Coenzyme Q10: A Patient Guide

Written By Michael ROGER

What is Coenzyme Q10?

Coenzyme Q10 (CoQ10), also called ubiquinone, is a natural substance found in every cell of your body. It is especially abundant in organs that require a lot of energy, such as your heart, liver, and kidneys.[1] Your body can make CoQ10 on its own, but this production decreases as you age.[2]

CoQ10 plays two main roles in your body:
- It helps your cells produce energy
- It acts as an antioxidant, protecting your cells from damage[1][3]

Where is CoQ10 Found Naturally?

CoQ10 is present in small amounts in certain foods, particularly organ meats (liver, kidney) and fatty fish.[4] However, the amounts in food are generally too small to have significant therapeutic effects.[4]

Why Take a CoQ10 Supplement?

Several situations can lead to decreased CoQ10 levels in your body:
- Natural aging[2]
- Certain chronic diseases
- Taking certain medications, especially statins (cholesterol-lowering drugs)[5][2]

Medical Uses of CoQ10

1.Heart Failure

The most promising research involves heart failure. A major study called Q-SYMBIO showed that in patients with moderate to severe heart failure, taking 300 mg of CoQ10 daily for 2 years resulted in:[6][7][4][5]
- Reduced risk of death
- Fewer hospitalizations related to heart failure
- Improved functional capacity (ability to perform daily activities)

However, the American Heart Association notes that additional studies are needed before CoQ10 can be firmly recommended for heart failure.[7] At this time, there is insufficient evidence to support or refute the use of CoQ10 in patients with heart failure.[8]

2.Statin-Related Muscle Pain

Many patients taking statins (cholesterol-lowering medications) develop muscle pain. Studies on using CoQ10 for these symptoms show mixed results.[5][9][10] Some studies suggest benefit, while others find none. Despite this, many doctors recommend trying CoQ10 because it is safe and may help some patients.[5]

3.High Blood Pressure

CoQ10 may have a modest effect on reducing blood pressure, particularly in patients with diabetes or high cholesterol.[11][12] The optimal dose appears to be 100-200 mg per day.[12]

4.Other Potential Uses

Research is ongoing to evaluate CoQ10 for:[1][2][3]
- Migraines
- Neurodegenerative diseases (Parkinson's, Alzheimer's)
- Type 2 diabetes
- Chronic fatigue
However, the evidence for these conditions is still preliminary and requires more studies.

What Dose Should I Take?

The doses used in studies vary depending on the condition being treated:[5][8]
- For heart failure: 100 to 300 mg per day
- For statin-related muscle pain: 200 to 400 mg per day
- For high blood pressure: 100 to 200 mg per day
It is important to discuss the appropriate dose for your situation with your doctor.

Is CoQ10 Safe?

CoQ10 is generally very well tolerated, even at high doses and over long periods.[5][13][14][15] Side effects are rare and usually mild, including:
- Mild digestive problems (nausea, diarrhea, stomach discomfort)
- Insomnia (if taken in the evening)
- Dizziness
Studies have shown that CoQ10 is safe at doses up to 1200 mg per day.[13][14]

Drug Interactions

CoQ10 has few known drug interactions, but it is important to note that:[5]
- It may improve blood sugar control in diabetics (possible adjustment of diabetes medications needed)
- It may slightly lower blood pressure (possible adjustment of blood pressure medications needed)
- A possible interaction with warfarin (blood thinner) has been reported but not confirmed

Important Points to Remember

- CoQ10 is not approved by health authorities as a medication, but is available as a nutritional supplement[5]

- It should not replace your regular treatments, but can be used as a complement

- Always talk to your doctor before starting CoQ10, especially if you take other medications

- Effects may take several weeks to appear

- Choose quality products from reputable manufacturers

Conclusion

CoQ10 is a promising supplement, particularly for heart failure and possibly for statin-related muscle pain. It has an excellent safety profile. However, more research is needed to confirm its benefits in many conditions. If you are considering taking CoQ10, discuss it with your doctor to determine if it is appropriate for your situation.

