual function when yohimbine was used alone, and the US National Center for Complementary and Integrative Health says there is not enough evidence to reach definite conclusions about yohimbe for any condition. Pharmacologically yohimbine blocks alpha-2 adrenergic receptors, which raises noradrenaline release and sympathetic activity - the same mechanism behind its documented cardiovascular and psychiatric adverse events. The safety literature is substantial: poison-centre data, a documented mismatch between label and actual content, and case reports of serious injury.

Evidence grade: Disputed.

What goes wrong

A 7-year review of California Poison Control System calls found 238 symptomatic adult yohimbine exposures, dominated by herbal products, with gastrointestinal distress, tachycardia, anxiety and hypertension the commonest events. (Source 1)

• Case series, Low certainty.
• Size: 238 cases over 2000-2006.
• Who: adults aged 18 and older symptomatic after exposure to a yohimbine-containing product, Naranjo causality possible or better.
• How long: 7-year retrospective review (2000-2006)
• Result: gastrointestinal distress 46%, tachycardia 43%, anxiety/agitation 33%, hypertension 25%; 98.7% involved herbal rather than prescription products.
• Funding: not stated.

Common ADEs reported included: gastrointestinal distress (46%), tachycardia (43%), anxiety/agitation (33%), and hypertension (25%).

Yohimbine exposures reported to that poison centre were several times more likely than the average exposure to end in a severe outcome or require care at a health-care facility. (Source 1)

• Case series, Low certainty.
• Size: 238 cases.
• Who: adults reporting to the California Poison Control System.
• How long: 2000-2006.
• Result: odds ratio 5.81 (95% CI 4.43 to 7.64) for severe outcomes and 2.35 (95% CI 1.82 to 3.04) for needing health-care facility management, versus the average substance exposure.
• Funding: not stated.

Yohimbine exposures were associated with a significantly greater proportion of severe outcomes and were more likely to require management at a health-care facility than the average substance exposure reported to the CPCS (odds ratios [95% CIs] were 5.81 [4.43 to 7.64] and 2.35 [1.82 to 3.04], respectively).

An analysis of 49 US supplement brands labelled as containing yohimbe or yohimbine found the amount per serving ranged from none detected to 12.1 mg, and most products that stated a quantity were inaccurately labelled. (Source 2)

• Survey study, Moderate certainty.
• Size: 49 supplement brands from seven major US retailers.
• Who: commercially sold dietary supplements, not people.
• How long: single sampling, published 2016.
• Result: yohimbine per recommended serving 0 to 12.1 mg; only 11/49 (22%) listed a quantity, of which actual content ranged from 23% to 147% of the label claim.
• Funding: not stated.

Most of these were inaccurately labelled (actual content ranged from 23% to 147% of the content on the label).

In 39% of those supplements the companion bark alkaloids were absent, indicating the yohimbine was from highly processed extract or was synthetic. (Source 2)

• Survey study, Moderate certainty.
• Size: 49 supplement brands.
• Who: commercially sold dietary supplements.
• How long: single sampling, published 2016.
• Result: 19 of 49 products (39%) contained no rauwolscine and no corynanthine.
• Funding: not stated.

Thirty-nine percent of the supplements (19/49) did not contain rauwolscine and corynanthine suggesting that the yohimbine was either from highly processed plant extract or synthetic in origin.

A published case report describes an intracranial haemorrhage in a woman after a single dose of a yohimbine-containing supplement while taking clonidine and noradrenergic antidepressants. (Source 3)

• Case report, Very low certainty.
• Size: 1 patient.
• Who: a 39-year-old woman taking clonidine, bupropion and desvenlafaxine.
• How long: single ingestion.
• Result: sympathomimetic toxicity with intracranial haemorrhage; the authors describe it as the first yohimbine-associated ICH in the literature.
• Funding: not stated.

Yohimbine toxicity causes a sympathomimetic syndrome as demonstrated by the case below of a female who developed an intracranial hemorrhage (ICH) following an ingestion of yohimbine.

A 2024 review of yohimbine describes dose-dependent adverse effects ranging from anxiety and raised blood pressure to arrhythmia, myocardial infarction, seizures and renal failure, plus interactions with adrenergic and serotonergic drugs. (Source 4)

• Expert review, not systematic, Low certainty.
• Size: not applicable - narrative review.
• Who: people taking yohimbine at therapeutic and higher doses.
• How long: not applicable.
• Result: no pooled effect estimate; effects described as dose-dependent.
• Funding: not stated.

