Alternative Medicine – Coenzyme Q10 (Ubiquinone)

Background

As of 2020, ubiquinone, or coenzyme Q10 (CoQ10), was the 3rd most common nutritional supplement used behind fish oil and multivitamins.

CoQ10 is a benzoquinone compound that is fat-soluble and is synthesized in the body from tyrosine. In its reduced form, called ubiquinol, this compound is the only lipophilic antioxidant that can be generated by cells.

CoQ10 is mostly found in highly metabolically active tissues such as the heart, kidneys, and liver. This is because it is a key component of the electron transport chain and other oxidative processes.1

Dietary sources of this compound include fish, meat (especially animal hearts and livers), nuts, and certain oils. Some factors that can lower CoQ10 levels include changes in synthesis or metabolism, inadequate intake, oxidative stress (which leads to excessive use of ubiquinone), and aging.

Because only limited data is available, CoQ10 has not been FDA approved for any indication.1

Therapeutic Uses and Clinical Evidence

Due to genetic differences, aging, and certain medical conditions where oxidative stress plays a major role, some patients may have lower physiological concentrations of CoQ10. Therefore, ubiquinol can be used as a supplement in order to replenish CoQ10 levels and to support oxidative phosphorylation.

Some potential therapeutic indications of CoQ10 include cardiovascular diseases, neurodegenerative disorders (e.g. Alzheimer’s, Parkinson, Huntington diseases), statin-induced myopathy, cancer, diabetes, migraines, and male infertility.

However, robust clinical evidence is still lacking with past trials showing inconclusive or only possibly-effective results.2

For instance, three different clinical trials enrolled patients with statin-associated muscle symptoms (SAMS) and randomized them to receive CoQ10 (100-600 mg daily) or matching placebo. After 1-3 months of CoQ10 administration, the results were conflicting, with two of the studies showing no improvement in muscle pain and the other trial revealing reduction in mild-to-moderate muscular symptoms, when compared to placebo.3-5

Another randomized study of 420 patients with chronic heart failure showed improvement in morbidity (i.e. major adverse cardiac events) and overall mortality in the CoQ10 group compared to placebo. Nevertheless, the clinical significance of these results is difficult to ascertain given the small study population and limited external validity.6

Safety: ADRs, Cautions, and Contraindications

For the most part, side effects are rare but may include diarrhea, GI discomfort, headache, loss of appetite, and nausea. Allergic reactions, including tongue swelling, have also been reported.

Although drug-drug interaction studies are conflicting, CoQ10 may increase the metabolism of warfarin, which may lead to subtherapeutic warfarin levels.7 This is clinically significant in patients who take warfarin indefinitely for other cardiovascular conditions such as atrial fibrillation.

Other possible interacting drugs include theophylline, and certain chemotherapy agents. There are no absolute contraindications that have been identified to date, and pregnancy and lactation data is also lacking.7

Final Recommendation

Although the clinical significance of using CoQ10 is still unclear, this supplement has a good safety profile and is generally well-tolerated.

The studies performed thus far have shown some evidence for use in cardiovascular diseases, especially congestive heart failure.

The addition of CoQ10 to a patient’s regimen should always be discussed with healthcare providers to ensure the possible benefits outweigh the risks.

The ideal candidate for CoQ10 supplementation would be a patient at high risk of cardiovascular disease, or who does not tolerate statin therapy, and does not take warfarin or any other interacting drugs.

References

  1. Arenas-Jal M, Suñé-Negre JM, García-Montoya E. Coenzyme Q10 supplementation: Efficacy, safety, and formulation challenges. Compr Rev Food Sci Food Saf. 2020 Mar;19(2):574-594. doi: 10.1111/1541-4337.12539. Epub 2020 Feb 19. PMID: 33325173.
  2. Ayers, J., Cook, J., Koenig, R.A. et al. Recent Developments in the Role of Coenzyme Q10 for Coronary Heart Disease: a Systematic Review. Curr Atheroscler Rep 20, 29 (2018). https://doi-org.ezproxy.sju.edu/10.1007/s11883-018-0730-1
  3. Bookstaver DA, Burkhalter NA, Hatzigeorgiou C. Effect of coenzyme Q10 supplementation on statin-induced myalgias. Am J Cardiol. 2012 Aug 15;110(4):526-9. doi: 10.1016/j.amjcard.2012.04.026. Epub 2012 May 18. PMID: 22608359.
  4. Taylor BA, Lorson L, White CM, Thompson PD. A randomized trial of coenzyme Q10 in patients with confirmed statin myopathy. Atherosclerosis. 2015 Feb;238(2):329-35. doi: 10.1016/j.atherosclerosis.2014.12.016. Epub 2014 Dec 17. PMID: 25545331; PMCID: PMC4298455.
  5. Skarlovnik A, Janić M, Lunder M, Turk M, Šabovič M. Coenzyme Q10 supplementation decreases statin-related mild-to-moderate muscle symptoms: a randomized clinical study. Med Sci Monit. 2014 Nov 6;20:2183-8. doi: 10.12659/MSM.890777. PMID: 25375075; PMCID: PMC4226312.
  6. Mortensen SA, Rosenfeldt F, Kumar A, Dolliner P, Filipiak KJ, Pella D, Alehagen U, Steurer G, Littarru GP; Q-SYMBIO Study Investigators. 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. 2014 Dec;2(6):641-9. doi: 10.1016/j.jchf.2014.06.008. Epub 2014 Oct 1. PMID: 25282031.
  7. Ubiquinone. Lexi-Drugs. Hudson, OH: Lexicomp, 2021. http://online.lexi.com/. Updated Dec 20, 2021. Accessed June 14, 2022.