Yohimbine

Is yohimbine safe?

Not by the standard most supplements are held to. Yohimbine is a drug that blocks alpha-2 receptors and releases noradrenaline, so it raises heart rate and blood pressure at the doses people take for fat loss or erections. It scores 34 here, close to red yeast rice and well below stimulant blends such as pre-workout.

Three problems stack up. The side effects come at normal doses. The amount in a capsule is often unknown or wrong. And regulators outside the US have mostly taken it off the shelf.

What do poison centres see?

The best real-world data come from the California Poison Control System. A review of its cases from 2000 to 2006 found 238 adults with symptoms after taking a yohimbine product, and 98.7% of them had used a herbal supplement, not a prescription drug. Reports rose from 1.8 to 8.0 per 10,000 adult exposures over those seven years.

Effect	Share of cases
Stomach upset	46%
Fast heart rate	43%
Anxiety or agitation	33%
High blood pressure	25%

Yohimbine cases were more likely to have a severe outcome than the average call (odds ratio 5.81) and more likely to need treatment in a hospital or clinic (odds ratio 2.35). People had mostly taken it for sexual enhancement, weight loss or energy.

NCCIH, the NIH's complementary health centre, lists irregular heartbeat, blood pressure problems, heart attacks and seizures among the harms linked to yohimbine. Deaths are rare but documented: forensic labs in Arizona and Los Angeles reported two fatal cases in 2013, and a 2021 report described four men poisoned at the same time in China, one of whom died. LiverToxLiverToxA free US National Institutes of Health database that summarises what is known about liver injury caused by medicines, herbs and supplements.More in the glossary, the NIH liver injuryDrug-induced liver injuryLiver damage caused by a medicine, herbal product or supplement. It is usually rare and unpredictable, but it can be serious.More in the glossary database, finds no link to liver damage, so the risk sits with the heart and nervous system.

Why the dose on the label is unreliable

A 2015 study tested 49 brands labelled as containing yohimbe or yohimbine from seven major US retailers. Yohimbine per serving ranged from none to 12.1 mg. Only 11 brands said how much they contained, and most of those were wrong, with actual content from 23% to 147% of the label. In 19 brands the other bark alkaloids were missing, which suggests synthetic or highly processed yohimbine sold as "yohimbe bark". Just two of the 49 gave an accurate amount and warned about side effects.

That matters more for yohimbine than for most supplements, because the gap between a dose that does something and a dose that causes a racing heart is small. A buyer cannot know which they are getting. Yohimbine also turns up in multi-ingredient fat burners and pre-workout products next to caffeine, which adds to its effect on the heart.

Where is yohimbine banned?

• European Union. Yohimbe was placed under EU scrutiny in 2015 because of possible harmful effects. Nobody submitted data showing it was safe, so Regulation 2019/650 moved yohimbe bark and its preparations to the list of substances prohibited in food from May 2019.
• Canada. Health Canada describes yohimbine as a prescription substance and has warned consumers not to use unapproved products that contain it, especially people with high blood pressure or heart, kidney or liver disease.
• United States. It remains on sale as a dietary supplement. Supplements do not need FDA approval for safety before sale, and NCCIH notes that yohimbe has been restricted or banned in many countries because of inaccurate labels and serious side effects.

Who should avoid it

• People with high blood pressure, heart disease, heart rhythm problems, kidney or liver disease.
• Anyone with anxiety, panic disorder or bipolar disorder, since yohimbine can provoke anxiety and agitation.
• People taking MAO inhibitors or tricyclic antidepressants (NCCIH), and anyone on blood pressure medicines such as amlodipine, which yohimbine works against.
• People on stimulant medicines such as amphetamine, or who already take caffeine pills or other stimulants.
• Pregnant or breastfeeding women; NCCIH says oral use may be unsafe.

If erectile dysfunction is the reason you are looking at yohimbine, talk to your doctor. It can be a sign of heart disease, and approved treatments have far better safety data.

If you take it anyway

Read the label for a stated yohimbine amount in milligrams; if there is none, you do not know your dose. Do not combine it with other stimulant products, and stop if you notice a pounding heart, chest pain, severe anxiety or a headache that may mean high blood pressure. Those symptoms need urgent medical attention.

How we scored it

Regulatory actions (20) and product quality (25) are the weakest factors: the EU prohibits yohimbe in food, Canada treats yohimbine as prescription-onlyPrescription-only medicineA medicine that can be supplied only with a prescription from a doctor or another authorised prescriber.More in the glossary, and most US labels misstate the dose or leave it out. Dose safety (35) and organ toxicity (40) reflect heart and blood pressure effects at ordinary doses and documented deaths. Interactions (45) score a little higher because the list of serious ones is shorter than for St John's wort.