Yohimbine is an indole alkaloid derived from the bark of the Central African yohimbe tree (Pausinystalia yohimbe) that is widely used as therapy for erectile dysfunction. Yohimbine use has been associated with occasional severe adverse events, but has not been linked to serum enzyme elevations or clinically apparent acute liver injury.


Yohimbine (yoe him' been) is a popular and widely used herbal which was traditionally used in Africa for multiple conditions including cough, fever, leprosy, heart disease and as an anesthetic, hallucinogen and aphrodisiac. In the West, yohimbe became popular as a sexual stimulant and used to treat erectile dysfunction. Yohimbe is derived from the bark of the African evergreen tree Pausinystalia yohimbe (synonym, P. johimbe). The bark extract has multiple constituents, but the focus of most interest has been yohimbine, an indole alkaloid which has been shown to be an alpha 2 adrenergic receptor antagonist. In animal models, yohimbine increases sexual activity and is likely to act by engagement and inhibition of the alpha 2 adrenergic receptors in the corpus cavernosum, causing sustained engorgement of the corporeal tissue of the penis. Yohimbine has been chemically synthesized and the synthetic form is what is currently marketed in the United States. The herbal bark extract may have other active components and is purported to be more potent and have more side effects. In clinical trials, synthetic yohimbine has had a consistent, although limited effect on erective dysfunction. Its effect on sexual desire is less well defined. The usual recommended dose of purified yohimbine is 5 to 10 mg three times a day. Drug tolerance or tachyphylaxis may occur. Side effects are usually mild and transient and are typical of alpha 2 adrenergic inhibition, including insomnia, anxiety, palpitations, chest pain, sweating, blurred vision and hypertension. Overdose can cause hypotension, tachycardia, seizures, paralysis and coma; deaths from overdose have been described.


In small clinical trials and case series, yohimbine therapy has not been linked to serum enzyme elevations or clinical liver disease. Although yohimbine is often found in weight loss and muscle building herbal combinations, it has not been associated with cases of clinically apparent acute liver injury.

Likelihood score: E (unlikely cause of clinically apparent liver injury).

Drug Class: Herbal and Dietary Supplements



Yohimbine – Generic


Herbal and Dietary Supplements


Fact Sheet at National Center for Complementary and Integrative Health, NIH



References updated: 05 April 2020

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    (Among 56 patients with phobias receiving visual reality exposure therapy [25 minutes twice, 3 times weekly] with yohimbine [15 mg], propranolol [40 mg] or placebo for 2 weeks, improvement in phobia was similar in all 3 groups and adverse events were not mentioned).