Yohimbine (Safety-Sensitive)
Commonly used for
Men's Health
Highest-risk item in the Supplement Guide -- real cardiovascular and psychiatric risk. Never self-combine with stimulants, blood-pressure medications, or antidepressants.
What is it? / Overview
Yohimbine blocks alpha-2 adrenergic receptors, which normally act as a brake on norepinephrine release -- removing that brake increases sympathetic output, which can support erectile function (its best-evidenced use, per an older meta-analysis of 7 RCTs) but the identical mechanism raises blood pressure, heart rate, and anxiety. Crude yohimbe bark extracts are notoriously inconsistent and often inaccurately labeled for actual alkaloid content, compounding the risk beyond what the standardized pharmaceutical form carries.
How is it used? / Administration
Form: Two distinct products: pharmaceutical yohimbine hydrochloride (standardized) and crude yohimbe bark extract (highly variable, often mislabeled alkaloid content) -- the crude bark extract is the more dangerous of the two
Typical dose studied: Prescription-style regimen studied at 5.4 mg three times daily (~16 mg/day); pressor (blood-pressure-raising) effects appear at 15-20 mg, so this is a functional dose ceiling, not a starting point to build up from
Timing: Divided daily doses if used at all; avoid late-day dosing and avoid combining with any other stimulant
Ships deliberately trigger-empty despite having real RCT-supported efficacy for erectile dysfunction -- the risk profile is severe enough (cardiovascular, psychiatric, and case reports of altered substance-seeking behavior) that this platform should never proactively surface it as a recommendation. Its purpose here is exclusively safety screening: hard-flagging the conditions and medications above if a user reports already taking it. Distinguish standardized yohimbine HCl from crude yohimbe bark extract whenever discussing this with a user -- they are not equivalent products.
How well does it work? / Evidence
~ Moderate evidence
Who should avoid it?
Avoid with: Primary hypertension / High blood pressure; Chronic coronary disease / Coronary artery disease; Atrial fibrillation / Atrial flutter; Generalized anxiety disorder; Bipolar disorder; Chronic kidney disease (Stage 3, 4, or 5) — NOT on dialysis; End-stage liver disease / Cirrhosis; Breastfeeding
Interacts with: Clonidine -- yohimbine directly opposes it (competing alpha-2 mechanisms); Tricyclic antidepressants -- pressor effects occur at lower doses when combined; MAO inhibitors, other stimulants/sympathomimetics -- additive hypertensive/adrenergic risk; Phenothiazines -- may potentiate alpha-blockade; SSRIs/SNRIs and other serotonergic or blood-pressure-affecting medications -- discuss with a doctor before combining
Already taking it? This is the single highest-risk entry in the Supplement Guide. Documented harms include severe anxiety/panic (reported even at doses as low as 10 mg), hypertension, arrhythmia, and case reports of mania and altered mental state. If currently taking it, a conversation with a doctor about the specific product (crude yohimbe bark vs. standardized yohimbine HCl), dose, and any of the conditions or medications above is genuinely warranted, not just a formality.
Research & references
Ernst E, Pittler MH (1998). Yohimbine for Erectile Dysfunction: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. The Journal of Urology. Tam SW et al. (2001). Yohimbine: A Clinical Review. Pharmacology & Therapeutics. Valli G, Giardina EG (2002). Benefits, Adverse Effects and Drug Interactions of Herbal Therapies With Cardiovascular Effects. Journal of the American College of Cardiology.