Yohimbe bark extract

Yohimbe/Drug Interactions:

  • GeneralGeneral: Multiple interactions have been suggested with the use of yohimbine hydrochloride. In theory, these effects may also apply to yohimbe bark extract, which contains variable (albeit low) concentrations of yohimbine alkaloid.
  • Alpha blockersAlpha blockers: In human case reports, yohimbine antagonized the effects of alpha-adrenergic agents by increasing norepinephrine release (19; 104; 6; 49). The author of a clinical trial suggested that patients being treated with alpha-2 adrenoreceptor antagonists plus medications with norepinephrine transporter blockade actions (such as bupropion, duloxetine, or venlafaxine) may experience increased blood pressure that could be dangerous (64).
  • AndrogensAndrogens: According to secondary sources, yohimbe has antiandrogenic properties.
  • Anti-anxiety agentsAnti-anxiety agents: According to a review and clinical trials, although early research in animal models suggested that yohimbine facilitated fear extinction, evidence in humans is mixed with studies showing benefit, lack of effect, or impairment (142; 132; 131; 61; 125).
  • AnticholinergicsAnticholinergics: Yohimbine has been shown to increase the availability of the acetylcholine (143).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Yohimbine may inhibit platelet aggregation by binding to the alpha-2 adrenoceptor responsible for noradrenaline-induced platelet aggregation (49; 50; 51; 52; 53; 54).
  • Antidepressant agents, monoamine oxidase inhibitors (MAOIs)Antidepressant agents, monoamine oxidase inhibitors (MAOIs): Evidence is mixed with respect to yohimbine in treatment of depression (126; 127; 62). In laboratory research, yohimbine had MAO inhibitor activity (65).
  • Antidepressant agents, selective serotonin reuptake inhibitor (SSRI) drugsAntidepressant agents, selective serotonin reuptake inhibitor (SSRI) drugs: Evidence is mixed with respect to yohimbine in treatment of depression (126; 127; 62). Yohimbine HCl has been suggested to improve sexual function that has been impaired due to the use of antidepressants (74; 80). In human research, yohimbine was suggested to have SSRI activity (57).
  • Antidepressant agents, tricyclic (TCAs)Antidepressant agents, tricyclic (TCAs): In human case studies, yohimbine was found to increase the risk of hypertension when combined with tricyclic antidepressants (128; 129). Yohimbine increased blood pressure in patients treated with clomipramine possibly due to inhibition of hepatic metabolism of yohimbine (129). Yohimbine has been used for the treatment of dry mouth caused by tricyclic antidepressants (TCA) to increase salivary outflow (137).
  • Antidiabetic agentsAntidiabetic agents: Anecdotally and in animal study, yohimbine has been reported to increase the effects of diabetic medications, including insulin (101), although there is limited scientific evidence in this area. In human research, yohimbine lacked an effect on blood glucose levels (102).
  • AntihistaminesAntihistamines: Use of yohimbine with antihistamines has been cautioned anecdotally, although there is limited reliable scientific evidence in this area.
  • AntihypertensivesAntihypertensives: In patients with orthostatic hypotension, yohimbine improved (increased) blood pressure in some, but not all, studies (64; 60; 134). Yohimbine use has been associated with hypertension or has increased blood pressure in other human studies; however, higher doses may elicit hypotension and lack of effect has also been noted (55; 41; 56; 57; 58; 47; 48; 59; 60; 61; 62; 63; 102). In human research, yohimbine significantly reduced the time to return to baseline for peak systolic velocity, end diastolic velocity, and the index of resistance for systolic data for the ophthalmic artery measurements (144). According to human case reports, yohimbine may antagonize the effects of antihypertensive agents (alpha blockers, ACE inhibitors, angiotensin II receptor antagonists, beta blockers, calcium channel blockers, diuretics, guanabenz, guanethidine) by increased norepinephrine release by yohimbine (19; 104; 6; 49). Beta-blockers may possess a protective role against yohimbine toxicity.
