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Yohimbine (Yocon, Yohimex) is derived from an herbal remedy. It appears to boost erectile function by improving blood flow. Studies have been inconclusive about its benefits, but a recent analysis of seven trials reported that between 34% and 75% of men achieved favorable results when taking 5 mg to 10 mg. The American Urologic Association does not recommend yohimbine for treating impotence, although some experts believe it is an inexpensive and reasonable option for some men. Yohimbine is available over the counter as an herbal remedy. It is not government regulated and brands vary in effectiveness and quality.

Side effects include nausea, insomnia, nervousness, and dizziness. Large doses of yohimbine can increase blood pressure and heart rate. One death has been reported from taking tablets of the standard dosage (5.4 mg). More rigorous studies are needed to confirm its effectiveness, and men suffering from anxiety or hypertension are cautioned against its use. To boost success rates, one study indicated that adding L-arginine, an amino acid, may be helpful.

Other Alternative Agents

Many alternative agents are marketed for impotence. Examples include the following:

• The Asian herbal remedies, gingko and ginseng, have been used to stimulate sexual function, although studies on these agents have been small and have had mixed results. One small study reported good results with Argin-Max, which contains a mix of vitamins and natural substances (L-arginine, ginseng, ginkgo). L- arginine, an amino acid, increases production of nitric oxide, a substance that relaxes blood vessels and promotes erections. Gingko, ginseng, and l-arginine can all have side effects, and the products containing them are not regulated.
• Many others are marketed for this condition. Very few have been studied and some can be harmful.

Warnings on Alternative Remedies Used for Erectile Dysfunction

Alternative or natural remedies are not regulated and their quality is not publicly controlled. In addition, any substance that can affect the bodys chemistry can, like any drug, produce side effects that may be harmful. There have been a number of reported cases of serious and even lethal side effects from so-called natural products.

Some so-called natural remedies have been found to contain standard prescription medication. Most reported problems occur in herbal remedies imported from Asia, with one study reporting a significant percentage of such remedies containing toxic metals. Even if studies report positive benefits, most, to date, are very small. In addition, the substances used in such studies are, in most cases, not what are being marketed to the public.

The following website is building a database of natural remedy brands that it tests and rates. Not all are yet available (www.consumerlab.com).

The Food and Drug Administration has a program called MEDWATCH for people to report adverse reactions to untested substances, such as herbal remedies and vitamins (800-332-1088).

The following are some alternative remedies used for erectile dysfunction.

Gamma-Butyrolactone (GBL). GBL is found in products marketed for improving sexual function (Verve, Jolt). This substance can convert to a chemical that can cause toxic and life-threatening effects, including seizures and even coma.

Ginseng. Ginseng has hormonal qualities and should not be used with estrogen. It has also been associated with a hypoglycemia (low blood sugar) and a higher risk for uterine bleeding. It may produce manic episodes, particularly in people on antidepressants. Of note, a great number of ginseng products have been found to contain little or no ginseng. Of particular concern are reports of pesticide and other toxic contaminants in many ginseng products. In one analysis, only nine out of 22 brands did not contain major contaminants. Among the brands that did not contain contaminants were Celestial Seasoning, Centrum, Ginsana, Walgreen's, and Root to Health American Ginseng.

Gingko. Although the risks for gingko appear to be low, there is an increased risk for bleeding at high doses and interaction with high doses of vitamin E, anti-clotting medications, aspirin, or other NSAIDs. Large doses have also been known to cause convulsion. Commercial gingko preparations have also been reported to contain colchicine, an agent that can be harmful in pregnant women and people with kidney or liver problems. It should be further noted that in a 2002 study one-third of 26 brands tested did not contain enough active ingredients to provide any effects at all.

L- arginine (also called arginine). Arginine may cause gastrointestinal problems. It can also lower blood pressure and change levels of certain chemicals and electrolytes in the body. It may increase the risk for bleeding. Some people have an allergic reaction to it, which in same cases may be severe. It may worsen asthma.

Aphrodisiacs. Aphrodisiacs are substances that are supposed to increase sexual drive, performance, or desire. Some examples include the following:

• Viramax is a well-marketed product that contains yohimbine and three herbal aphrodisiacs: catuaba, muira puama, and maca. It has not been proven to be either effective or safe, and interactions with medications are unknown.
• Spanish fly, or cantharides, which is made from dried beetles, is the most widely-touted aphrodisiac but can be particularly harmful. It irritates the urinary and genital tract and can cause infection, scarring, and burning of the mouth and throat. In some cases, it can be life threatening. No one should try any aphrodisiac without consulting a physician.

Other Alternative Products Marketed for Erectile Dysfunction. Vinarol is an over-the-counter supplement that has been recalled after reports that it contains the same ingredients as found in Viagra. Of note, herbal supplements sold as Viagro and Vaegra have no association with Viagra.