 Written by Dr Michael Roger
Family Medicine Consultant

References

  1. Coenzyme Q10: Clinical Applications Beyond Cardiovascular Diseases. Testai L, Martelli A, Flori L, Cicero AFG, Colletti A. Nutrients. 2021;13(5):1697. doi:10.3390/nu13051697.

  2. Coenzyme Q10 in Aging and Disease. Gasmi A, Bjørklund G, Mujawdiya PK, et al. Critical Reviews in Food Science and Nutrition. 2024;64(12):3907-3919. doi:10.1080/10408398.2022.2137724.

  3. Coenzyme Q Supplementation for the Reduction of Oxidative Stress: Clinical Implications in the Treatment of Chronic Diseases. Gutierrez-Mariscal FM, Arenas-de Larriva AP, Limia-Perez L, et al. International Journal of Molecular Sciences. 2020;21(21):E7870. doi:10.3390/ijms21217870.

  4. Lifestyle Modifications for Preventing and Treating Heart Failure. Aggarwal M, Bozkurt B, Panjrath G, et al. Journal of the American College of Cardiology. 2018;72(19):2391-2405. doi:10.1016/j.jacc.2018.08.2160.

  5. Coenzyme Q for Patients With Cardiovascular Disease: JACC Focus Seminar. Raizner AE, Quiñones MA. Journal of the American College of Cardiology. 2021;77(5):609-619. doi:10.1016/j.jacc.2020.12.009.

  6. Coenzyme Q10 for Heart Failure. Al Saadi T, Assaf Y, Farwati M, et al. The Cochrane Database of Systematic Reviews. 2021;(2):CD008684. doi:10.1002/14651858.CD008684.pub3.

  7. Complementary and Alternative Medicines in the Management of Heart Failure: A Scientific Statement From the American Heart Association. Chow SL, Bozkurt B, Baker WL, et al. Circulation. 2023;147(2):e4-e30. doi:10.1161/CIR.0000000000001110.

  8. Coenzyme Q10 for Heart Failure. Covey C. American Family Physician. 2021;104(5):458-459.

  9. Effects of Coenzyme Q10 on Statin-Induced Myopathy: An Updated Meta-Analysis of Randomized Controlled Trials. Qu H, Guo M, Chai H, et al. Journal of the American Heart Association. 2018;7(19):e009835. doi:10.1161/JAHA.118.009835.

  10. Effect of Coenzyme Q10 on Statin-Associated Myalgia and Adherence to Statin Therapy: A Systematic Review and Meta-Analysis. Kennedy C, Köller Y, Surkova E. Atherosclerosis. 2020;299:1-8. doi:10.1016/j.atherosclerosis.2020.03.006.

  11. Coenzyme Q10 as Adjunctive Therapy for Cardiovascular Disease and Hypertension: A Systematic Review. Sue-Ling CB, Abel WM, Sue-Ling K. The Journal of Nutrition. 2022;152(7):1666-1674. doi:10.1093/jn/nxac079.

  12. Dose-Response Effect of Coenzyme Q10 Supplementation on Blood Pressure Among Patients With Cardiometabolic Disorders: A Grading of Recommendations Assessment, Development, and Evaluation (GRADE)-Assessed Systematic Review and Meta-Analysis of Randomized Controlled Trials. Zhao D, Liang Y, Dai S, et al. Advances in Nutrition (Bethesda, Md.). 2022;13(6):2180-2194. doi:10.1093/advances/nmac100.

  13. Safety Assessment of Coenzyme Q10 (CoQ10). Hidaka T, Fujii K, Funahashi I, Fukutomi N, Hosoe K. BioFactors (Oxford, England). 2008;32(1-4):199-208. doi:10.1002/biof.5520320124.

  14. Risk Assessment for Coenzyme Q10 (Ubiquinone). Hathcock JN, Shao A. Regulatory Toxicology and Pharmacology : RTP. 2006;45(3):282-8. doi:10.1016/j.yrtph.2006.05.006.

  15. Clinical Applications of Coenzyme Q10. Garrido-Maraver J, Cordero MD, Oropesa-Avila M, et al. Frontiers in Bioscience (Landmark Edition). 2014;19(4):619-33. doi:10.2741/4231.

Michael ROGER