Benefits and side effects, review article
Yohimbe is the name of the bark of a tall evergreen tree in western Africa known as Pausinystalia or Corynanthe yohimbe. This natural aphrodisiac has been used for centuries in western African nations for sexual enhancement. Although tolerated well in low doses, users should be aware that dose-dependent unpleasant symptoms can occur, for instance increased sweating and heart rate going faster.
     
Is it only for men or does it also work in women?
Yohimbe herb is often thought of for male erectile function. Most people don't realize that this herb is also a sexual stimulant in women. Women like the enhanced sensation and engorgement of genital organs that it provides, as long as the dose is kept low to prevent the adverse reactions discussed below. Passion Rx with Yohimbe is preferred by users much more than a yohimbe product by itselt.

Passion Rx with Yohimbe extract -- Medical Doctor formulated for Men and Women
Passion Rx is a best selling natural supplements for sexual enhancement. This herbal sexual formula provides results within two to four days, and the benefits continue to improve with use. Some people with clinical impotence or erectile dysfunction may have underlying heart disease and should be cautious using herbs or drugs for sexual enhancement until a medical evaluation has been completed. Dr. Sahelian and his research staff tested numerous doses and extracts of dozens of herbs from a number or raw material suppliers to determine the ideal dosage and combination for optimal aphrodisiac properties with the fewest side effects.

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A sexual pleasure and performance enhancing herbal formula for men and women

The potent herbal extracts in Passion Rx include ashwagandha, catuaba, cnidium, Horny Goat Weed, Maca, Muira puama, Passion flower, Tongkat Ali and LJ100, Tribulus and Yohimbe.
This formula supports and enhances healthy:

Purchase Yohimbe supplement, Passion Rx formula, libido herbs such as Tongkat ali, Tribulus Terrestris, Maca, Horny Goat Weed or other aphrodisiac herbs.

Extracts come in varying strengths
Yohimbe bark contains up to 6% total alkaloids, 5-15% of which is yohimbine, an alpha-2-adrenergic blocking agent. In other words, a small percentage of a chemical called yohimbine is found in the bark. Currently yohimbe bark extracts are sold in varying alkaloid concentrations, ranging from plain powder, to 4% extract, 8%, and up to 20%. The higher the concentration, the more potent the product will be, and the more likely side effects will occur. But then again, the higher percentage extracts are more effective at a lower dosage.

Natrol Yohimbe Bark supplement 500 mg each pill, Whole Herb Powder
Thus far we have combined small amounts of this product, such as a quarter of capsule, with several herbs and have not found any significant side effects. Yohimbe usually starts having an effect within an hour or two while other herbs take much longer. It's best to take it as needed since it works so quickly and there's no need for it to build up in the system like other herbs. Overall Passion Rx, which has a combination of aphrodisiac herbs, is more effective and appreciated by users than this single herb.

Directions: Take a quarter or half a yohimbe capsule two to three hours before intimacy. If you are sensitive to herbs, take less than half. This herbal product is not recommended for anyone with heart problems or who has heart irregularities. Some people with clinical impotence or erectile dysfunction may have underlying heart disease. Be cautious using herbs or drugs for sexual enhancement until a thorough medical evaluation has been done.

Yohimbe side effects and cautions, risks and danger
Yohimbe should be used cautiously by anyone with a medical condition, particularly those with unstable hypertension, heart disease, diabetes, or those taking medicines, particularly tranquilizers, antidepressants, sedatives, antihistamines, amphetamines and other stimulants, including caffeine and herbal stimulants such as ginseng. Some of the side effects of high dose yohimbe include anxiety, changes in blood pressure, heart rate increase, palpitations, dizziness, agitation, anxiety, headache, visual disturbances, nausea or abdominal cramps, increased body temperature and sweating. I do not recommend this herb to anyone over the age of 65. Since high doses may cause confusion and disorientation, it should not be taken while operating machinery, driving, or performing hazardous activities. In most people it raises blood pressure and it is dosage dependent. If you get side effects they should taper off in a few hours.
   As with many herbs or medicines, the right dose works well but too high a dose causes side effects. If you have moderate to severe hypertension, then you should avoid yohimbe. However, if you have mild hypertension, then small amounts, that is, less than 150 mg, should be fine, especially with the consent of your doctor. The blood pressure effects don't last all day, only a few hours. The first thing you may notice after an hour or two is sweating under the arms. On higher doses you will notice a higher body temperature, an even higher doses of yohimbe lead to slightly blurred vision, mild anxiety, and a sense of not feeling well. Very high doses lead to heart palpitations. Fortunately, most of these yohimbe side effects only last a few hours.
   This African aphrodisiac increases body temperature, so I don't think it's a good idea to take it and engage in heavy physical activity, particularly in warm weather or to work out with weights in a gym. Drink cold water when you take it.