  • Anti-obesity agentsAnti-obesity agents: In human research, yohimbine was shown to induce lipid mobilization (15) and a product containing yohimbine, related agents, and methylsynephrine increased area-under-the curve for epinephrine, norepinephrine, glycerol, free fatty acids, and caloric expenditure (63). However, a randomized control study demonstrated that yohimbine does not influence the function of the alpha-2 adrenoceptors on adipocytes, and does not facilitate weight loss, as previously thought (14; 145).
  • AtomexetineAtomexetine: In human research, the combination of yohimbine plus atomoxetine increased seated systolic blood pressure and improved orthostatic tolerance compared to atomoxetine or yohimbine alone (64).
  • BenzodiazepinesBenzodiazepines: In human research, concomitant yohimbine administration antagonized the effects of alprazolam on blood pressure and attenuated alprazolam-induced changes in cortisol (62).
  • Cardiovascular agentsCardiovascular agents: Yohimbine acts centrally to increase sympathetic outflow, and peripherally to increase the release of norepinephrine from adrenergic nerve terminals. This increases the plasma norepinephrine, and elicits pressor effects (30; 85; 97; 98; 22). In human case reports, yohimbine antagonized the effects of antihypertensive agents (alpha blockers, ACE inhibitors, angiotensin II receptor antagonists, beta blockers, calcium channel blockers, diuretics, guanabenz, guanethidine) by increased norepinephrine release by yohimbine (19; 104; 6; 49). In human research, tachycardia, fluid retention, palpitations, and chest discomfort have also been reported as adverse effects to yohimbine (20; 66; 5; 67; 55; 68; 69; 70; 71; 72; 41; 56; 57; 58; 48), as has increased heart rate in some (63; 59; 20; 66; 5; 67; 55; 68; 69; 70; 71; 72; 41) but not all (102) studies.
  • CNS stimulantsCNS stimulants: Over-the-counter (OTC) products containing stimulants, including caffeine, phenylephrine, phenylpropanolamine (removed from the US market), may lead to additive effects when used in combination with yohimbe bark extract (96). Based on human study, yohimbine may mediate sexual function through increased penile blood flow and increased central excitatory impulses to the genital tissue (99; 100). Anecdotally, the use of yohimbine with amphetamines has been cautioned, although there is limited reliable scientific evidence in this area. Caffeine-containing medications may theoretically increase the risk of hypertensive crisis when taken with yohimbine. In animal research, using yohimbine to block noradrenaline alpha(2A)-receptors in the prefrontal cortex produces an ADHD-like profile with locomotor hyperactivity, impulsivity and poor working memory (141).
  • Cytochrome P450 metabolized agentsCytochrome P450 metabolized agents: In human research, yohimbine (16.2mg PO three times daily) increased plasma catecholamine concentrations (143). Yohimbine was shown to induce a more pronounced sympathetic response and may accelerate overall colonic transit in subjects who are poor metabolizers, as characterized by CYP2D6 and CYP3A4 status. In vitro, yohimbine inhibited CYP2D6 (146).
  • DesipramineDesipramine: In a clinical trial, the authors stated that yohimbine treatment appeared to attenuate the ability of desipramine to decrease plasma levels of free 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) (62).
  • Dermatologic agentsDermatologic agents: Rash, erythrodermic skin eruption, exanthema, flushing and sweating have been reported with use of yohimbine (73; 74; 58; 47; 37; 48) and according to secondary sources, skin flushing and piloerection have been associated with the use of yohimbe bark extract.
  • DiureticsDiuretics: Renal failure and increased urinary frequency have been reported with yohimbine use (36; 73; 82; 80; 58; 74; 46; 35; 48) and according to secondary sources, dysuria has been associated with yohimbe bark extract use.
  • Dopamine antagonistsDopamine antagonists: Yohimbine moderately increased the depletion of dopamine in the brain (147).
  • Drugs that may lower seizure thresholdDrugs that may lower seizure threshold: In animal research, yohimbe lowered seizure threshold (86) and has induced clonic seizures in mice (103). In a case report, seizures occurred following a single 5g dose (59).
  • Erectile dysfunction agentsErectile dysfunction agents: In human research, yohimbine hydrochloride is used in the treatment of erectile dysfunction according to meta-analyses and systematic reviews (148; 43; 149; 150; 139) and has been shown to improve orgasm dysfunction in men (41); however, clinical trials in support of yohimbe are lacking. Also, adverse effects to yohimbe extract include severe intractable priaprism (58) and according to secondary sources, genital pain, and adverse effects to yohimbine include dartos contraction (41) and decreased libido (46).
