Coenzyme Q10 (CoQ10)—When and When Not to Use It with Your Patients

by Michael Stanclift, ND

It goes by many names, ubiquinol (“yoo-bik-quin-ol”), ubiquinone (“yoo-bik-quin-ohn”), coenzyme Q10, or everybody’s favorite nickname, CoQ10. It’s found all over the body, in our mitochondria, which gives you an idea of how important it is to our health. CoQ10 is a fat-soluble antioxidant that we get by eating oily fish, organ meats, and whole grains, and CoQ10’s job is to help us make energy and protect our cells from free radicals. A wide range of medical conditions can deplete CoQ10, such as cardiovascular diseases, chronic kidney disease, type II diabetes, and liver disease.¹ Our heart, muscles, brain, and kidneys are susceptible to damage when CoQ10 is deficient—which is why it has been used to help manage a range of conditions.¹ In this article, we’ll discuss what we currently know—where strong evidence suggests its use vs. where more research may be needed.

Studies showing no or mixed benefit of CoQ10 supplementation

• Statin-induced myopathies (muscle pain): Statin drugs indirectly block our body’s natural production pathway for making CoQ10, and since muscle pains are a commonly reported side effect with these drugs, it makes sense that CoQ10 would be an obvious choice for combatting these problems.² For years I made sure every patient on a statin was also on CoQ10, but during the research for this article I uncovered evidence that seemed to conflict with this practice.^3,4 A 2018 meta-analysis of randomized controlled trials suggests CoQ10 provided benefits to statin-induced muscle symptoms, but a more recent (2020) systematic review and meta-analysis was able to discover flaws in the methodology and provide evidence to the contrary.^3,5 Both the 2018 and 2020 articles were published in high-impact journals and provide varied findings.
• Parkinson’s disease: CoQ10 gets depleted in Parkinson’s patients, and numerous trials have tested its use in this population.⁶ Unfortunately, a systematic review of randomized controlled trials in Parkinson’s patients found CoQ10 supplementation did not improve symptoms or slow the decline of the disease.⁶
• Exercise performance: Because CoQ10 is an antioxidant and involved with the mitochondria, athletes, and clinicians who treat them, have looked at it in hopes of finding a performance advantage. A recent review of CoQ10 studies for exercise performance showed mixed results, which is to say “your results may vary.”⁷ For athletes looking to get an edge, it might be worth a try. Typical doses are between 100-300 mg/day with studies ranging from 1 week to 6 months.⁷

Studies showing a benefit with Coq10 supplementation

• Female infertility: A systematic review and meta-analysis looking at CoQ10 supplementation in women using assisted reproduction procedures found it nearly doubled pregnancy rates and had no effect on rates of live births or miscarriage rates.⁸ In women with poor ovarian response (POR), dosages used in the studies ranged between 600 mg and 1200 mg per day (often in divided doses) for 8-12 weeks.⁸ In women with polycystic ovarian syndrome (PCOS) the dosage used was 60 mg three times per day starting on their first or second cycle day until their hCG administration day.⁸
• Male infertility: For men looking to increase their fertility rate, treatment needed to be longer than in the women cited previously. In trials under three months’ duration, no benefits were observed; however, after six months of intervention, improvements were seen in sperm motility, total sperm count, concentration, and morphology.⁹ This makes sense, as sperm are essentially a small packet of genes with a rocket engine of mitochondria that propels the tail. Dosages used in these studies were between 200-300 mg per day.⁹
• Migraine headache: A 2021 meta-analysis looked at placebo-controlled studies using CoQ10 for migraine prevention.¹⁰ They found CoQ10 didn’t affect the severity of headaches but did help with reducing their duration (by 11 minutes) and frequency (1.52 fewer occurrences per month).¹⁰ Over time, this could mean significantly less time spent in the agony of a migraine, which for some patients would be worth trying.
• Diabetes: A recent systematic review of randomized controlled trials found CoQ10 supplementation can lower cardiovascular risks in diabetic patients by lowering total and LDL cholesterol levels.¹¹ The same review found CoQ10 also improves endothelial (blood vessel lining) health in this same population.¹¹
• Heart health: A recent in-depth systematic review of randomized placebo-controlled trials found CoQ10 benefits patients with congestive heart failure.¹² Heart failure causes a depletion of CoQ10, which further worsens the disease.¹² Supplementing CoQ10 can produce significant improvements in cardiac output, reduce hospitalizations, and improve survival by 24%.¹² Heart failure patients treated with CoQ10 also have improvements in exercise tolerance.¹³ Studies, including a Cochrane Review, looking at patients with hypertension found doses from 100-200 mg per day can decrease both systolic and diastolic blood pressures significantly.¹⁴ Systolic pressure lowered up to 17 mmHg, with diastolic lowered up to 10 mmHg.¹⁴ In patients with hypertension, providing CoQ10 may reduce nonfatal (relative risk reduction: 2.92; NNT: 34) and fatal heart attacks (relative risk reduction: 1.65; NNT: 60).¹⁵ In patients with coronary artery disease a dosage of 150 mg/day significantly lowered oxidative stress (measured as malondialdehyde) in 12 weeks, when compared to a 60 mg dose or placebo.¹⁶ CoQ10 given at 300 mg/day for two weeks before cardiac surgery also decreased oxidative stress and improved cardiac muscle recovery when compared to placebo.¹⁷

