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Complementary Medicine - Cam

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Coenzyme Q10

Coenzyme Q10

Uses

What Are Star Ratings?

Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.

For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.

3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.

2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.

1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

This supplement has been used in connection with the following health conditions:

Used for Why
3 Stars
Angina
150 mg daily
CoQ10 contributes to the heart’s energy-making mechanisms. Angina patients given CoQ10 have experienced greater ability to exercise without chest pain.

Coenzyme Q10  contributes to the energy-making mechanisms of the heart. Angina patients given 150 mg of coenzyme Q10 each day have experienced greater ability to exercise without experiencing chest pain.1 This has been confirmed in independent investigations.2

3 Stars
Heart Attack
500 to 800 mcg daily
Taking CoQ10 may help reduce complications following a heart attack.

Coenzyme Q10 (CoQ10) also contributes to the energy-making mechanisms of the heart and has been reported to lower lipoprotein(a), a risk factor for heart disease .3 Animal studies confirm CoQ10’s ability to protect heart muscle against reduced blood flow.4 , 5 In one double-blind trial, either 120 mg of CoQ10 or placebo was given to people who had recently survived a heart attack. After 28 days, the CoQ10 group had experienced significantly fewer repeat heart attacks, fewer deaths from heart disease, and less chest pain than the placebo group.6 In another double-blind study of people suffering a heart attack, supplementation with 60 mg of coenzyme Q10 twice a day for one year significantly reduced the incidence of recurrent cardiac events (fatal or non-fatal heart attack). 7 Treatment was begun within 72 hours of the onset of the heart attack. CoQ10 used with selenium (see below) has also been reported to increase the rate of heart attack survival.8

The relation between selenium and protection from heart attacks remains uncertain. Low blood levels of selenium have been reported in people immediately following a heart attack,9 suggesting that heart attacks may increase the need for selenium. However, other researchers claim that low selenium levels are present in people before they have a heart attack, suggesting that the lack of selenium might increase heart attack risk.10 One report found that low blood levels of selenium increased the risk of heart attack only in smokers,11 and another found the link only in former smokers.12 Yet others have found no link between low blood levels of selenium and heart attack risk whatsoever.13 In a double-blind trial, individuals who already had one heart attack were given 100 mcg of selenium per day or placebo for six months.14 At the end of the trial, there were four deaths from heart disease in the placebo group but none in the selenium group (although the numbers were too small for this difference to be statistically significant). In other controlled research, a similar group was given placebo or 500 mcg of selenium six hours or less after a heart attack followed by an ongoing regimen of 100 mcg of selenium plus 100 mg of coenzyme Q10 per day.15 One year later, six people had died from a repeat heart attack in the placebo group, compared with no heart attack deaths in the supplement group. Despite the lack of consistency in published research, some doctors recommend that people at risk for a heart attack supplement with selenium—most commonly 200 mcg per day.

3 Stars
Hypertension
100 mg twice per day
Taking coenzyme Q10 may have a significant impact on blood pressure.

Both preliminary16 , 17 , 18 and double-blind19 , 20 trials have reported that supplementation with coenzyme Q10 (CoQ10) leads to a significant decrease in blood pressure in people with hypertension. Much of this research has used 100 mg of CoQ10 per day for at least ten weeks.

2 Stars
Athletic Performance
Refer to label instructions
Strenuous physical activity lowers blood levels of coenzyme Q10 (CoQ10). A few studies have reported that CoQ10 supplementation benefitted some trained athletes.

Strenuous physical activity lowers blood levels of coenzyme Q10 (CoQ10).21 However, while some studies have shown that CoQ10 improves the way the healthy body responds to exercise,22 other studies have found no improvement.23 , 24 , 25 , 26 A few studies, using at least four weeks of CoQ10 supplementation at 60 to 100 mg per day, have reported improvements in measures of work capacity ranging from 3 to 29% in sedentary people and from 4 to 32% in trained athletes.27 However, recent double-blind and/or placebo-controlled trials in trained athletes, using performance measures such as time to exhaustion and total performance, have found either no significant improvement or significantly poorer results in those taking CoQ10.28 , 29 , 30

2 Stars
Cardiomyopathy
100 to 150 mg daily
Most studies using coenzyme Q10 in treating cardiomyopathy have shown positive results, including improved quality of life, heart function tests, and survival rates.