  • Exercise performance enhancement agentsExercise performance enhancement agents: Although yohimbe is historically used for body building and enhancing athletic performance (21), clinical trials in support of this use are lacking (151), and yohimbine lacked effect on total body mass or body muscle mass in athletes (133).
  • Gastrointestinal agentsGastrointestinal agents: Nausea, vomiting, increased salivation, diarrhea, and gastrointestinal distress in general may occur with yohimbine use (75; 76; 77; 78; 79; 41; 80; 81; 57; 58; 47; 37; 46; 35; 59) and according to secondary sources, anorexia has been associated with the use of yohimbe bark extract.
  • Hormonal agentsHormonal agents: According to secondary sources, yohimbine has hormonal effects.
  • HydrocortisoneHydrocortisone: In human research, hydrocortisone plus yohimbine prompted a shift from goal-directed behavior towards habitual control as compared with goal-directed behavior following hydrocortisone or yohimbine alone (152; 153).
  • Mood stabilizersMood stabilizers: Yohimbine acts as an alpha-2 adrenoceptor antagonist and blocks the decrease in central noradrenergic response and blocks the reduction in peripheral sympathetic activity (154; 155; 156; 82; 75; 157; 84).
  • MorphineMorphine: Based on results of a human study, yohimbine was suggested to enhance morphine analgesia (158; 159).
  • Musculoskeletal agentsMusculoskeletal agents: Muscle aches have been reported with yohimbine (82).
  • Neurologic agentsNeurologic agents: Yohimbine has been associated with reports of general central nervous system and autonomic excitation, tremulousness (83; 84; 85; 41; 74), head twitching, seizure threshold changes (86), enhanced brain norepinephrine release (increasing resting heart rate and blood pressure) (87; 41), decreased energy (46), dizziness and vertigo (35; 48), headache (41; 58; 35; 48), cold feet (47), and chills (35). According to secondary sources, dizziness and tremors have occurred with the use of yohimbe bark extract.
  • Norepinephrine transporter blockersNorepinephrine transporter blockers: The author of a clinical trial suggested that patients being treated with alpha-2 adrenoreceptor antagonists plus medications with norepinephrine transporter blockade actions (such as bupropion, duloxetine, or venlafaxine) may experience increased blood pressure that could be dangerous (64).
  • Ocular agentsOcular agents: According to secondary sources, mydriasis has been noted.
  • Opiate antagonistsOpiate antagonists: In human research, yohimbine increased or decreased naloxone-precipitated withdrawal symptoms (91; 92).
  • PhenothiazinesPhenothiazines: According to secondary sources, concomitant use of yohimbe and phenothiazines may increase the risk of toxic effects due to the risk of increased alpha 2-adrenergic antagonism.
  • PhenyotinPhenyotin: In a clinical trial, the authors indicated that one patient experienced a possible interaction between yohimbine and either phenytoin and/or primidone (47).
  • PhysostigminePhysostigmine: In human research, concurrent use of yohimbine and physostigmine in patients with Alzheimer's disease has been associated with anxiety, agitation, restlessness, and chest pain (5).
  • PrimidonePrimidone: In a clinical trial, the authors indicated that one patient experienced a possible interaction between yohimbine and either phenytoin and/or primidone (47).
  • Psychiatric agentsPsychiatric agents: Yohimbine is often not recommended for use in psychiatric patients due to reports of excitation, tremor, insomnia, anxiety, irritability, potential to trigger psychoses in predisposed patients, and possible exacerbation of post-traumatic stress disorder (PTSD) (105; 82; 106; 36; 107; 108; 109; 110; 111). Yohimbine may also precipitate panic attacks, anxiety or manic episodes in predisposed patients (112; 113; 87; 114; 115; 116; 117; 118; 119; 120; 125). Other adverse effects to yohimbine include increased acoustic startle reflexes and fear (121; 122), increased malaise, fatigue, insomnia, restlessness, agitation, and anxiety (41; 74; 80; 56; 57; 58; 47; 37; 46; 35; 48; 62; 59), increased impulsivity (94; 95), panic (123; 124; 120), and according to secondary sources, agitation, irritability, and nervousness have occurred with the use of yohimbe bark extract. In animal research, yohimbine reinstated alcohol or drug seeking in previously addicted animals (88; 89) and according to a review, yohimbine also increases relapse to food seeking (90).
