The following is the summary of “Intracranial hemorrhage after a single dose of Yohimbine in a chronic user of clonidine” published in the December 2022 issue of Emergency medicine by Hodapp, et al.
Yohimbine is an alpha-2 adrenoreceptor antagonist that has been used to treat low libido, erectile dysfunction, dry mouth, and to increase weight loss. The example below of a girl with intracranial hemorrhage (ICH) after ingesting yohimbine demonstrates the sympathomimetic state brought on by yohimbine poisoning. An hour after taking a female sexual enhancement pill (BioXgenic Nature’s Desire) containing yohimbine, a 39-year-old woman went to the emergency department (ED) complaining of nausea, emesis, and flushing. At the first sign of symptoms, the patient took her 0.1 mg dose of clonidine. The patient’s blood pressure was 198/93 when they were first seen. She suffered neurological consequences like a drooping left half of her face and weakened right limbs. Acute hemorrhage in the basal ganglia with minimal mass effect and subarachnoid hemorrhage was seen on computed tomography.
She was taken to a larger hospital for treatment, and 16 days later, despite continuing neurological complications, she was released to a rehabilitation facility. Temporary sympathetic toxicity was observed after yohimbine administration in this patient. Multiple elements in our patient’s background raised the odds of a negative reaction to yohimbine. Researchers have found that long-term clonidine treatment reduces alpha-2 receptor activity. This results in clonidine reliance for adrenergic homeostasis and may enhance yohimbine’s effects. This patient’s sympathomimetic response was likely exacerbated by the concomitant use of bupropion and desvenlafaxine, both of which impede norepinephrine reuptake. However, because researchers did not perform confirmatory tests of yohimbine content and the possibility of adulterants, researchers were unable to draw a conclusive association between yohimbine and our patient’s ICH. Multiple studies show that supplement components can vary despite label claims, suggesting that the supplement market is not strictly regulated by the FDA.
Since the Food and Drug Administration does not mandate safety or efficacy testing for dietary supplements, it is crucial that companies provide transparent post-marketing information about the risks associated with using different supplements. Users need to be aware of the potential toxicity of yohimbine-containing products. It is critical for doctors and patients to be aware of the potential drug-supplement interactions of yohimbine and the emergence of sympathomimetic symptoms.
Source: sciencedirect.com/science/article/abs/pii/S0735675722005551