People with dilated congestive cardiomyopathy (DCM) have been shown to be deficient in coenzyme Q10 .31 Most studies using coenzyme Q10 in the treatment of cardiomyopathy have demonstrated positive results, including improved quality of life, heart function tests, and survival rates.32 , 33 , 34 Coenzyme Q10 also has been shown to improve cardiac function in people with hypertrophic cardiomyopathy—a less common form of cardiomyopathy.35 A few studies, however, have found no benefit from CoQ10 supplementation in treating people with cardiomyopathy.36 , 37 Despite a lack of consistency in the outcomes of published research, many doctors recommend that 100 to 150 mg be taken each day, with meals.

2 Stars
Congestive Heart Failure
0.9 mg daily per pound of body weight with a doctor's supervision
CoQ10 enhances the production of energy in the heart muscle and has been reported to help people with CHF, sometimes dramatically.

As is true for several other heart conditions, coenzyme Q10 (CoQ10) has been reported to help people with congestive heart failure,38 , 39 sometimes dramatically.40 Positive effects have been confirmed in double-blind research41 and in an overall analysis of eight controlled trials.42 However, some double-blind trials have reported modest43 or no improvement44 , 45 , 46 in exercise capacity or overall quality of life. Most CoQ10 research used 90–200 mg per day. The beneficial effects of CoQ10 may not be seen until after several months of treatment. In one preliminary trial, treatment with ubiquinol (the chemically reduced form of CoQ10) was beneficial for people with severe heart failure, after the standard form of CoQ10 had been ineffective.47 Discontinuation of CoQ10 supplementation in people with congestive heart failure has resulted in severe relapses and should only be attempted under the supervision of a doctor.48

2 Stars
Gingivitis
50 to 60 mg daily
Supplementing with CoQ10 may reduce gingivitis symptoms and repair damaged gum tissues.

Preliminary evidence has linked gingivitis to a coenzyme Q10 (CoQ10) deficiency.49 Some researchers believe this deficiency could interfere with the body’s ability to repair damaged gum tissue. In a double-blind trial, 50 mg per day of CoQ10 given for three weeks was significantly more effective than a placebo at reducing symptoms of gingivitis.50 Compared with conventional approaches alone, topical CoQ10 combined with conventional treatments resulted in better outcomes in a group of people with periodontal disease.51

2 Stars
Halitosis and Gum Disease
50 to 60 mg daily
Coenzyme Q10 is often recommended by doctors to help prevent and treat periodontitis.

Nutritional supplements recommended by some doctors for prevention and treatment of periodontitis include vitamin C (people with periodontitis are often found to be deficient),52 vitamin E , selenium , zinc, coenzyme Q10 , and folic acid .53 Folic acid has also been shown to reduce the severity of gingivitis when taken as a mouthwash.54

2 Stars
Macular Degeneration (Acetyl-L-Carnitine, Fish Oil)
Follow label directions
In one study, supplementing with a proprietary blend of acetyl-L-carnitine, fish oil, and coenzyme Q10 improved visual function in people with macular degeneration.

In a double-blind study, supplementation with a proprietary blend of acetyl-L-carnitine , omega-3 fatty acids from fish oil , and coenzyme Q10 for 12 months resulted in an improvement in both visual function and in objective findings on eye examination (a decrease in the drusen-covered area on the retina).55

2 Stars
Migraine Headache
100 to 150 mg daily
In a preliminary trial, supplementation with coenzyme Q10 for three months reduced the average number of days with migraine headaches by 60%.