Do not use this herbal product if you have heart disease (including irregular rhythm), kidney, thyroid or liver disease, a seizure disorder or stroke. Do not take it with any antidepressant medications or MAO inhibitors, or with foods containing high amounts of tyramine (such as cheese or red wine) or with decongestants, diet aids, products containing phenylpropanolamine, hormones such as DHEA or pregnenolone, or supplements that have a stimulating effects, such as sexual enhancement herbs, SAM-e, tyrosine, etc. Consult with your doctor before use if you have any health problems or are taking any medications. Discontinue use and consult your doctor if you experience high blood pressure, heart palpitations or rapid heart beat, dizziness, headache, rash, tremors, depression or hallucinations. Other adverse reactions may include nervousness, anxiety, mood changes, insomnia, nausea, vomiting, urinary retention, dilation of pupils, or skin flushing. The adverse effects are dose dependent.

Q. How many mg of yohimbe is considered safe or not having side effects. I'm taking high blood medication, is there a safe dose in my case.
   A. It's very hard to say since the herb comes in different potency extracts. One can purchase yohimbe powder or more concentrated extracts such as 2%, 4%, and up to 20%. The higher the percentage, the more potent. As to the powder, it's probably safe under 100 mg but each person is different and there is a wide range of response. Overall it would be preferable that someone with high blood pressure not use this product. Perhaps one can try to use natural ways to reduce blood pressure.

Q. I'm on beta blockers, can I take it?
   A. Beta blockers are known to lower sex drive and cause erectile dysfunction. Small amounts of yohimbe taken infrequently should not cause problems, but of course this has to be done under medical supervision.

Q. I wanted to let you know about my yohimbe experience. I took one tablet of a GNC product called Yohimbe Active which contains 122.5 mg of yohimbe bark powdered extract (8% alkaloid). I took the pill in the evening, about 8 pm. Within an hour I felt hot, nauseated, kind of a sick feeling, with my heart pounding. Even my vision was blurred. I had sweating in the arm pits. It did work to make my erection come up spontaneously when I barely touched my penis, and it lasted all through my lovemaking, but while making love to my wife I was too distracted by the hot feeling and sweating.

Regarding Passion Rx. What is the amount of yohimbe in it? Will this product raise blood pressure in a significant amount?
   The amount in the formula with yohimbe is not high in order to minimize side effects but it is a proprietary formula so we do not list the exact amount. We have not had any reports from users that there has been a significant rise in blood pressure when using one capsule.

J Med Toxicol. 2009. Refractory priapism associated with ingestion of yohimbe extract. Extracts of the bark of the central African tree Pausinystalia yohimbe contain yohimbine, an indole alkaloid, which is used to treat erectile dysfunction. The reported side effects of over-the-counter preparations of yohimbine include gastrointestinal upset, anxiety, increased blood pressure, headache, agitation, rash, tachycardia, and frequent urination. In this report, we describe a severe case of intractable priapism associated with the ingestion of yohimbe extract.

Yohimbine versus yohimbe bark
Yohimbine is a drug approved by the FDA for the treatment of erectile dysfunction. Almost all clinical studies have been conducted with it rather than yohimbe bark powder or extracts. For more than 80 years it has been used as a treatment for male and female sexual difficulties. In my opinion, yohimbe bark works quite well.