  • Respiratory agentsRespiratory agents: Bronchospasm, cough, and rhinorrhea have been documented with use of yohimbine (93; 82).
  • SympathomimeticsSympathomimetics: According to secondary sources, sympathomimetics may potentiate the toxic effects of yohimbe.
  • VasopressorsVasopressors: Yohimbine acts centrally to increase sympathetic outflow, and peripherally to increase the release of norepinephrine from adrenergic nerve terminals. Researchers concluded that this increases the plasma norepinephrine, and elicits pressor effects (30; 85; 97; 98; 22).

    • Yohimbe/Herb/Supplement Interactions:

  • GeneralGeneral: Multiple interactions have been suggested with the use of yohimbine hydrochloride. In theory, these effects may also apply to yohimbe bark extract, which contains variable (albeit low) concentrations of yohimbine alkaloid.
  • Alkaloid agentsAlkaloid agents: According to secondary sources, yohimbine is an alkaloid and may theoretically act synergistically with other alkaloid agents.
  • AndrogensAndrogens: According to secondary sources, yohimbe has antiandrogenic properties.
  • Antiadrenergic herbs and supplementsAntiadrenergic herbs and supplements: In human case reports, yohimbine antagonized the effects of alpha-adrenergic agents by increasing norepinephrine release (19; 104; 6; 49).
  • Anti-anxiety agentsAnti-anxiety agents: According to a review and clinical trials, although early research in animal models suggested that yohimbine facilitated fear extinction, evidence in humans is mixed with studies showing benefit, lack of effect, or impairment (142; 132; 131; 61; 125).
  • Anticholinergic herbsAnticholinergic herbs: Yohimbine has been shown to increase the availability of the acetylcholine (143).
  • Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Yohimbine may inhibit platelet aggregation by binding to the alpha-2 adrenoceptor responsible for noradrenaline-induced platelet aggregation (49; 50; 51; 52; 53; 54).
  • Antidepressant agents, monoamine oxidase inhibitors (MAOIs)Antidepressant agents, monoamine oxidase inhibitors (MAOIs): Evidence is mixed with respect to yohimbine in treatment of depression (126; 127; 62). In laboratory research, yohimbine had MAO inhibitor activity (65).
  • Antidepressant agents, selective serotonin reuptake inhibitor (SSRI) agentsAntidepressant agents, selective serotonin reuptake inhibitor (SSRI) agents: Evidence is mixed with respect to yohimbine in treatment of depression (126; 127; 62). Yohimbine HCl has been suggested to improve sexual function that has been impaired due to the use of antidepressants (74; 80). In human research, yohimbine was suggested to have SSRI activity (57).
  • Antidepressant agents, tricyclics (TCAs)Antidepressant agents, tricyclics (TCAs): In human case studies, yohimbine was found to increase the risk of hypertension when combined with tricyclic antidepressants (128; 129). Yohimbine has been used for the treatment of dry mouth caused by tricyclic antidepressants (TCA) to increase salivary outflow (137).
  • AntihistaminesAntihistamines: Use of yohimbine with antihistamines has been cautioned anecdotally, although there is limited reliable scientific evidence in this area.
  • Anti-obesity agentsAnti-obesity agents: In human research, yohimbine was shown to induce lipid mobilization (15) and a product containing yohimbine, related agents, and methylsynephrine increased area-under-the curve for epinephrine, norepinephrine, glycerol, free fatty acids, and caloric expenditure (63). However, a randomized control study demonstrated that yohimbine does not influence the function of the alpha-2 adrenoceptors on adipocytes, and does not facilitate weight loss, as previously thought (14; 145).
  • AntihistaminesAntihistamines: Use of yohimbine with antihistamine agents has been cautioned anecdotally, although there is limited reliable scientific evidence in this area.
