Yohimbine extract dosage for erectile dysfunction treatment, how safe is this herbal extract? Review of dosage, benefits, and side effects by Ray Sahelian, M.D.
November 15 2016

Yohimbine has been studied quite extensively and most results show it to be effective in helping with erections, particularly in those whose erectile dysfunction is due to psychological causes. It has also been shown to be helpful in women.

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Information
The yohimbe tree is an evergreen native to western Africa. The bark of this tree contains a number of substances including an active chemical called yohimbine, which has been available as a prescription impotence medication for a number of decades, and its popularity plummeted when the impotence drug Viagra came on the market. The amount in nutritional supplements vary; some yohimbe products have little yohimbine whereas others have quite a high amount. The standardized form of yohimbine, hydrochloride or hcl, is still available as a prescription medicine. When you buy an over the counter Yohimbe supplement, there will be yohimbine in it, the amount depending on the dosage and extract potency of the raw material in the product.

Mechanism of action, how it works for erectile dysfunction
Yohimbine acts through the nervous system to increase blood flow to the genital region. Although many pharmacological properties of yohimbine have been described, at the plasma concentration attained at recommended dosages in humans the predominant activity is antagonism of alpha 2-adrenoceptors.

Combining with sidenafil, Viagra
Eur J Pharmacol. 2013. Potential effects of yohimbine and sildenafil on erectile dysfunction in rats. Results showed that both yohimbine and sildenafil have a relaxant effect on rat corpus cavernosum strips in a dose dependant manner, which is confirmed by the increase in nitric oxide content in rats' penis shown by sildenafil.

Studies
Yohimbine has been evaluated in the management of erectile disorder by means of many placebo-controlled trials. It does appear to have a modest therapeutic benefit, particularly in psychological cases of erectile disorder. Here's one summary of a study:
A 1977 German double-blind, placebo-controlled clinical trial of yohimbine hydrochloride included 86 patients with erectile dysfunction and without clearly detectable organic or psychologic causes. Yohimbine was administered orally in a dosage of 30 mg a day (two 5 mg tablets three times daily) for eight weeks. Patients were seen for follow-up after four weeks' treatment, and for a final visit after eight weeks. Efficacy evaluation was based on both subjective and objective criteria. Subjective criteria included improvement in sexual desire, sexual satisfaction, frequency of sexual contacts, and quality of erection (penile rigidity) during sexual contact/intercourse. Objective criteria of outcome were based on improvement in penile rigidity determined by use of polysomnography in the sleep laboratory. Overall it was found significantly more effective than placebo in terms of response rate: 71 versus 45% and it was well-tolerated.

Psychopharmacology (Berl). 2013. Yohimbine increases opioid-seeking behavior in heroin-dependent, buprenorphine-maintained individuals. In laboratory animals, the biological stressor yohimbine (α(2)-noradrenergic autoreceptor antagonist) promotes drug seeking. Human laboratory studies have demonstrated that psychological stressors can increase drug craving but not that stressors alter drug seeking. This clinical study tested whether yohimbine increases opioid-seeking behavior. Ten heroin-dependent, buprenorphine-stabilized (8 mg/day) volunteers sampled two doses of hydromorphone [12 and 24 mg IM in counterbalanced order, labeled drug A (session 1) and drug B (session 2)]. During each of six later sessions (within-subject, double-blind, randomized crossover design), volunteers could respond on a 12-trial choice progressive ratio task to earn units (1 or 2 mg) of the sampled hydromorphone dose (drug A or B) vs money ($2) following different oral yohimbine pretreatment doses (0, 16.2, and 32.4 mg). Behavioral economic demand intensity and peak responding (O (max)) were significantly higher for hydromorphone 2 than 1 mg. Relative to placebo, yohimbine significantly increased hydromorphone demand inelasticity, more so for hydromorphone 1-mg units (P (max) = 909, 3,647, and 3,225 for placebo, 16.2, and 32.4 mg yohimbine doses, respectively) than hydromorphone 2-mg units. Yohimbine produced significant but clinically modest dose-dependent increases in blood pressure (systolic ≈ 15 and diastolic ≈ 10 mmHg) and opioid withdrawal symptoms, and decreased opioid agonist symptoms and elated mood. These findings concur with preclinical data by demonstrating that yohimbine increases drug seeking; in this study, these effects occurred without clinically significant subjective distress or elevated craving, and partly depended on opioid unit dose.

Pharmacol Biochem Behav. 2016. Baclofen blocks yohimbine induced increases in ethanol-reinforced responding in rats.

Side effects and caution, safety, risk, danger
Yohimbine should be used cautiously by anyone with a medical condition, particularly those with hypertension, heart disease, diabetes, or those taking medications, particularly heart drugs, blood pressure pills, tranquilizers, antidepressants, sedatives, antihistamines, amphetamines or other stimulants, including caffeine. Yohimbine side effects include anxiety, changes in blood pressure, heart rate increase or palpitations, dizziness, headache, visual disturbances, nausea or abdominal cramps, increased body temperature and sweating.
    Since high doses of yohimbine may cause confusion and disorientation, it should not be taken while operating machinery, driving, or performing hazardous activities.

Is yohimbe bark devoid of the alkaloid yohimbine?
This is not a true statement. Yohimbe bark does contain yohimbine. The amount depends on the quality of the raw material, the manufacturing process, and the extract potency, whether it is a 2 percent extract or an 8 percent extract or a 20 percent extract. The higher the extract percentage, the more yohimbine is likely to be present in the supplement.

Is Passion Rx with Yohimbine more effective than the one without?
    Actually the aphrodisiac formula contains yohimbe which has a small amount of yohimbine. Most people find the formula with yohimbe to be more potent.

Does small doses of Cialis 5 mg or small doses of Viagra or Levitra and Yohimbine small doses taken concomitantly result in more reliable and sustainable results? Your website is quite informative but I could not find an answer to the above question. Your opinion will be very much appreciated.
    It depends how small the dosage of the yohimbine, and it also depends on the person, how healthy they are, whether they have a heart condition, their age, and other supplements or medications used. Both the prescription medication and the herbal product have side effects and, in some people, the combination could cause very unpleasant reactions. It is difficult to answer such questions since there is a great deal of individual responses and much depends on the dosage of the yohimbe extract product.