Abstract
Purpose
Yohimbine is an indole alkaloid extracted from the bark of the Pausinystalia yohimbe tree, which has found a clinical application through the treatment of erectile dysfunction. Yohimbine is also widely used by the bodybuilding community for its sympathomimetic effects and its presumed lipolytic effects. This substance is, however, associated with adverse effects, including cardiac and neurologic side-effects, but only few fatal cases have been described to date. In this context, this manuscript aims at documenting a fatal case of a 27-year-old male.
Methods
Ethanol concentration determination and toxicological screening were performed using gas chromatography with flame ionization detection, liquid chromatography with diode array detection and gas chromatography with mass spectrometry detection. Liquid chromatography with diode array detection allowed the quantification of yohimbine.
Results
Toxicological analysis of subclavian blood, vitreous humor, and urine samples highlighted the presence of yohimbine and tramadol. Yohimbine was quantified at the concentration of 8000 µg/L in the peripheral blood and 2600 µg/L in the vitreous humor. Tramadol blood concentration was below the toxic threshold.
Conclusion
Only a very few number of yohimbine fatalities has been reported so far. In the current case, yohimbine acute intoxication appeared to be the most likely cause of death. In fact, the blood concentration highlighted here is the highest ever reported to date.
Similar content being viewed by others
References
Tam SW, Worcel M, Wyllie M (2001) Yohimbine: a clinical review. Pharmacol Ther 91:215–243. https://doi.org/10.1016/S0163-7258(01)00156-5
Le Corre P, Dollo G, Chevanne F, Le Verge R (1999) Biopharmaceutics and metabolism of yohimbine in humans. Eur J Pharm Sci 9:79–84. https://doi.org/10.1016/S0928-0987(99)00046-9
Berlan M, Verge RL, Galitzky J, Corre PL (1993) Mx2-Adrenoceptor antagonist potencies of two hydroxylated metabolites of yohimbine. Br J Pharmacol 108:927–932. https://doi.org/10.1111/j.1476-5381.1993.tb13488.x
Owen JA, Nakatsu SL, Fenemore J, Condra M, Surridge DHC, Morales A (1987) The pharmacokinetics of yohimbine in man. Eur J Pharm Sci 32:577–582. https://doi.org/10.1007/bf02455991
Kearney T, Tu N, Haller C (2010) Adverse drug events associated with yohimbine-containing products: a retrospective review of the California Poison Control System reported cases. Ann Pharmacother 44:1022–1029. https://doi.org/10.1345/aph.1P060
Schulz M, Iwersen-Bergmann S, Andresen H, Schmoldt A (2012) Therapeutic and toxic blood concentrations of nearly 1000 drugs and other xenobiotics. Crit Care 16:R136. https://doi.org/10.1186/cc11441
Giampreti A, Lonati D, Locatelli C, Rocchi L, Campailla MT (2009) Acute neurotoxicity after yohimbine ingestion by a body builder. Clin Toxicol (Phila) 47:827–829. https://doi.org/10.1080/15563650903081601
Cimolai N, Cimolai T (2011) Yohimbine use for physical enhancement and its potential toxicity. J Diet Suppl 8:346–354. https://doi.org/10.3109/19390211.2011.615806
McCarty MF (2002) Pre-exercise administration of yohimbine may enhance the efficacy of exercise training as a fat loss strategy by boosting lipolysis. Med Hypotheses 58:491–495. https://doi.org/10.1054/mehy.2001.1459
Anderson C, Anderson D, Harre N, Wade N (2013) Case study: two fatal case reports of acute yohimbine intoxication. J Anal Toxicol 37(8):611–614. https://doi.org/10.1093/jat/bkt057
U.S. Food and Drug Administration (2018) Guidance for industry: Bioanalytical method validation. https://www.fda.gov/media/70858/download. Accessed May 2018
Cimolai N (2017) An overview of yohimbine in sports medicine. In: Bagchi D (ed) Sustained energy for enhanced human functions and activity, 1st edn. Academic Press, Cambridge, pp 251–260
Gicquel T, Hugbart C, Le Devehat F, Lepage S, Baert A, Bouvet R et al (2016) Death related to consumption of Rauvolfia sp. powder mislabeled as Tabernanthe iboga. Forensic Sci Int 266:e38–e42. https://doi.org/10.1016/j.forsciint.2016.06.014
Pounder DJ, Osselton MD (2016) Autopsy findings: postmortem drug sampling and redistribution. In: Byard R, Payne-James J (eds) Encyclopedia of forensic and legal medicine, 2nd edn. Elsevier, Amsterdam, pp 348–353
Sastre C, Bartoli C, Baillif-Couniou V, Leonetti G, Pelissier-Alicot A-L (2018) Post mortem redistribution of drugs: current state of knowledge. Curr Pharm Des 23:5530–5541. https://doi.org/10.2174/1381612823666170622111739
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There are no financial, or other, relations that could lead to a conflict of interest.
Ethical approval
This article does not contain any studies with human participants or animals that were performed by any of the authors.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Drevin, G., Palayer, M., Compagnon, P. et al. A fatal case report of acute yohimbine intoxication. Forensic Toxicol 38, 287–291 (2020). https://doi.org/10.1007/s11419-019-00512-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11419-019-00512-y