  • Cardiovascular herbs and supplementsCardiovascular herbs and supplements: Yohimbine acts centrally to increase sympathetic outflow, and peripherally to increase the release of norepinephrine from adrenergic nerve terminals. This increases the plasma norepinephrine, and elicits pressor effects (30; 85; 97; 98; 22). In human case reports, yohimbine antagonized the effects of antihypertensive agents by increased norepinephrine release by yohimbine (19; 104; 6; 49). In human research, tachycardia, fluid retention, palpitations, and chest discomfort have also been reported as adverse effects to yohimbine (20; 66; 5; 67; 55; 68; 69; 70; 71; 72; 41; 56; 57; 58; 48), as has increased heart rate in some (63; 59; 20; 66; 5; 67; 55; 68; 69; 70; 71; 72; 41) but not all (102) studies.
  • Cytochrome P450 herbs and supplementsCytochrome P450 herbs and supplements : In human research, yohimbine (16.2mg PO three times daily) increased plasma catecholamine concentrations (143). Yohimbine was shown to induce a more pronounced sympathetic response and may accelerate overall colonic transit in subjects who are poor metabolizers, as characterized by CYP2D6 and CYP3A4 status. In vitro, yohimbine inhibited CYP2D6 (146).
  • Dermatologic agentsDermatologic agents: Rash, erythrodermic skin eruption, exanthema, flushing and sweating have been reported with use of yohimbine (73; 74; 58; 47; 37; 48) and according to secondary sources, skin flushing and piloerection have been associated with the use of yohimbe bark extract.
  • DiureticsDiuretics: Renal failure and increased urinary frequency have been reported with yohimbine use (36; 73; 82; 80; 58; 74; 46; 35; 48) and according to secondary sources, dysuria has been associated with yohimbe bark extract use.
  • Dopamine antagonistsDopamine antagonists: Yohimbine moderately increased the depletion of dopamine in the brain (147).
  • Erectile dysfunction agentsErectile dysfunction agents: In human research, yohimbine hydrochloride is used in the treatment of erectile dysfunction according to meta-analyses and systematic reviews (148; 43; 149; 150; 139) and has been shown to improve orgasm dysfunction in men (41); however, clinical trials in support of yohimbe are lacking. Also, adverse effects to yohimbe extract include severe intractable priaprism (58) and according to secondary sources, genital pain, and adverse effects to yohimbine include dartos contraction (41) and decreased libido (46).
  • Exercise performance enhancement agentsExercise performance enhancement agents: Although yohimbe is historically used for body building and enhancing athletic performance (21), clinical trials in support of this use are lacking (151), and yohimbine lacked effect on total body mass or body muscle mass in athletes (133).
  • Gastrointestinal agentsGastrointestinal agents: Nausea, vomiting, increased salivation, diarrhea, and gastrointestinal distress in general may occur with yohimbine use (75; 76; 77; 78; 79; 41; 80; 81; 57; 58; 47; 37; 46; 35; 59) and according to secondary sources, anorexia has been associated with the use of yohimbe bark extract.
  • GoldensealBerberineGoldenseal, Berberine: Berberine, an alkaloid present in goldenseal, has been shown to competitively inhibit the binding of yohimbine to cell surface receptors (96).
  • Herbs/supplements that lower seizure thresholdHerbs/supplements that lower seizure threshold: In animal research, yohimbe lowered seizure threshold (86) and has induced clonic seizures in mice (103). In a case report, seizures occurred following a single 5g dose (59).
  • Hormonal herbs and supplementsHormonal herbs and supplements: According to secondary sources, yohimbine has hormonal effects.
  • HypoglycemicsHypoglycemics: Anecdotally and in animal study, yohimbine has been reported to increase the effects of diabetic medications, including insulin (101), although there is limited scientific evidence in this area. In human research, yohimbine lacked an effect on blood glucose levels (102).