Side effects and drug-nutrient interactions:

CoQ10 appears to be safe and well-tolerated at dosages up to 1,200 mg/day.¹⁸ CoQ10 can possibly cause a rash and digestive upset, including nausea, vomiting, and diarrhea.¹⁹ CoQ10 can lower blood pressure, so careful monitoring is advised for patients on antihypertensives.^19,20 Alkylating agents used mostly for the treatment of cancer may interact with antioxidants, so caution is advised with this combination.²⁰ CoQ10 can also interact with some anticoagulants (blood thinners), such as anisindione, dicumarol, and warfarin.²¹

Citations

1. Hargreaves I et al. Disorders of human coenzyme Q10 metabolism: an overview. Int J Mol Sci. 2020;21(18):6695.
2. Sathasivam S et al. Statin induced myopathy. 2008;337:a2286.
3. Kennedy C et al. Effect of coenzyme Q10 on statin-associated myalgia and adherence to statin therapy: A systematic review and meta-analysis. 2020;299:1-8.
4. Zaleski AT et al. Coenzyme Q10 as treatment for statin-associated muscle symptoms-a good Idea, but…. Adv Nutr. 2018;9(4):519S-523S.
5. Qu H et al. Effects of coenzyme Q10 on statin-induced myopathy: an updated meta-analysis of randomized controlled trials. J Am Heart Assoc. 2018;7(19):e009835.
6. Negida A et al. Coenzyme Q10 for patients with Parkinson’s disease: a systematic review and meta-analysis. CNS Neurol Disord Drug Targets. 2016;15(1):45-53.
7. Mason SA et al. Antioxidant supplements and endurance exercise: Current evidence and mechanistic insights. Redox Biol. 2020;35:101471.
8. Florou P et al. Does coenzyme Q₁₀supplementation improve fertility outcomes in women undergoing assisted reproductive technology procedures? A systematic review and meta-analysis of randomized-controlled trials. J Assist Reprod Genet. 2020;37(10):2377-2387.
9. Salas-Huetos A et al. The effect of nutrients and dietary supplements on sperm quality parameters: a systematic review and meta-analysis of randomized clinical trials. Adv Nutr. 2018;9(6):833-848.
10. Sazali S et al. Coenzyme Q10 supplementation for prophylaxis in adult patients with migraine-a meta-analysis. BMJ Open. 2021;11(1):e039358.
11. Dludla PV et al. The impact of coenzyme Q₁₀on metabolic and cardiovascular disease profiles in diabetic patients: a systematic review and meta-analysis of randomized controlled trials. Endocrinol Diabetes Metab. 2020;3(2):e00118.
12. Jafari M et al. Coenzyme Q10 in the treatment of heart failure: a systematic review of systematic reviews. Indian Heart J. 2018;70 Suppl 1(Suppl 1):S111-S117.
13. Keogh A et al. Randomised double-blind, placebo-controlled trial of coenzyme Q, therapy in class II and III systolic heart failure. Heart Lung Circ. 2003;12(3):135-141.
14. Gutierrez-Mariscal FM et al. Coenzyme Q₁₀and cardiovascular diseases. Antioxidants (Basel). 2021;10(6):906.
15. Shah IA et al. Role of Coenzyme Q10 in prophylaxis of myocardial infarction. Cureus. 2021;13(2):e13137.
16. Lee BJ et al. Coenzyme Q10 supplementation reduces oxidative stress and increases antioxidant enzyme activity in patients with coronary artery disease. Nutrition. 2012;28(3):250-255.
17. Rosenfeldt F et al Coenzyme Q10 therapy before cardiac surgery improves mitochondrial function and in vitro contractility of myocardial tissue. J Thorac Cardiovasc Surg. 2005;129(1):25-32.
18. Hathcock JN et al. Risk assessment for coenzyme Q10 (Ubiquinone). Regul Toxicol Pharmacol. 2006;45(3):282-288.
19. CoQ10 side effects. Drugs.com. https://www.drugs.com/sfx/coq10-side-effects.html. Accessed February 1, 2022)
20. Natural Medicines Comprehensive Database. http://naturaldatabaseconsumer.therapeuticresearch.com/(X(1)S(43cuc455dfizyrrfaojn3o45))/nd/Search.aspx?cs=kaiser~cepda&s=NDC&pt=100&sh=1&id=938&searchid=64544724. Accessed February 1, 2022.
21. CoQ10 (ubiquinone) interactions. Drugs.com. https://www.drugs.com/drug-interactions/ubiquinone,coq10.html. Accessed February 1, 2022.

Michael Stanclift, ND graduated from Bastyr University’s school of naturopathic medicine and practiced in Edinburgh, Scotland, and Southern California. He enjoys educating other healthcare providers and impacting the lives of their many patients. When he’s not working, he spends his hours with his wife and two children.