At higher doses or in susceptible individuals, more severe adverse effects can occur. These may include cardiac arrhythmias, myocardial infarction, seizures, and renal failure.

NCCIH records yohimbine's association with arrhythmia, blood pressure problems, heart attacks and seizures, and advises against combining yohimbe with MAOIs or tricyclic antidepressants. (Source 5)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: general public.
• How long: page last updated May 2025.
• Result: no rates given on the page.
• Funding: US government agency.

Yohimbine, a component of yohimbe, has been associated with cardiac arrhythmia (irregular heartbeat), blood pressure problems, heart attacks, and seizures.

What the evidence supports

A 2022 systematic review and meta-analysis of eight randomised trials found yohimbine, alone or combined with other supplements, was associated with greater odds of improved erectile function than placebo. (Source 6)

• Meta-analysis, Low certainty.
• Size: 8 randomised controlled trials identified from 543 screened studies.
• Who: men with erectile dysfunction.
• How long: not stated in the abstract.
• Result: Yohimbine alone OR = 2.08, 95% CI 1.30-3.32, P = .002; combined OR = 6.35, 95% CI 3.01-13.41, P < .001; overall versus placebo OR = 2.87, 95% CI 1.94-4.25, P < .001.
• Funding: not stated.

Both Yohimbine alone (odds ratio [OR] = 2.08, 95% CI 1.30-3.32, P = .002) and combined (OR = 6.35, 95% CI 3.01-13.41, P < .001) showed a significantly greater probability of erectile function improvement compared to the placebo group (OR = 2.87, 95% CI 1.94-4.25, P < .001).

What the evidence does not support

In the same meta-analysis, yohimbine used on its own did not significantly improve sexual function. (Source 6)

• Meta-analysis, Low certainty.
• Size: 8 randomised controlled trials.
• Who: men with erectile dysfunction.
• How long: not stated in the abstract.
• Result: no significant difference for yohimbine alone (P = .07); pooled across subgroups OR = 2.65, 95% CI 1.43-4.92, P = .002.
• Funding: not stated.

Yohimbine alone did not show a significant difference in the rate of improved sexual function (P = .07); however, the pooled results of both subgroups indicated a higher rate of improved sexual function (OR = 2.65, 95% CI 1.43-4.92, P = .002).

NCCIH's position, as of May 2025, is that the human research on yohimbe as a dietary supplement is too sparse to support conclusions for any condition, including erectile dysfunction, athletic performance or obesity. (Source 5)

• Official position, Certainty not rated.
• Size: not applicable.
• Who: general public.
• How long: page last updated May 2025.
• Result: no effect estimate given.
• Funding: US government agency.

There is not enough research to say whether yohimbe as a dietary supplement is helpful for any condition, including erectile dysfunction, athletic performance, or obesity.

Where the research disagrees

Whether yohimbine works for erectile dysfunction

• Alkhateeb and colleagues, 2022 systematic review and meta-analysis, meta-analysis of 8 randomised controlled trials: Sole administration of Yohimbine and its combination with other supplements can improve the erectile function in ED patients. (Source 6)
• NCCIH, position as of May 2025, agency position statement: There is not enough evidence for definite conclusions to be reached about yohimbe's effectiveness for any health condition. (Source 5)

How much

• Reference intake: No reference intake exists. Yohimbe is a bark extract sold as a dietary supplement, not a nutrient, so no body has set an RDA or AI for it. (Source 2)
• Upper limit: No tolerable upper intake level has been set. The relevant US regulatory position, recorded by NCCIH as of May 2025, is that marketing an over-the-counter yohimbine product for erectile dysfunction without FDA approval is illegal. (Source 5)
• Studied: Analysis of 49 US supplement brands found yohimbine per recommended serving ranging from none detected to 12.1 mg. The doses used in the randomised trials were not stated in the sources we could reach. (Source 2)

A common belief, and what the research shows

The belief: A yohimbe supplement delivers the same thing as the yohimbine studied in trials.

What the research shows: Product analysis contradicts this. Content per serving ranged from nothing to 12.1 mg across 49 brands, and NCCIH states that "Yohimbe sold as a dietary supplement may not work like the prescription medication that contains yohimbine." In 39% of brands the companion bark alkaloids were missing entirely, suggesting synthetic or heavily processed material rather than bark.