  • HypotensivesHypotensives: In patients with orthostatic hypotension, yohimbine improved (increased) blood pressure in some, but not all, studies (64; 60; 134). Yohimbine use has been associated with hypertension or has increased blood pressure in other human studies; however, higher doses may elicit hypotension and lack of effect has also been noted (55; 41; 56; 57; 58; 47; 48; 59; 60; 61; 62; 63; 102). In human research, yohimbine significantly reduced the time to return to baseline for peak systolic velocity, end diastolic velocity, and the index of resistance for systolic data for the ophthalmic artery measurements (144). According to human case reports, yohimbine may antagonize the effects of antihypertensive by increased norepinephrine release by yohimbine (19; 104; 6; 49). Beta-blockers may possess a protective role against yohimbine toxicity.
  • Mood stabilizersMood stabilizers: Yohimbine acts as an alpha-2 adrenoceptor antagonist and blocks the decrease in central noradrenergic response and blocks the reduction in peripheral sympathetic activity (154; 155; 156; 82; 75; 157; 84).
  • Musculoskeletal agentsMusculoskeletal agents: Muscle aches have been reported with yohimbine (82).
  • Neurologic agentsNeurologic agents: Yohimbine has been associated with reports of general central nervous system and autonomic excitation, tremulousness (83; 84; 85; 41; 74), head twitching, seizure threshold changes (86), enhanced brain norepinephrine release (increasing resting heart rate and blood pressure) (87; 41), decreased energy (46), dizziness and vertigo (35; 48), headache (41; 58; 35; 48), cold feet (47), and chills (35). According to secondary sources, dizziness and tremors have occurred with the use of yohimbe bark extract.
  • Norepinephrine transporter blockersNorepinephrine transporter blockers: The author of a clinical trial suggested that patients being treated with alpha-2 adrenoreceptor antagonists plus medications with norepinephrine transporter blockade actions (such as bupropion, duloxetine, or venlafaxine) may experience increased blood pressure that could be dangerous (64).
  • Ocular agentsOcular agents: According to secondary sources, mydriasis has been noted.
  • Opiate antagonistsOpiate antagonists: In human research, yohimbine increased or decreased naloxone-precipitated withdrawal symptoms (91; 92).
  • Psychiatric agentsPsychiatric agents: Yohimbine is often not recommended for use in psychiatric patients due to reports of excitation, tremor, insomnia, anxiety, irritability, potential to trigger psychoses in predisposed patients, and possible exacerbation of post-traumatic stress disorder (PTSD) (105; 82; 106; 36; 107; 108; 109; 110; 111). Yohimbine may also precipitate panic attacks, anxiety or manic episodes in predisposed patients (112; 113; 87; 114; 115; 116; 117; 118; 119; 120; 125). Other adverse effects to yohimbine include increased acoustic startle reflexes and fear (121; 122), increased malaise, fatigue, insomnia, restlessness, agitation, and anxiety (41; 74; 80; 56; 57; 58; 47; 37; 46; 35; 48; 62; 59), increased impulsivity (94; 95), panic (123; 124; 120), and according to secondary sources, agitation, irritability, and nervousness have occurred with the use of yohimbe bark extract. In animal research, yohimbine reinstated alcohol or drug seeking in previously addicted animals (88; 89) and according to a review, yohimbine also increases relapse to food seeking (90).
  • Respiratory agentsRespiratory agents: Bronchospasm, cough, and rhinorrhea have been documented with use of yohimbine (93; 82).
  • StimulantsStimulants: Over-the-counter (OTC) products containing stimulants, including caffeine, phenylephrine, phenylpropanolamine (removed from the US market), may lead to additive effects when used in combination with yohimbe bark extract (96). Based on human study, yohimbine may mediate sexual function through increased penile blood flow and increased central excitatory impulses to the genital tissue (99; 100). Anecdotally, the use of yohimbine with amphetamines has been cautioned, although there is limited reliable scientific evidence in this area. Caffeine-containing medications may theoretically increase the risk of hypertensive crisis when taken with yohimbine. In animal research, using yohimbine to block noradrenaline alpha(2A)-receptors in the prefrontal cortex produces an ADHD-like profile with locomotor hyperactivity, impulsivity and poor working memory (141).
  • SympathomimeticsSympathomimetics: According to secondary sources, sympathomimetics may potentiate the toxic effects of yohimbe.
