Oral yohimbine increases blood pressure and sympathetic nervous outflow in hypertensive patients

Yohimbine is an α₂-adrenoceptor antagonist that is FDA approved for treatment of impotence. The drug is an indolalkylamine alkaloid chemically similar to reserpine and is believed to act through sympatholysis. We examined effects of oral yohimbine on blood pressure (BP) and plasma levels of catechols in patients with essential hypertension, a condition in which most drug treatments can produce impotence. In 25 unmedicated hypertensive subjects, vital signs were measured and blood samples were obtained through an indwelling ante-cubital venous catheter at baseline and 1 and 2 h after subjects ingested 4 5.4-mg tablets of yohimbine. Mean blood pressure (MBP) increased by an average of 5 mm Hg (p < 0.01), plasma norepinephrine (NE) levels increased by 66% (p < 0.001), and plasma dihydroxyphen-ylglycol (DHPG) levels increased by 25% (p < 0.01) at 1 h after drug administration. The magnitude of the pressor response was unrelated to baseline MBP but positively correlated with the baseline NE level (r = 0.61, p < 0.01) and with the yohimbine-induced increment in plasma NE (r = 0.4, p < 0.01). The results indicate that yohimbine does not inhibit and actually stimulates sympathetically mediated NE release in humans and that the increased NE release produces a pressor response. Yohimbine should be administered with caution to patients with high BP, especially in individuals with evidence for increased basal sympathetic outflow or those undergoing concurrent treatment with tricyclic antidepressants or other drugs that interfere with neuronal uptake or metabolism of NE.