Questions and answers

What is it?

Yohimbe is the bark of a West African evergreen tree, Pausinystalia johimbe. Its principal active alkaloid is yohimbine. Extracts are sold in hundreds of US dietary supplements even though the bark is banned in many other countries. (Source 2)

What does it do in the body?

Yohimbine blocks alpha-2 adrenergic receptors, and it binds the presynaptic ones more strongly than the postsynaptic ones. Blocking them removes the brake on noradrenaline release, so noradrenaline rises in the synapse and sympathetic nervous system activity increases. That single mechanism explains both the claimed effects and the cardiovascular and anxiety-type side effects. (Source 7)

Is it good or bad for you?

The balance in the published literature leans towards harm. A 2022 meta-analysis of eight randomised trials found a benefit for erectile function, but NCCIH's position is that the human evidence is too thin for conclusions about any condition, while the safety literature is comparatively large: poison-centre data, case reports of serious injury, and mislabelled products. Context matters - the amount in a given product is unpredictable. (Source 5)

How do you get more of it?

Yohimbe is not a nutrient and is not obtained from the diet; it reaches people as bark extract capsules and tablets sold as supplements. What a product actually delivers is unpredictable: across 49 US brands the yohimbine per serving ran from none detected to 12.1 mg. This is a description of what was measured, not a suggestion to take it. (Source 2)

If it is harmful, what reduces it?

The literature we reached does not describe any treatment that removes yohimbine other than stopping exposure and getting medical care. In the California poison-centre series, yohimbine exposures were more than twice as likely as the average exposure to need management in a health-care facility, which is how these episodes were handled. (Source 1)

Why might someone be low in it or missing it?

The question does not apply in the usual sense. Yohimbe is a plant extract sold as a supplement, not a nutrient the body needs or makes, so there is no deficiency state and nothing to be low in. Someone simply has none unless they take a product containing it. (Source 2)

Which whole foods contain it or feed it?

No whole food contains yohimbine. It comes from the bark of Pausinystalia johimbe, which is processed into extracts for supplements rather than eaten as a food. In many products the material is not even whole bark: in 39% the companion bark alkaloids were absent, pointing to processed or synthetic yohimbine. (Source 2)

What happens if you do not have it?

Nothing is known to go wrong from not having yohimbe. There is no deficiency syndrome, and NCCIH's position is that there is not enough research to say it helps with any condition at all, so no health benefit is forgone that the evidence can identify. (Source 5)

How can you test for it?

No validated clinical test for a person's yohimbine status exists in the literature we searched. What does exist is laboratory testing of products: ultra high-performance liquid chromatography with mass spectrometry has been used to measure yohimbine, rauwolscine and corynanthine in supplements, which is how the labelling problem was documented. (Source 2)

We searched: Searched PubMed, NCCIH and the yohimbine toxicology and analytical literature for a validated human assay or biomarker; only product-level chromatographic assays and post-mortem or clinical toxicology blood measurements appeared, no validated status test.

References

1. Annals of Pharmacotherapy. Adverse Drug Events Associated with Yohimbine-Containing Products: A Retrospective Review of the California Poison Control System Reported Cases. 2010. PMID 20551300, DOI 10.1345/aph.1P060. Read the source
2. Drug Testing and Analysis. Pharmaceutical quantities of yohimbine found in dietary supplements in the USA. 2016. PMID 26391406, DOI 10.1002/dta.1849. Read the source
3. American Journal of Emergency Medicine. Intracranial hemorrhage after a single dose of Yohimbine in a chronic user of clonidine. 2022. Read the source
4. International Journal of Molecular Sciences (MDPI). Multifaced Nature of Yohimbine - A Promising Therapeutic Potential or a Risk? (adverse effects passage). 2024. DOI 10.3390/ijms252312856. Read the source
5. National Center for Complementary and Integrative Health (NCCIH), US National Institutes of Health. Yohimbe: Usefulness and Safety. 2025. Read the source
6. Urology Research & Practice (formerly Turkish Journal of Urology). Yohimbine as a treatment for erectile dysfunction: A systematic review and meta-analysis. 2022. PMID 35118966. Read the source
7. International Journal of Molecular Sciences (MDPI). Multifaced Nature of Yohimbine - A Promising Therapeutic Potential or a Risk? (pharmacology passage). 2024. DOI 10.3390/ijms252312856. Read the source