title: Acute neurotoxicity after yohimbine ingestion by a body builder.
abstract: Yohimbine is an alkaloid obtained from the Corynanthe yohimbe tree and other biological sources. Yohimbine is currently approved in the United States for erectile dysfunction and has undergone resurgence in street use as an aphrodisiac and mild hallucinogen. In recent years yohimbine use has become common in body-building communities for its presumed lipolytic and sympathomimetic effects. We describe a 37-year-old bodybuilder in which severe acute neurotoxic effects occurred in 2 h after yohimbine ingestion. The patient presented with malaise, vomiting, loss of consciousness, and repeated seizures after ingestion of 5 g of yohimbine during a body-building competition in a gymnasium. His Glasgow Coma Score was 3, requiring orotracheal intubation. Two hours after admission, vital signs were blood pressure 259/107 mmHg and heart rate 140 beats/min. Treatment with furosemide, labetalol, clonidine, and urapidil and gastrointestinal decontamination were performed. Twelve hours later the patient was extubated with normal hemodynamic parameters and neurological examination. The yohimbine blood levels at 3, 6, 14, and 22 h after ingestion were 5,240; 2,250; 1,530; and 865 ng/mL, respectively, with a mean half-life of 2 h. Few data are available about yohimbine toxicity and the related blood levels. This is a case of a large ingestion of yohimbine in which severe hemodynamic and neurological manifestations occurred and elevated blood levels of yohimbine were detected.
authors.affiliation: Pavia Poison Control Center and National Toxicology Information Centre, Toxicology Unit, IRCCS Maugeri Foundation and University of Pavia, Italy. andrea.giampreti@unipv.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Giampreti
authors.forename: Davide
authors.initials: D
authors.lastname: Lonati
authors.forename: Carlo
authors.initials: C
authors.lastname: Locatelli
authors.forename: Loretta
authors.initials: L
authors.lastname: Rocchi
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Campailla
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000317:Adrenergic alpha-Antagonists / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D020258:Neurotoxicity Syndromes / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014891:Weight Lifting; D015016:Yohimbine / Q000097:blood / Q000493:pharmacokinetics / Q000506:poisoning*
chemical_list: D000317:Adrenergic alpha-Antagonists; D015016:Yohimbine