Yohimbine has been evaluated in the management of erectile disorder by means of many placebo-controlled trials. It does appear to have a therapeutic benefit. In contract, yohimbe has not been studied much. 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 Yohimbine was found significantly more effective than placebo in terms of response rate: 71 vs 45%. Only 7% of patients rated tolerability fair or poor, and most adverse experiences were mild. There was no serious adverse event.

Bodybuilding or to increase muscle mass
I am not aware of good evidence that it is of benefit in bodybuilding, exercise tolerance, physical performance, or positive changes in body mass.

Weight loss
Some companies promote this plant for weight loss. I have not found this herb effective for the purposes of losing weight. The adverse effects are too annoying for it to be effective for this purpose.

Would a woman benefit?
A study conducted at the University of Texas at Austin, Texas examined the effects of arginine combined with yohimbine on sexual arousal in postmenopausal women with Female Sexual Arousal Disorder. Twenty-four women participated in three treatment sessions in which self-report and vaginal sexual responses to erotic stimuli were measured following treatment with either L-arginine (6 g) plus yohimbine (6 mg), yohimbine alone (6 mg), or placebo, using a randomized, double-blind, three-way cross-over design. Sexual responses were measured at approximately 60 minutes postdrug administration. The combined oral administration of L-arginine and yohimbine substantially increased vaginal pulse amplitude responses to the erotic film at 60 min postdrug administration. The vaginal response was measured with an instrument called a vaginal photoplethysmograph. Even though yohimbe was not tested, it would make sense that it would also have similar activity.
   Many women notice sexual benefits from the use of this herb, but it is best to use low dosages, a portion of a tablet or capsule, since adverse effects are quite common in a woman on higher dosages. This supplement can be used with coke or a soft drink but it is best not to combine it with alcohol.

Mechanism of action, how it works
Yohimbine acts through the nervous system to increase blood flow to the genital region. Although many pharmacological properties have been described, at the plasma concentration attained at recommended dosages in humans the predominant activity is antagonism of alpha 2-adrenoceptors. It is not clear whether the other alkaloids in the bark also have a pro-sexual effect.

Availability of supplements, how they are sold, dosage
Yohimbe bark is sold widely in different dosages and extract potencies including 4%, 6%, 8%, and 10% alkaloids. It is difficult to give precise dosage recommendations for extracts since sometimes manufacturers and formulas are not consistent in their content or extract potencies of yohimbe. In one study, of twenty commercial aphrodisiac preparations were analyzed and the amount of yohimbine measured and expressed as the maximal dose per day suggested on product labels ranged from 1.3 to 23.1 mg.

Timing and frequency of use
Yohimbe may be used either daily or before planned activity. In my opinion, since it works quite quickly, it makes sense that it be taken as needed one to three hours before planned sexual activity rather than taken daily. The effects last several hours. I don't recommend you take it close to bedtime since it can have a stimulant and alertness causing effect for several hours. I don't recommend you mix yohimbe with alcohol or stimulant drugs, including high doses of caffeine.

Interactions with other supplements
Small amounts can be used with other dietary supplements including fish oils and anything that does not raise body temperature or increase heart rate.

Research studies
Endothelin-like action of Pausinystalia yohimbe aqueous extract on vascular and renal regional hemodynamics in Sprague Dawley rats.
Methods Find Exp Clin Pharmacology. 2003.
In vivo studies with yohimbe in Sprague Dawley rats demonstrated a dose-dependent increase in mean blood pressure and an increase in medullary blood flow (MBF). Both the pressor action and renal medullary vasodilation of yohimbe were blocked by endothelinA (ETA) receptor antagonist BMS182874 and endothelinB (ETB) receptor antagonist BQ788 in combination. L-Nomega-nitro-l-arginine methyl ester (L-NAME) also inhibited the increase in MBF induced by yohimbe. In vitro studies in isolated perfused kidney and in pressurized renal microvessels confirmed the dose-dependent vasoconstrictor action of this extract. These preliminary observations indicate that, in addition to the alpha-adrenergic antagonist actions that characterize yohimbine, yohimbe possesses endothelin-like actions and affects nitric oxide (NO) production in renal circulation. These findings suggest a strong possibility of post-receptor cross-talk between alpha2-adrenoceptors and endothelin, as well as a direct effect of alpha2-adrenoceptors on renal NO production.

