Yohimbine Uses, Benefits, Dosage, Side Effects & Safety | DrugsAtlas
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DRUG NAME: Yohimbine
Therapeutic Class: Alpha-Adrenergic Blocking Agent
Subclass: Alpha-2 Adrenergic Receptor Antagonist
Speciality: Urology
Schedule (India): Schedule H
Route(s): Oral
Formulations Available in India:
- Tablets: 5.4 mg
- Note: Availability limited; many products are fixed-dose combinations with herbal ingredients — verify authenticity before prescribing
INDICATIONS + DOSING — FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
Erectile Dysfunction (Psychogenic or Mild Organic)
Used as adjunctive or alternative therapy when PDE5 inhibitors are contraindicated, not tolerated, or ineffective.
| Step | Dose | Clinical Notes |
| Starting dose | 5.4 mg once daily | Preferably in morning; assess tolerability |
| Titration | 5.4 mg twice daily after 1 week if tolerated | Monitor BP and anxiety symptoms before increasing |
| Usual maintenance dose | 5.4 mg two to three times daily (10.8–16.2 mg/day) | Response may take 2–3 weeks to manifest |
| Maximum dose | 10.8 mg three times daily (32.4 mg/day) | Use beyond 4 weeks requires specialist review |
Key Clinical Notes:
- Not first-line therapy for erectile dysfunction in India
- Requires baseline psychiatric and cardiac assessment
- Efficacy evidence is modest, primarily useful in psychogenic cases
- Discontinue if no response after 8–10 weeks
Secondary Indications – Adults (Off-label, if any)
Orthostatic Hypotension (Neurogenic Origin)
- Dose: 5.4 mg twice daily
- Duration: Short-term use only
- Specialist only: Yes — Neurology/Autonomic specialist
- OFF-LABEL
- Evidence basis: Small clinical trials and specialist neurologist practice in autonomic failure syndromes; limited Indian data
PAEDIATRIC DOSING (Specialist Only)
Primary Indications
Not applicable — No approved paediatric indications exist.
Secondary Indications – Paediatrics (Off-label, if any)
Not applicable
Safety Statement:
- Not recommended below 18 years of age
- No safety or efficacy data available in children or adolescents
- Should be strictly avoided in paediatric population
RENAL ADJUSTMENT
| Renal Function | Recommendation |
| Mild impairment (eGFR 60–89) | Use with caution; standard dosing may be used |
| Moderate impairment (eGFR 30–59) | Use cautiously; start at lowest dose; monitor BP |
| Severe impairment (eGFR <30) | Avoid use — insufficient data; risk of accumulation |
| Haemodialysis | No data available; avoid use |
Note: No formal renal dosing guidelines established; monitor renal parameters periodically if used.
HEPATIC ADJUSTMENT
| Severity | Recommendation |
| Mild impairment (Child-Pugh A) | Use cautiously; initiate at lowest dose (5.4 mg once daily) |
| Moderate impairment (Child-Pugh B) | Avoid or use only under specialist supervision with close monitoring |
| Severe impairment (Child-Pugh C) | Contraindicated — increased risk of CNS toxicity and unpredictable pharmacokinetics |
CONTRAINDICATIONS
- Known hypersensitivity to yohimbine or any excipients
- Severe hepatic impairment
- Severe renal impairment
- Pre-existing psychiatric disorders (anxiety disorders, panic disorder, schizophrenia, bipolar disorder)
- Uncontrolled hypertension
- Active peptic ulcer disease
- Concurrent use of monoamine oxidase inhibitors (MAOIs)
- Recent myocardial infarction or unstable angina
CAUTIONS
- Cardiovascular disease (coronary artery disease, arrhythmias, heart failure)
- Anxiety-prone individuals — may exacerbate or precipitate anxiety symptoms
- Elderly patients — enhanced CNS sensitivity and fall risk
- Concurrent use of caffeine, decongestants, or other sympathomimetic agents
- Concomitant PDE5 inhibitor use — risk of enhanced hypotension
- History of seizures
- Prostate disorders
- Diabetes mellitus — may alter glycaemic control
PREGNANCY
| Parameter | Recommendation |
| Risk category | Not established; presumed unsafe |
| Overall safety | Not recommended during pregnancy |
| Specific concerns | Potential uterine stimulant effect; may increase risk of uterine contractions |
| Preferred alternatives | None applicable (erectile dysfunction agents not indicated in pregnancy) |
| If accidental exposure | Discontinue immediately; monitor for uterine activity; obstetric consultation |
LACTATION
| Parameter | Recommendation |
| Compatibility | Not compatible with breastfeeding |
| Transfer into milk | Unknown; presumed to transfer |
| Preferred alternatives | None applicable |
| Infant monitoring | If inadvertent exposure occurs — monitor for irritability, poor feeding, tachycardia |
ELDERLY
- Starting dose: 5.4 mg once daily
- Titration: Slower than in younger adults; increase after 2 weeks if tolerated
- Maximum dose: Consider limiting to 16.2 mg/day unless essential
- Specific risks:
-
- Increased risk of orthostatic hypotension and falls
- Higher susceptibility to CNS effects (agitation, confusion)
