Yohimbine
Place in Therapy
Place in Therapy
There is limited evidence available for the use of yohimbine in the treatment of xerostomia. Three randomized control trials have been completed exploring the effects of oral yohimbine on salivary excretion. Two of these trials involved patients diagnosed with depression according to DSM criteria and being treated with a tricyclic antidepressant. These studies found a statistically significant increase in salivary volume; however, subjective measures such as symptom improvement and patient satisfaction were not included as study outcomes.
The safety of oral yohimbine is not well established in patients using antidepressant medications. The small randomized control trials performed in this population reported limited side effects but did not include an assessment of impact on antidepressant therapy. Natural Standard recommends avoiding the use of yohimbine in patients taking tricyclic antidepressants as the risk of adverse events such as hypertension and serotonin syndrome may be increased. Natural Standard further advises that the use of yohimbine in patients with psychiatric disorders may exacerbate anxiety, panic attacks, impulsivity, or manic episodes secondary to monoamine oxidase inhibitory activity.
For these reasons, the use of yohimbine for xerostomia should be reserved for patients using psychotropic medications that have not had relief from safer agents with more efficacy data. This agent is Schedule 1 in Canada; however, the dried bark of the yohimbe tree is used as a tea and can be purchased in Canada. The concentrated extract, yohimbe, and its’ salts should never be recommended without consultation with a physician and a legal prescription.
References:
Bagheri H, L Schmitt, M Berian, and JL Montastuc. A comparative study of the effects of yohimbine and anetholtrithione on salivary secretion in depressed patients treated with psychotropic drugs. Eur J Clin Pharmacol. 1997; 52:339-342.
Chatelut E, Y Rispail, M Berlan, JL Montastruc. Yohimbine increases human salivary secretion. Br J clin Pharmac. 1989; 28: 366-368
Bagheri H, L Schmitt, M Berlan and JL Montastruc. Effect of 3 weeks treatment with yohimbine on salivary secretion in healthy volunteers and in depressed patients treated with tricyclic antidepressants. Br J clin Pharmac. 1992; 34: 555-558.
Natural Standard Professional Monograph. Yohimbe bark extract. Available at: http://www.naturalstandard.com.proxy.lib.uwaterloo.ca/databases/herbssupplements/yohimbe.asp? Accessed July 15, 2013. Natural Standard Research Collaboration, 2013.
There is limited evidence available for the use of yohimbine in the treatment of xerostomia. Three randomized control trials have been completed exploring the effects of oral yohimbine on salivary excretion. Two of these trials involved patients diagnosed with depression according to DSM criteria and being treated with a tricyclic antidepressant. These studies found a statistically significant increase in salivary volume; however, subjective measures such as symptom improvement and patient satisfaction were not included as study outcomes.
The safety of oral yohimbine is not well established in patients using antidepressant medications. The small randomized control trials performed in this population reported limited side effects but did not include an assessment of impact on antidepressant therapy. Natural Standard recommends avoiding the use of yohimbine in patients taking tricyclic antidepressants as the risk of adverse events such as hypertension and serotonin syndrome may be increased. Natural Standard further advises that the use of yohimbine in patients with psychiatric disorders may exacerbate anxiety, panic attacks, impulsivity, or manic episodes secondary to monoamine oxidase inhibitory activity.
For these reasons, the use of yohimbine for xerostomia should be reserved for patients using psychotropic medications that have not had relief from safer agents with more efficacy data. This agent is Schedule 1 in Canada; however, the dried bark of the yohimbe tree is used as a tea and can be purchased in Canada. The concentrated extract, yohimbe, and its’ salts should never be recommended without consultation with a physician and a legal prescription.
References:
Bagheri H, L Schmitt, M Berian, and JL Montastuc. A comparative study of the effects of yohimbine and anetholtrithione on salivary secretion in depressed patients treated with psychotropic drugs. Eur J Clin Pharmacol. 1997; 52:339-342.
Chatelut E, Y Rispail, M Berlan, JL Montastruc. Yohimbine increases human salivary secretion. Br J clin Pharmac. 1989; 28: 366-368
Bagheri H, L Schmitt, M Berlan and JL Montastruc. Effect of 3 weeks treatment with yohimbine on salivary secretion in healthy volunteers and in depressed patients treated with tricyclic antidepressants. Br J clin Pharmac. 1992; 34: 555-558.
Natural Standard Professional Monograph. Yohimbe bark extract. Available at: http://www.naturalstandard.com.proxy.lib.uwaterloo.ca/databases/herbssupplements/yohimbe.asp? Accessed July 15, 2013. Natural Standard Research Collaboration, 2013.