Blood levels of coenzyme Q10 have been found to be low in about one-third of migraine sufferers.56 In a preliminary trial, supplementation of migraine sufferers with 150 mg per day of coenzyme Q10 for three months reduced the average number of days with migraine headaches by 60%.57 The beneficial effect of coenzyme Q10 was confirmed in a four-month double-blind study. By the fourth month of treatment, a reduction in migraine frequency of 50% or greater occurred in 47.6% of people receiving 100 mg of coenzyme Q10 three times a day, but in only 14.4% of those receiving a placebo (a statistically significant difference).58 However, another double-blind trial found that coenzyme Q10 was not more effective than a placebo in children with recurrent migraines, although children receiving coenzyme Q10 appeared to improve faster than those given the placebo.59

2 Stars
Parkinson’s Disease
1,200 mg a day
In a double-blind trial, coenzyme Q10 given to people with early Parkinson's disease significantly slowed the progression of the disease.

In a double-blind trial, administration of 1,200 mg of coenzyme Q10 per day for 16 months to people with early Parkinson's disease significantly slowed the progression of the disease, compared with a placebo.60 Smaller amounts of CoQ10 were slightly more effective than placebo, but the difference was not statistically significant.
2 Stars
Preeclampsia
200 mg per day
In a double-blind study at women who were at high risk of developing preeclampsia, supplementing with coenzyme Q10 reduced the incidence of preeclampsia by 44%.

Pregnant women with preeclampsia have significantly lower plasma coenzyme Q10 levels, when compared with women with healthy pregnancies. In a double-blind study at women who were at high risk of developing preeclampsia, supplementing with coenzyme Q10 reduced the incidence of preeclampsia by 44%. The amount used was 200 mg per day; treatment was begun during the twentieth week of pregnancy and continued until delivery.61

2 Stars
Type 2 Diabetes
120 mg daily of a standardized herbal extract
Supplementing with CoQ10 may improve blood sugar metabolism.
Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. People with type 2 diabetes have been found to have significantly lower blood levels of CoQ10 compared with healthy people.62 In one trial, blood sugar levels fell substantially in 31% of people with diabetes after they supplemented with 120 mg per day of CoQ7, a substance similar to CoQ10.63 The importance of CoQ10 supplementation for people with diabetes remains an unresolved issue, though some doctors recommend approximately 50 mg per day as a way to protect against possible effects associated with diabetes-induced depletion.
1 Star
Alzheimer’s Disease (Iron, Vitamin B6)
Refer to label instructions
A combination of coenzyme Q10, iron (sodium ferrous citrate), and vitamin B6 may improve mental status in people with Alzheimer’s disease.

In a preliminary report, two people with a hereditary form of Alzheimer’s disease received daily: coenzyme Q10 (60 mg), iron (150 mg of sodium ferrous citrate), and vitamin B6 (180 mg). Mental status improved in both patients, and one became almost normal after six months.64

1 Star
Breast Cancer
Refer to label instructions
Some studies have found that women who take CoQ10 have a greater chance of remaining cancer-free after breast-cancer treatment.

French researchers have reported that the lower the blood level of CoQ10 in breast cancer patients, the worse the chance of remaining free of disease.65 For several years, researchers from Denmark and the United States have been studying the effects CoQ10 in a group of 32 breast cancer patients who were either at high risk of suffering a recurrence or had already been diagnosed with advanced disease.66 After 18 months, only one patient had suffered a recurrence, all were still alive, those who did not have advanced disease at the beginning of the trial had not progressed to advanced disease, one patient with advanced disease had stabilized, and two patients with advanced disease had significantly improved.67 Patients continued to do well after two years of supplementation,68 and after three to five years, surprising improvements were reported in two patients who had had advanced disease at the beginning of the trial.69

At first, 90 mg of CoQ10 per day was used. In subsequent reports, the amount of CoQ10 was increased until some women were receiving 390 mg per day.70 Initially, the CoQ10 was accompanied by the use of many other supplements.71 The researchers of this trial have attributed the therapeutic effects observed primarily to CoQ10 and, in later reports, no further mention of other supplements was made.72 , 73 , 74

This preliminary investigation has been conducted with no control group, and published reports have provided only sketchy details about the conditions of most of the women being studied. Some of the patients were given conventional treatments along with CoQ10. Therefore, CoQ10 remains unproven as a cancer treatment.

