Use of an herbal supplement containing yohimbine resulted in extremely high blood pressure, well above the threshold for seeking emergency care, according to a case reported in the April 25, 2019 issue of The Journal of Emergency Medicine. The 49-year-old man had a recorded blood pressure of 280/160 mmHg, while 180/120 mmHg is considered to be a level requiring immediate medical attention.
What is yohimbine?
Yohimbine is a chemical found in the bark of the yohimbe tree (Pausinystalia yohimbe), an evergreen native to central and western Africa. Yohimbine hydrochloride is a form of yohimbine that is used in a prescription drug called Aphrodyne and Yocon.
Various herbal supplements on the market list yohimbine, yohimbe bark extract, or yohimbine hydrochloride as an active ingredient. In the case of the latter substance, products that contain man-made yohimbine hydrocholoride are not legal to sell as a dietary supplement in the United States.
Yohimbine can increase blood flow and nerve impulses to the penis, which is why some men take the supplement for erectile dysfunction or to enhance their sexual experience. The supplement is also taken to improve athletic performance and help manage fatigue, chest pain, low blood pressure, diabetic nerve pain, and depression.
Yohimbine and high blood pressure
However, yohimbine also can cause elevated blood pressure, as seen in this case. More specifically, despite the use of two separate drugs to lower the patient’s blood pressure, it remained higher than 210/125 mmHg. High blood pressure that resists treatment is known as refractory hypertension, a side effect that has been reported with this herbal remedy.
In this patient, the doctors were eventually able to lower blood pressure to 152/76 mmHg after using an aggressive approach, the drug nitroprusside. Uncontrolled hypertension can result in organ failure, which was averted in this case.
Other side effects of yohimbine include rapid heart rate, stomach problems, heart attack, anxiety, dizziness, irritability, headache, bloating, rash, nausea, vomiting, and seizures.
Take away message
The patient in this case initially did not tell the emergency physicians that he had used the herbal supplement containing yohimbine. Full disclosure at the time of medical treatment can allow experts to more effectively and accurately provide treatment.
It is important for men who wish to use any type of natural supplement to consult with a knowledgeable healthcare provider before starting supplementation because the ingredients may cause unintended consequences and interactions with other medications or supplements being used. At the same time, physicians need to ask patient specifically about any over-the-counter medication or natural supplement use.
Prescott A, Smereck J. Hypertensive urgency: an undesirable complication of a “male performance” herbal product. The Journal of Emergency Medicine 2019 Apr 25