  • Vasopressor herbs and supplementsVasopressor herbs and supplements: Yohimbine acts centrally to increase sympathetic outflow, and peripherally to increase the release of norepinephrine from adrenergic nerve terminals. Researchers concluded that this increases the plasma norepinephrine, and elicits pressor effects (30; 85; 97; 98; 22).

    • Yohimbe/Food Interactions:

  • GeneralGeneral: Multiple interactions have been suggested with the use of yohimbine hydrochloride. In theory, these effects may also apply to yohimbe bark extract, which contains variable (albeit low) concentrations of yohimbine alkaloid. According to a review, yohimbine increases relapse to food seeking (90).
  • Caffeine-containing foodsCaffeine-containing foods: According to secondary sources, foods that increase blood pressure, such as coffee, tea, cola, or chocolate theoretically may increase the risk of hypertensive crisis when taken concomitantly with yohimbe.
  • Tyramine-containing foodsTyramine-containing foods: According to secondary sources, because of the monoamine oxidase inhibitor activity of yohimbine (65), tyramine-containing foods, including red wines, fermented meats, and aged cheeses theoretically may increase the risk of hypertensive crisis when taken concomitantly with yohimbine.

    • Yohimbe/Lab Interactions:

  • GeneralGeneral: Multiple interactions have been suggested with the use of yohimbine hydrochloride. In theory, these effects may also apply to yohimbe bark extract, which contains variable (albeit low) concentrations of yohimbine alkaloid.
  • Alpha-amylaseAlpha-amylase: In human research, yohimbine increased levels of alpha-amylase in salivary samples at some, but not all, testing sessions (131; 61).
  • Blood pressureBlood pressure: In patients with orthostatic hypotension, yohimbine improved (increased) blood pressure in some, but not all, studies (64; 60; 134). Yohimbine use has been associated with hypertension or has increased blood pressure in other human studies; however, higher doses may elicit hypotension and lack of effect has also been noted (55; 41; 56; 57; 58; 47; 48; 59; 60; 61; 62; 63; 102).
  • Coagulation panelCoagulation panel: Yohimbine may inhibit platelet aggregation by binding to the alpha-2 adrenoceptor responsible for noradrenaline-induced platelet aggregation (49; 50; 51; 52; 53; 54).
  • CortisolCortisol: In human research, concomitant yohimbine administration antagonized the effects of alprazolam on blood pressure and attenuated alprazolam-induced changes in cortisol (62).
  • Free fatty acidsFree fatty acids: In human research, Meltdown?, containing the beta-adronergic agonist methylsynephrine, and the alpha-andrenergic antagonists yohimbine HCl, alpha-yohimbine, and 11-OH-yohimbine, increased area-under-the curve for free fatty acids (63)
  • GlycerolGlycerol: In human research, Meltdown?, containing the beta-adronergic agonist methylsynephrine, and the alpha-andrenergic antagonists yohimbine HCl, alpha-yohimbine, and 11-OH-yohimbine, increased area-under-the curve for glycerol (63)
  • Heart rateHeart rate: Yohimbe has been shown to increase heart rate in some (63; 59; 20; 66; 5; 67; 55; 68; 69; 70; 71; 72; 41) but not all (102) studies, including human studies.
  • Insulin/blood glucoseInsulin/blood glucose: Anecdotally and in animal study, yohimbine has been reported to increase the effects of diabetic medications, including insulin (101), although there is limited scientific evidence in this area. In human research, yohimbine lacked an effect on blood glucose levels (102).
  • CatecholaminesCatecholamines: Studies indicate that yohimbine increases plasma norepinephrine in most (30; 85; 97; 98; 22), but not all (lacking statistical significance) (102) studies. In human research, Meltdown?, containing the beta-adronergic agonist methylsynephrine, and the alpha-andrenergic antagonists yohimbine HCl, alpha-yohimbine, and 11-OH-yohimbine, increased area-under-the curve for epinephrine and norepinephrine (63). In a clinical trial, the authors stated that yohimbine treatment appeared to attenuate the ability of desipramine to decrease plasma levels of free 3-methoxy-4-hydroxyphenylethyleneglycol (MHPG) (62). In human research, yohimbine increased plasma MHPG (160).
  • ProlactinProlactin: In animal research, yohimbine led to an increase in plasma prolactin levels (161).