Yohimbine plus sildenafil (Viagra)
I was careful trying the combination of yohimbine and sildenafil citrate, but I am glad I did. This is one of the few cases where a combination clearly is superior to either of the drugs alone, at least in my personal experience.
I started combining 5 to 10 milligrams of yohimbine with 10 to 20 milligrams of sildenafil citrate, and the results were surprisingly good; they were definitely better than the results for sildenafil citrate alone.
While a phosphodiesterase inhibitor alone may be a reliable agent in bringing about an erection, even in men who otherwise cannot achieve one, phosphodiesterase inhibitors have far less of a central mental effect than does yohimbine. If the aim is making good sex better, and not just making intercourse physically possible, then yohimbine alone has an edge over a phosphodiesterase inhibitor alone regarding libido.
However, as stated above, I have found the combination of a regular dose of yohimbine with a comparatively small dose of sildenafil citrate to be a surprisingly pleasant experience. Though for both medications, cardiovascular issues are cited as possible side effects, I myself did not experience any complications. (Medical Note: Combining yohimbine, which can raise heart rate and blood pressure, with sildenafil, a systemic vasodilator that lowers blood pressure, can lead to unpredictable cardiovascular effects, including reflex tachycardia, severe headaches, and blood pressure instability. This combination carries significant medical risks and should only be attempted under strict medical supervision.) The sildenafil citrate just resulted in a very quick and lasting erectile reflex, while the yohimbine provided the usual mental and physical sexual tension as a base on which to start. The effects of sildenafil citrate wore off faster than those of the yohimbine (sildenafil citrate = 4 to 6 hours, yohimbine around 12 to 20 hours).
I have tried to increase the sildenafil component in the combination but achieved no better results. When going up to 50 milligrams of sildenafil citrate, I actually seemed to have weaker orgasms than on some 20 milligrams. The 20 milligrams of sildenafil citrate in combination with the yohimbine already provided an erection that didn’t leave much to be desired, so any further attempts could only target orgasm strength. To that end, reducing the sildenafil to some 20 milligrams is actually helpful for my specific physiology.
On the other hand, further increasing the yohimbine component gives me tachycardia (increased heartbeat), which I’d like to avoid if possible. In the case of combining yohimbine with sildenafil citrate, I was lucky to have found the combination that works best for me right in my first trial.
Please note: sildenafil alone is a disappointment for me; it produces an erection all right, but an erection alone doesn’t result in desire, and without increased desire, intercourse is boring.
I am not a physician. Therefore, my report on my own experience is not intended as medical advice. I myself meanwhile have a good tolerance for yohimbe/yohimbine. Still, between sildenafil citrate and yohimbine, the latter is more likely to cause unpleasant side effects. Whoever intends to experiment with a combination of sildenafil citrate and yohimbine should start with very low dosages of both medications, just to see how well they are tolerated, and ideally consult a doctor first.
While sildenafil citrate is a prescription medication in the US and most other countries, yohimbine is widely available as an over-the-counter dietary supplement (though prescription yohimbine HCl historically existed). I am not aware of physicians commonly prescribing the two in tandem. They generally do not, due to the cardiovascular risks mentioned above. It also doesn't seem as if Pfizer would have done studies of the two drugs in combination, or that the FDA would have required such studies. Pfizer’s interest is obviously in marketing sildenafil citrate, not in promoting another therapeutic agent like yohimbine.