- Cardiovascular effects may be more pronounced
- Monitoring: Regular BP assessment (supine and standing), periodic psychiatric evaluation
MAJOR DRUG INTERACTIONS
| Interacting Drug | Effect | Recommendation |
| MAO inhibitors (phenelzine, isocarboxazid, tranylcypromine) | Risk of hypertensive crisis | CONTRAINDICATED — do not co-administer |
| Tricyclic antidepressants (amitriptyline, imipramine) | Increased risk of arrhythmias and hypertension | Avoid combination |
| Clonidine | Antagonism of antihypertensive effect | Avoid — may cause hypertensive rebound |
| PDE5 inhibitors (sildenafil, tadalafil) | Additive vasodilation; severe hypotension | Avoid concurrent use; if essential, use under close supervision |
| CNS stimulants (methylphenidate, pseudoephedrine) | Additive tachycardia, CNS excitation, hypertension | Avoid combination |
MODERATE DRUG INTERACTIONS
| Interacting Drug | Effect | Recommendation |
| Antihypertensives (ACE inhibitors, ARBs, beta-blockers) | May potentiate or oppose hypotensive effects; unpredictable BP changes | Monitor BP closely |
| SSRIs/SNRIs | Additive CNS stimulation; increased anxiety risk | Use cautiously; monitor for psychiatric symptoms |
| Diuretics | Additive orthostatic hypotension in volume-depleted patients | Ensure adequate hydration; monitor BP |
| Alcohol | May exacerbate hypotension or CNS adverse effects | Advise moderation or avoidance |
| Caffeine | Enhanced CNS stimulation and cardiovascular effects | Advise limiting caffeine intake |
COMMON ADVERSE EFFECTS
- Anxiety and nervousness
- Irritability
- Increased heart rate, palpitations
- Headache
- Dizziness
- Nausea
- Sweating (diaphoresis)
- Mild elevation in blood pressure
- Insomnia
- Flushing
SERIOUS ADVERSE EFFECTS
- Severe hypertension (hypertensive emergency in susceptible individuals)
- Psychosis or manic episodes (especially in predisposed patients)
- Seizures (rare; reported at high doses)
- Acute myocardial infarction (case reports at high doses)
- Severe anxiety or panic attacks
- Priapism (very rare)
Action Required: Discontinue immediately if severe agitation, chest pain, hallucinations, or prolonged erection occurs. Seek urgent medical evaluation.
MONITORING REQUIREMENTS
| Phase | Parameters |
| Baseline | Blood pressure (supine and standing), heart rate, psychiatric history assessment, ECG if cardiac risk factors present, renal and hepatic function |
| During titration | BP and pulse at each dose change, psychiatric symptom review |
| Long-term (if >4 weeks) | Periodic BP monitoring, renal function tests, assessment of ongoing need |
| Patient counselling | Report palpitations, chest pain, severe anxiety, or mood changes immediately |
BRANDS AVAILABLE IN INDIA
- Limited standalone pharmaceutical preparations available
- Most products available as fixed-dose combinations with herbal aphrodisiacs
- Verify product authenticity and yohimbine content before prescribing
- Caution: Unregulated supplements claiming yohimbine may have variable content and quality
Note: Specific verified brand names NOT AVAILABLE in standard pharmaceutical databases for India. Products marketed as ”yohimbine“ may be herbal supplements rather than approved drugs.
PRICE RANGE (INR)
- Estimated: ₹5–₹15 per 5.4 mg tablet (where available in private market)
- NLEM status: Not listed under National List of Essential Medicines
- Government supply: NOT AVAILABLE in standard government EML kits
- Availability: Limited to select private pharmacies; may require special ordering
CLINICAL PEARLS
- Not a first-line agent for erectile dysfunction — reserve for cases where PDE5 inhibitors fail, are contraindicated, or not tolerated
- Efficacy is modest and most evident in psychogenic erectile dysfunction
- Onset of action is delayed; maximal benefit may require 2–3 weeks of consistent use
- Tolerance and tachyphylaxis may develop with extended use — reassess efficacy periodically
- Patients with underlying anxiety are more likely to discontinue due to CNS stimulation
- Avoid unregulated ”herbal“ combination products claiming yohimbine — content is often unreliable and safety is unverified
- Always conduct baseline psychiatric screening before initiation
TAGS
yohimbine; erectile dysfunction; alpha-2 blocker; alpha-adrenergic antagonist; Schedule H; psychogenic ED; orthostatic hypotension; CNS stimulant; urology; India
VERSION
RxIndia v0.9 — 14 Feb 2026
REFERENCES
- Indian Pharmacopoeia (IP)
- CDSCO Database
- NLEM India — Not listed
- API Textbook of Medicine
- Goodman & Gilman’s The Pharmacological Basis of Therapeutics
- Indian urology specialist practice guidelines
- Selected RCTs for off-label use — marked accordingly where applicable
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Clinical Responsibility
This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
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