1 Star
Chronic Obstructive Pulmonary Disease
Refer to label instructions
CoQ10 levels have been found to be low in people with COPD. Supplementing with CoQ10 improved blood oxygenation, exercise performance, and heart rate in one study.

Researchers have also given coenzyme Q10 (CoQ10) to people with COPD after discovering their blood levels of CoQ10 were lower than those found in healthy people.75 In that trial, 90 mg of CoQ10 per day, given for eight weeks, led to no change in lung function, though oxygenation of blood improved, as did exercise performance and heart rate. Until more research is done, the importance of supplementing with CoQ10 for people with COPD remains unclear.
1 Star
Fibromyalgia
Refer to label instructions
In a preliminary trial, headaches and overall symptoms in people with fibromyalgia significantly improved after supplementing with coenzyme Q10.
In a preliminary trial, supplementing with coenzyme Q10 (100 mg three times per day for three months) resulted in significant improvements in headaches and overall symptoms in patients with fibromyalgia.76 In another study, cellular levels of CoQ10 were significantly lower in women with fibromyalgia than in healthy women. In the same study, ten women with fibromyalgia received 300 mg of CoQ10 per day for three months. Significant improvements were seen in symptoms such as fatigue, pain, depression, and anxiety.77 Placebo-controlled trials are needed to confirm these preliminary observations.
1 Star
HIV and AIDS Support
Refer to label instructions
In one trial, people with HIV who took CoQ10 experienced no further infections for up to seven months, and counts of infection-fighting white blood cells improved in some cases.

Blood levels of coenzyme Q10 (CoQ10) were also found to be low in people with HIV infection or AIDS. In a small preliminary trial, people with HIV infection took 200 mg per day of CoQ10. Eighty-three percent of these people experienced no further infections for up to seven months, and the counts of infection -fighting white blood cells improved in three cases.78

1 Star
Insulin Resistance Syndrome
Refer to label instructions
Coenzyme Q10 may improve insulin sensitivity in people with components of IRS.

A double-blind trial showed that coenzyme Q10 , 120 mg per day, reduced glucose and insulin blood levels in people with high blood pressure and heart disease .79 These results suggest that coenzyme Q10 may improve insulin sensitivity in people with components of IRS, but more research is needed.
1 Star
Lung Cancer
Refer to label instructions
In an unpublished report, 4 of 11 lung cancer patients were said to be alive following ten years of daily CoQ10 supplementation.

In an unpublished report, 4 of 11 lung cancer patients were said to be alive following ten years of supplementation with 100 mg of coenzyme Q10 per day.80 Such undocumented case reports require confirmation from published research trials.
1 Star
Male Infertility
Refer to label instructions
CoQ10 is a nutrient used by the body to produce energy. While its exact role in the formation of sperm is unknown, even small amounts appear to increase sperm count and motility.

Coenzyme Q10 (CoQ10) is a nutrient used by the body in the production of energy. While its exact role in the formation of sperm is unknown, there is evidence that as little as 10 mg per day (over a two-week period) will increase sperm count and motility.81 In one study, men with low sperm counts were given CoQ10 (60 mg per day for about three months). No significant change was noted in most sperm parameters, but a significant improvement was noted in in-vitro fertilization rates.82

1 Star
Prostate Cancer
600 mg daily
Supplementing with CoQ10 may reduce levels of PSA—a marker of cancer activity.

In an unpublished report, after one year, 10 of 15 prostate cancer patients experienced a 78% decrease in the level of PSA—a marker of cancer activity.83 The amount of   coenzyme Q10 given to these men was 600 mg per day; after four months, PSA scores began to decline.84 Such undocumented case reports require confirmation from published research trials.
1 Star
Tinnitus
Refer to label instructions
For people who are deficient in CoQ10, supplementing with the nutrient may improve tinnitus.

