Yohimbine toxicity

Background

Indole alkylamine from West African Yohimbine tree (Corynanthe yohimbe)
α2-adrenergic antagonist with cholinergic activity
Commonly used for treating erectile dysfunction. Also, for other uses (eg, postural hypotension); marketed as athletic performance enhancers, dieting agent.
Can be obtained via prescription.

Clinical Features

• Tachycardia
• Hypertension
• Mydriasis
• Nausea, vomiting, salivation
• Anxiety
• Large ingestions may cause mania, bronchospasm, lupus-like syndrome

Management

Symptomatic patients:
Benzodiazepines for agitation/anxiety/sympathomimetic effects

Avoid β-Adrenergic antagonists - may lead to unopposed α1-adrenergic activity → ↑ hypertension

References

Chu J. Genitourinary Principles. In: Hoffman RS, Howland M, Lewin NA, Nelson LS, Goldfrank LR. eds. Goldfrank's Toxicologic Emergencies, 10e New York, NY: McGraw-Hill; 2015.