J AOAC Int. 2015. Determination of Yohimbine in Yohimbe Bark and Related Dietary Supplements Using UHPLC-UV/MS: Single-Laboratory Validation. A single-laboratory validation was performed on a practical ultra-HPLC (UHPLC)-diode array detector (DAD)/tandem MS method for determination of yohimbine in yohimbe barks and related dietary supplements. Good separation was achieved using a Waters Acquity ethylene bridged hybrid C18 column with gradient elution using 0.1% (v/v) aqueous ammonium hydroxide and 0.1% ammonium hydroxide in methanol as the mobile phases. The method can separate corynanthine from yohimbine in yohimbe bark extract, which is critical for accurate quantitation of yohimbine in yohimbe bark and related dietary supplements. Accuracy of the method was demonstrated using standard addition methods. Both intraday and interday precisions of the method were good. The method can be used without MS since yohimbine concentration in yohimbe barks and related dietary supplements are usually high enough for DAD detection, which can make it an easy and economical method for routine analysis of yohimbe barks and related dietary supplements.

Emails
Q. My wife and I tried yohimbe (taken 1.5 hours before activity) and we both found it to be very effective. This brand was 112 mg, 8% yohimbine alkaloids. But we later learned that it is on the FDA list of dangerous supplements, causing kidney failure and even death.  Since you include it in some of your products, in what way would this product cause these problems? Also, I noticed that  some foods should be avoided when taking this supplement.
   A. Yohimbe is an effective herb for healthy erectile function. It has a narrow range of effectiveness versus side effects. I have tried the dosage and potency you mention and it was effective but I felt very hot and my heart was racing. Passion Rx has a small amount which leads to much fewer side effects. Yohimbe has long term side effects if taken in high doses 2 or 3 times daily -- perhaps the kidney problem you mention -- although it is very rare, and more worrisome is heart palpitations. Once the herbal use is stopped, the adverse effects will subside. I only recommend yohimbe during sexual activity which for most people is not more than 2 or 3 times a week.

Q. I tried yohimbe and my life will never be the same -- unfortunately. For the past three weeks I have suffered from cardiac arrhythmia. As a result, I may have to postpone much needed orthopedic surgery. Right now I am waiting to hear from my physician, who is consulting a heart specialist on this matter. I have never had heart disease in my entire life. At the age of 57 I have low cholesterol and low blood pressure, and my EKGs have always been normal. Until recently, I also had a nice, slow, steady pulse. Throughout most of my adult life, sex was very enjoyable, without any special devices. However, after menopause my physical responses dropped dramatically, although my desire never faded, especially after a very happy second marriage. Damiana, ginkgo, ginseng, estrogen suppositories, and other remedies failed to bring about any noticeable change. After taking yohimbe, sex with my wonderful husband was just a little bit like it was in the old days. But the medical consequences are not at all worth it. I would rather have more quiet sex and a healthy heart. May I suggest that you include a disclaimer in your books and on your website that these remedies are definitely not for people over fifty?
   A.  We are distressed that this happened to you. Of all the herbs that are often used for sexual enhancement, yohimbe is probably the most difficult to dose. We wonder what dosage you used. We hope this is temporary for you and the rhythm returns to normal. Was it a one time yohimbe dose, or did you take it multiple times? It would be highly unlikely that any medicine or herb to cause permanent heart irregularities unless there was an underlying heart problem. If it is a normal heart to begin, and an irregular rhythm occurred due to a one time dose of an herb such as yohimbe, or medicine, the heart should revert back to normal after a certain time. As with anything in life, there are risks and benefits, including engaging in sports. For instance, one can have great pleasure while skiing, but there can also be serious injuries.