In a preliminary trial, supplementation with coenzyme Q10 (CoQ10) in the amount of 100 mg three times per day for 16 weeks significantly improved tinnitus in people who had initially low blood levels of CoQ10. However, CoQ10 was not beneficial for people whose initial blood levels were not low.85

1 Star
Type 1 Diabetes
Refer to label instructions
Supplementing with CoQ10 may improve blood sugar metabolism.
Coenzyme Q10 (CoQ10) is needed for normal blood sugar metabolism. Animals with diabetes have been reported to be CoQ10 deficient. In one trial, blood sugar levels fell substantially in 31% of people with diabetes after they supplemented with 120 mg per day of CoQ7, a substance similar to CoQ10.86 In people with type 1 diabetes, however, supplementation with 100 mg of CoQ10 per day for three months neither improved glucose control nor reduced the need for insulin.87 The importance of CoQ10 supplementation for people with diabetes remains an unresolved issue, though some doctors recommend approximately 50 mg per day as a way to protect against possible effects associated with diabetes-induced depletion.

How It Works

How to Use It

Adult levels of supplementation are usually 30–90 mg per day, although people with specific health conditions may supplement with higher levels (with the involvement of a physician). Most of the research on heart conditions has used 90–150 mg of CoQ10 per day. People with cancer who consider taking much higher amounts should discuss this issue with a doctor before supplementing. There are several anecdotal reports of large amounts of CoQ10 resulting in improvements in certain types of cancer. However, controlled trials are needed to confirm these preliminary observations. Most doctors recommend that CoQ10 be taken with meals to improve absorption.

Where to Find It

CoQ10 is found primarily in fish and meat, but the amounts in food are far less than what can be obtained from supplements.

Possible Deficiencies

Deficiency is poorly understood, but it may be caused by synthesis problems in the body rather than an insufficiency in the diet. Low blood levels have been reported in people with heart failure , cardiomyopathy , gingivitis (inflammation of the gums), morbid obesity , hypertension , muscular dystrophy, diabetes , AIDS , and in some people on kidney dialysis. People with phenylketonuria (PKU) may be deficient in CoQ10 because of dietary restrictions.88 CoQ10 levels are also generally lower in older people. The test used to assess CoQ10 status is not routinely available from medical laboratories.

Best Form to Take

Some,89 but not all,90 research suggests that a fat-soluble form of CoQ10 is absorbed better than CoQ10 in granular (powder) form.91

Interactions

Interactions with Supplements, Foods, & Other Compounds

At the time of writing, there were no well-known supplement or food interactions with this supplement.

Interactions with Medicines

Certain medicines interact with this supplement.

What Are Drug Interactions
Types of interactions: Beneficial Adverse Check

Replenish Depleted Nutrients

  • Amitriptyline

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.92 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Amoxapine

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.93 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Atorvastatin

    In a group of patients beginning treatment with atorvastatin, the average concentration of coenzyme Q10 in blood plasma decreased within 14 days, and had fallen by approximately 50% after 30 days of treatment.94 In a preliminary study, supplementation with 100 mg of CoQ10 per day reduced the severity of muscle pain by 40% in people with muscle pain caused by a statin drug.95 Many doctors recommend that people taking HMG-CoA reductase inhibitor drugs such as atorvastatin also supplement with approximately 100 mg CoQ10 per day, although lower amounts, such as 10 to 30 mg per day, might conceivably be effective in preventing the decline in CoQ10 levels.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Clomipramine

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.96 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Desipramine

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.97 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Doxepin

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.98 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Fluvastatin

