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Coenzyme Q10

By

Laura Shane-McWhorter

, PharmD, University of Utah College of Pharmacy

Last full review/revision Jul 2020| Content last modified Jul 2020
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Coenzyme Q10 (CoQ10, ubiquinone) is an antioxidant, produced naturally in humans, that is also a cofactor for mitochondrial ATP generation. The levels of CoQ10 seem to be lower in older people and in people with chronic diseases, such as cardiac problems, cancer, Parkinson disease, diabetes, HIV/AIDS, and muscular dystrophies. However, it is not known whether these low levels contribute to these disorders. Rich dietary sources are meat, fish, and vegetable oils. Most trials recommended that the supplement dose range between 100 and 300 mg/day (eg, 100 mg 3 times a day).

Claims

CoQ10 is said to be useful because of its antioxidant effect and role in energy metabolism. Specific claims include an anticancer effect mediated by immune stimulation, decreased insulin requirements in patients with diabetes, slowed progression of Parkinson disease, efficacy in treatment of heart failure, and protection against anthracycline cardiotoxicity. The most prominent claim may be ameliorating endothelial cell dysfunction that contributes to cardiovascular disease. Although some preliminary studies suggest CoQ10 may be useful in treating these disorders, results are unclear and more testing is needed.

Evidence

A 2012 meta-analysis evaluated 5 randomized, controlled trials with a total of 194 patients and found a significant improvement in endothelial function, as measured by flow-mediated peripheral arterial dilation (1).

A 2013 meta-analysis of randomized controlled trials suggested that CoQ10 may improve functional status in patients with heart failure (2). However, this meta-analysis consisted of trials mainly of small size and short duration of treatment.

A 2014 randomized, controlled, multicenter study of 420 patients with heart failure showed that CoQ10, 100 mg orally 3 times a day, when added to standard therapy, was safe, relieved symptoms, and reduced major cardiovascular events (3). In these meta-analyses, the doses and target blood levels of CoQ10 were not standardized, a further limitation.

A Cochrane review of 7 studies (914 subjects) concluded there was no evidence to support or disprove CoQ10 for heart failure (4), while a 2017 meta-analysis of 14 randomized controlled trials (2149 subjects) stated that CoQ10 users had greater exercise capacity and lower mortality than those on placebo (5). A clinical controversy is whether CoQ10 supplementation decreases statin-associated muscle symptoms. Some studies have shown decreases, while others have not. A 2018 meta-analysis of 100 to 600 mg daily of CoQ10 for 30 days to 3 months reported significant decreases in muscle symptoms of pain, weakness, cramps, and tiredness, compared to placebo. A limitation was heterogeneity of the included studies (6).

Adverse effects

There are relatively few case reports of gastrointestinal symptoms (eg, loss of appetite, abdominal pain, nausea, vomiting) and central nervous system symptoms (eg, dizziness, photophobia, irritability, headache). Other adverse effects include itching, rash, fatigue, and flu-like symptoms.

Drug interactions

CoQ10 may decrease response to warfarin.

Coenzyme Q10 references

  • Gao L, Mao Q, Cao J, et al: Effects of coenzyme Q10 on vascular endothelial function in humans: a meta-analysis of randomized controlled trials. Atherosclerosis 221(2):311-316, 2012. doi: 10.1016/j.atherosclerosis.2011.10.027.

  • Fotino AD, Thompson-Paul AM, Bazzano LA: Effect of coenzyme Q10 supplementation on heart failure: a meta-analysis. Am J Clin Nutr 97(2):268-275, 2013.

  • Mortensen SA, Rosenfeldt F, Kumar A, et al: The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure results from Q-SYMBIO: a randomized double-blind trial. JACC Heart Fail 2(6):641-649, 2014. doi:10.1016/j.jchf.2014.06.008.

  • Madmani ME, Yusuf Solaiman A, Tamr Agha K, et al: Coenzyme Q10 for heart failure. Cochrane Database Syst Rev (6):CD008684, 2014. doi: 10.1002/14651858.CD008684.pub2.

  • Lie L, Liu Y: Efficacy of coenzyme Q10 in patients with cardiac failure: a meta-analysis of clinical trials. BMC Cardiovasc Disord 17(1):196, 2017. doi:  10.1186/s12872-017-0628-9.

  • Qu H, Guo M, Chai H, et al: Effects of coenzyme Q10 on statin-induced myopathy: an updated meta-analysis of randomized controlled trials. J Am Heart Assoc 2;7(19):e009835, 2018. doi: 10.1161/JAHA.118.009835.

More Information

The following is an English-language resource that may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

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COUMADIN
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