Q. A number of reports state that yohimbe is very dangerous and that it has a narrow band between being effective and being toxic. They also claim that Viagra is a much safer alternative.  Most of the products containing Yohimbe, that I have found, are standardized to 9 mg. of yohimbine with the bark content running from 120 mg to 300 mg. Is a 9mg. dose of yohimbine the right amount to be effective without bad side effects?
   A. The right amount of yohimbe, combined with other sex herbs, is preferable to me than Viagra alone. I find Passion Rx with yohimbe to be such a combination. The drawback to yohimbe use is that it does have a narrow range of effectiveness versus side effects.  At lease yohimbe does not cause the potential blindness that Viagra can sometimes cause. However Viagra works much better and quicker in terms of blood flow to penis and immediate erection.

Q. I saw a flyer in a health food store regarding Advanced Yohimbe Plus and it said Ray Sahelian, M.D. had formulated this product. Can you tell me if Advanced Yohimbe Plus is endorsed by Dr. Sahelian?
   A. Dr. Sahelian formulated Advanced Yohimbe Plus back in the year 2000 but he is no longer associated with Irwin Naturals, the company that makes Advanced Yohimbe Plus. Therefore we cannot comment on this product. Dr. Sahelian voluntary withdrew his association in all forms and matters from Irwin Naturals in April of 2006.

Q. I greatly enjoy Dr Sahelian's writings. However, I believe it is a mistake to include yohimbe in libido formulations because of the frequent association between sexual dysfunction & heart disease. A cautionary note is not IMHO sufficient. Or in the alternative have formulations for those over 40 free of yohimbe.
   A. Every medicine or herb has the potential for side effects and as long as people are aware of the side effects with yohimbe and low doses are used, yohimbe has a role to play in sexual enhancement. The safety profile of yohimbe is not necessarily worse than Viagra. There have been more serious side effects reported with Viagra than with yohimbe.

I am taking 8 mg yohimbine per day and want to know how much is in Passion Rx formula so I can adjust the amount accordingly.
   We would suggest not taking the yohimbine the same day as Passion Rx. They can be alternated every day with a day or two off each week if your doctor approves.

Before i buy this product i would like to know why yohimbe is banned in certain countries? Also is it suitable for vegetarian? If i order the product will it be allowed to enter uk? i am 49 yrs not married but soon will so can i take this product as part of my healthy sex life after marriage? can i take yohimbe product with tongkat ali?
    Yohimbe, in high dosages, has side effects. The banning of certain dietary supplements by certain countries are arbitrary. Many countries allow the sale of aspirin and acetaminophen without a prescription even though these medications cause tens of thousands of deaths or hospital admissions each year in the United States alone. This herb is allowed for sale or import in the UK, England, Wales, Ireland, Scotland, etc. We suggest not mixing yohimbe and tongkat ali the same day since they are both potent unless they are in lower dosages found in a sexual enhancing product that has been formulated by a knowledgeable nutritionist or physician with a great deal of experience in this field. One such herbal product is Passion Rx.

I have a mild hypertension (upper 80 or lower 90 on a diastolic number). So I shouldn't use Passion Rx with Yohimbe because it may raise blood pressure even more. Is my understanding correct? But yohimbe is a crucial ingredient in sexual enhancing products How do you compensate for the absence of yohimbe to maintain the quality of your product Passion Rx?
    Other herbal extract are substituted to provide sexual enhancement, but the benefits take 2 or 3 days longer to be noticed.

I have a kidney worry after taking Yohimbe extract 5mg twice daily for 3 consecutive days (so all in all 30 mg in 3 days, is this considered as a high dose?) I stopped after the 3d day because of kidney pain and water retention (but not acute). It's now several days that I am hoping to recover ... do you think this problem is going to stay / worsen (I am 53 yrs old) or attenuate? Thank you for reply and advice.
    I cannot predict in your particular situation what would occur, but, most of the time, if a side effect was caused by the use of a natural supplement the condition will improve within a few days after stopping the product.

I use and enjoy yohimbe, including the Passion Rx product. I’m concerned about the August 2010 bad press that certain herbal supplements have garnered, in a Consumer Report article it has a list of the “dirty dozen” supplements one of them is yohimbe. Do you think there is a chance that the FDA will ban it?
   I don't know what the FDA will do, but thus far we have not had any serious problems reported to us by users of Passion Rx with yohimbe, particularly since the amount of the bark extract is not high in the product and people in general only use the pills two or three days a week for long term use.