    In a randomized, double-blind trial, blood levels of coenzyme Q10 (CoQ10) were measured in 45 people with high cholesterol treated with lovastatin or pravastatin (drugs related to fluvastatin) for 18 weeks.101 A significant decline in blood levels of CoQ10 occurred with either drug. One study found that supplementation with 100 mg of CoQ10 prevented declines in CoQ10 when taken with simvastatin (another HMG-CoA reductase inhibitor drug).102 Many doctors recommend that people taking HMG-CoA reductase inhibitor drugs such as fluvastatin also supplement with approximately 100 mg CoQ10 per day, although lower amounts, such as 10–30 mg per day, might conceivably be effective in preventing the decline in CoQ10 levels.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Gemfibrozil

    In a randomized study of 21 men with combined hyperlipidemia, ten to twelve weeks of gemfibrozil therapy reduced coenzyme Q10 blood levels to the levels seen in healthy men.103 The clinical significance of this finding is unknown.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Imipramine

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.104 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Lovastatin

    It has been clearly documented that HMG Co-A reductase inhibitors, including lovastatin,105 deplete coenzyme Q10 (CoQ10) levels in the blood, an effect that may be responsible for other side effects of the drug, such as abnormal liver function. In a double-blind trial, blood levels of CoQ10 were measured in 45 people with high cholesterol treated with lovastatin (20–80 mg per day) or pravastatin (10–40 mg per day) for 18 weeks.106 A significant decline in blood levels of CoQ10 occurred with both drugs. Supplementation with 90–100 mg per day CoQ10 has been shown to prevent reductions in blood levels of CoQ10 due to simvastatin .107 , 108 In a preliminary study, supplementation with 100 mg of CoQ10 per day reduced the severity of muscle pain by 40% in people with muscle pain caused by a statin drug.109

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Nortriptyline

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.110 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Protriptyline

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.113 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Rosuvastatin

    In a randomized, double-blind trial, blood levels of coenzyme Q10 (CoQ10) were measured in 45 people with high cholesterol treated with lovastatin or pravastatin (drugs related to fluvastatin) for 18 weeks.114 A significant decline in blood levels of CoQ10 occurred with either drug. One study found that supplementation with 100 mg of CoQ10 prevented declines in CoQ10 when taken with simvastatin (another HMG-CoA reductase inhibitor drug).115 Many doctors recommend that people taking HMG-CoA reductase inhibitor drugs such as fluvastatin also supplement with approximately 100 mg CoQ10 per day, although lower amounts, such as 10–30 mg per day, might conceivably be effective in preventing the decline in CoQ10 levels.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Trimipramine

    A number of tricyclic antidepressants have been shown to inhibit enzymes that require coenzyme Q10 (CoQ10), a nutrient that is needed for normal heart function.118 It is therefore possible that CoQ10 deficiency may be a contributing factor to the cardiac side effects that sometimes occur with tricyclic antidepressants. Some practitioners advise patients taking tricyclic antidepressants to supplement with 30–100 mg of CoQ10 per day.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.

Reduce Side Effects

  • Doxorubicin

    Pretreating people with the antioxidant coenzyme Q10 before administration of doxorubicin has reduced cardiac toxicity99 —an action also reported in animals.100 Some doctors recommend 100 mg per day.

  • Perphenazine

    Phenothiazine drugs similar to perphenazine can cause changes in heart activity in some people, which might be prevented by supplementing with coenzyme Q10.111 , 112 Therefore, some health practitioners may recommend coenzyme Q10 supplementation to people taking perphenazine.

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Thioridazine

    Phenothiazine drugs like thioridazine can cause changes in heart activity in some people, which might be prevented with coenzyme Q10 supplementation.116 Therefore, some doctors and pharmacists may recommend coenzyme Q10 supplements to individuals taking thioridazine.

  • Timolol

    In a group of 16 glaucoma patients treated with a timolol eye preparation, six weeks of oral coenzyme Q10 (90 mg per day) was reported to reduce timolol-induced cardiovascular side effects without affecting intraocular pressure treatment.117

Support Medicine

  • none

Reduces Effectiveness

  • Warfarin

    Coenzyme Q10 (CoQ10) is structurally similar to vitamin K and may affect blood coagulation.119 Four case reports describe possible interference by CoQ10 with warfarin activity.120 , 121 , 122 It remains unknown how common or rare this interaction is. Those taking warfarin should only take CoQ10 with the guidance of their doctor.

Potential Negative Interaction

  • none

Explanation Required

  • Pravastatin

    In double-blind trials, treatment with pravastatin and other HMG-CoA reductase inhibitors has resulted in depleted blood levels of coenzyme Q10 (CoQ10).123 , 124 Supplementation with 90–100 mg CoQ10 per day has been shown to prevent reductions in blood levels of CoQ10 due to simvastatin , another drug in the same category as pravastatin.125 , 126 In a preliminary study, supplementation with 100 mg of CoQ10 per day reduced the severity of muscle pain by 40% in people with muscle pain caused by a statin drug.127

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Propranolol

    Propranolol inhibits enzymes dependent on coenzyme Q10 (CoQ10). In one trial, propranolol-induced symptoms were reduced in people given 60 mg of CoQ10 per day.128

    The interaction is supported by preliminary, weak, fragmentary, and/or contradictory scientific evidence.
  • Simvastatin

    In patients with high cholesterol , simvastatin therapy results in decreased serum coenzyme Q10 (CoQ10) levels.129 , 130 Several trials, including double-blind trials, have confirmed this effect of simvastatin and other HMG-CoA reductase inhibitors, such as lovastatin and pravastatin .131 , 132 , 133 Supplementation with 100 mg per day or 10 mg three times daily of CoQ10 has been shown to prevent reductions in blood levels of CoQ10 due to simvastatin.134 , 135 In the latter study, people taking CoQ10 along with simvastatin increased their blood CoQ10 concentration by 63%. In a preliminary study, supplementing with 100 mg of CoQ10 per day reduced the severity of muscle pain by 40% in people with muscle pain caused by a statin drug.136 However, in a double-blind trial, supplementation with 200 mg of CoQ10 per day did not improve muscle symptoms or tolerance to simvastatin.137 Because low CoQ10 levels are undesirable in people who have or are at risk for developing heart disease, many doctors recommend that people taking HMG-CoA reductase inhibitor drugs such as simvastatin also supplement with approximately 100 mg CoQ10 per day, although lower amounts, such as 10 to 30 mg per day might conceivably be effective in preventing the decline in CoQ10 levels.

The Drug-Nutrient Interactions table may not include every possible interaction. Taking medicines with meals, on an empty stomach, or with alcohol may influence their effects. For details, refer to the manufacturers’ package information as these are not covered in this table. If you take medications, always discuss the potential risks and benefits of adding a supplement with your doctor or pharmacist.

Side Effects

Side Effects

Congestive heart failure patients who are taking CoQ10 should not discontinue taking CoQ10 supplements unless under the supervision of a doctor.

An isolated test tube study reported that the anticancer effect of a certain cholesterol-lowering drug was blocked by addition of CoQ10.138 So far, experts in the field have put little stock in this report because its results have not yet been confirmed in animal, human, or even other test tube studies. The drug used in the test tube is not used to treat cancer, and preliminary information regarding the use of high amounts of CoQ10 in humans suggests the possibility of anticancer activity.139 , 140 , 141

References

1. Kamikawa T, Kobayashi A, Yamashita T, et al. Effects of coenzyme Q10 on exercise tolerance in chronic stable angina pectoris. Am J Cardiol 1985;56:247.

2. Mortensen SA. Perspectives on therapy of cardiovascular diseases with coenzyme Q10 (ubiquinone). Clin Investig 1993;71:S116–23 [review].

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