Original Article:http://www.mayoclinic.com/health/coenzyme-q10/NS_patient-coenzymeq10

Coenzyme Q10

Natural Standard® Patient Monograph, Copyright © 2008 (www.naturalstandard.com). All Rights Reserved. Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

Background

Coenzyme Q10 (CoQ10) is produced by the human body and is necessary for the basic functioning of cells. CoQ10 levels are reported to decrease with age and to be low in patients with some chronic diseases such as heart conditions, muscular dystrophies, Parkinson’s disease, cancer, diabetes, and HIV/AIDS. Some prescription drugs may also lower CoQ10 levels.

Levels of CoQ10 in the body can be increased by taking CoQ10 supplements, although it is not clear that replacing “low CoQ10″ is beneficial.

CoQ10 has been used, recommended, or studied for numerous conditions, but remains controversial as a treatment in many areas.

Synonyms

Andelir®, CoenzymeQ, Co-enzyme Q10, Coenzyme Q (50), CoQ, CoQ10, CoQ(50), Co-Q10, CoQ-10, 2,3 dimethoxy-5 methyl-6-decaprenyl benzoquinone, Heartcin®, idebenone (synthetic analogue), mitoquinone, Neuquinone®, Q10, Taidecanone®, ubidecarenone, ubiquinone, ubiquinone-10, ubiquinone-Q10, Udekinon®, vitamin q10, vitamin Q10.

Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Uses based on scientific evidence	Grade*
High blood pressure (hypertension) Preliminary research suggests that CoQ10 causes small decreases in blood pressure (systolic and possibly diastolic). Low blood levels of CoQ10 have been found in people with hypertension, although it is not clear if CoQ10 “deficiency” is a cause of high blood pressure. It is not known what dose is safe or effective. CoQ10 is less commonly used to treat hypertension than it is for other heart conditions such as congestive heart failure. Well-designed long-term research is needed to strengthen this recommendation.	B
Alzheimer’s disease Promising preliminary evidence from human research suggests that CoQ10 supplements may slow down, but not cure, dementia in people with Alzheimer’s disease. Additional well-designed studies are needed to confirm this result before a firm recommendation can be made.	C
Angina (chest pain from clogged heart arteries) Preliminary small human studies suggest that CoQ10 may reduce angina and improve exercise tolerance in people with clogged heart arteries. Better studies are needed before a firm recommendation can be made.	C
Anthracycline chemotherapy heart toxicity Anthracycline chemotherapy drugs, such as doxorubicin (Adriamycin®), are commonly used to treat cancers such as breast cancer or lymphoma. Heart damage (cardiomyopathy) is a major concern with the use of anthracyclines, and CoQ10 has been suggested to protect the heart. However, studies in this area are small and not high quality and the effects of CoQ10 remain unclear.	C
Breast cancer Several studies in women with breast cancer report reduced levels of CoQ10 in diseased breast tissue or blood. It has been suggested by some researchers that raising CoQ10 levels with supplements might be helpful. However, it is not clear if CoQ10 is beneficial in these patients, or if the low levels of CoQ10 may actually be a part of the body’s natural response to cancer, helping to fight disease. Supplementation with CoQ10 has not been proven to reduce cancer, and has not been compared to other forms of treatment for breast cancer.	C
Cardiomyopathy (dilated, hypertrophic) There is conflicting evidence from research on the use of CoQ10 in patients with dilated or hypertrophic cardiomyopathy. Different levels of disease severity have been studied (New York Heart Association heart failure classes I through IV). Some studies report improved heart function (ejection fraction, stroke volume, cardiac index, exercise tolerance), while others find no improvements. Most trials are small or not well designed. Better research is needed in this area before a recommendation can be made.	C
Exercise performance The effects of CoQ10 on exercise performance have been tested in athletes, normal healthy individuals, and in people with chronic lung disease. Results are variable, with some research suggesting benefits, and other studies showing no effects. Most trials have not been well-designed. Better research is necessary before a firm conclusion can be drawn.	C
Friedreich’s ataxia Preliminary research reports promising evidence for the use of CQ10 in the treatment of Friedreich’s ataxia. Further evidence is necessary before a firm conclusion can be drawn.	C
Gum disease (periodontitis) Preliminary human studies suggest possible benefits of CoQ10 taken by mouth or placed on the skin or gums in the treatment of periodontitis. Improvements in bleeding, swelling, and pain are reported. However, available studies are small and not high quality. Better research is needed before a conclusion can be drawn.	C
Heart attack (acute myocardial infarction) There is preliminary human study of CoQ10 given to patients within three days after a heart attack. Reductions in deaths, abnormal heart rhythms, and second heart attacks are reported, although better research is needed before a firm conclusion can be drawn.	C
Heart conditions (mitral valve prolapse in children) There is early data to support the use of CoQ10 in children with mitral valve prolapse. Well-designed clinical trials are needed before a recommendation can be made.	C
Heart failure The evidence for CoQ10 in the treatment of heart failure is controversial and remains unclear. Different levels of disease severity have been studied (New York Heart Association classes I through IV). Several studies have shown benefits of coenzyme Q10 in people who have been diagnosed with chronic heart failure (with or without cardiomyopathy), including in transplant recipients. Some studies report improved heart function (ejection fraction, stroke volume, cardiac index, exercise tolerance), while others find no improvements. Most trials are small or not well designed. In some parts of Europe, Russia, and Japan, CoQ10 is considered a part of standard therapy for congestive heart failure patients. Better research is needed in this area, studying effects on quality of life, hospitalization, death rates, before a recommendation can be made.	C
Heart protection during surgery Several studies suggest that the function of the heart may be improved after major heart surgeries such as coronary artery bypass graft (CABG) or valve replacement when CoQ10 is given to patients before or during surgery. Better studies that measure effects on long-term heart function and survival are necessary before a recommendation can be made.	C
HIV/AIDS There is limited evidence that natural levels of CoQ10 in the body may be reduced in people with HIV/AIDS. There is no reliable scientific research showing that CoQ10 supplements have any effect on this disease.	C
Increasing sperm count (idiopathic spermatozoa) There is early evidence that supports the use of CoQ10 in the treatment of increasing sperm count and motility. Better studies are needed before a strong recommendation can be made.	C
Kidney failure There is initial data from one small trial to support the use of CoQ10 in the treatment of kidney (renal) failure. More research is needed before a recommendation can be made	C
Migraine There is fair evidence to support the use of CoQ10 treatment in migraine prevention or treatment. However, more well-designed studies are needed to confirm these findings.	C
Mitochondrial diseases and Kearns-Sayre syndrome COQ10 is often recommended for patients with mitochondrial diseases, including myopathies, encephalomyopathies, and Kearns-Sayre syndrome. Several early studies report improvements in metabolism and physical endurance in patients with these conditions after treatment with CoQ10, although most available research is not high quality or definitive. Better studies are needed before a strong recommendation can be made.	C
Muscular dystrophies Preliminary studies in patients with muscular dystrophy taking COQ10 supplements describe improvements in exercise capacity, heart function, and overall quality of life. Additional research is needed in this area.	C
Parkinson’s disease There is promising human evidence for the use of CoQ10 in the treatment of Parkinson’s disease. Better-designed trials are needed to confirm these results.	C
Diabetes Preliminary evidence suggests that CoQ10 does not affect blood sugar levels in patients with type 1 or type 2 diabetes, and does not alter the need for diabetes medications.	D
Huntington’s disease There is negative evidence from studies that used CoQ10 in the treatment of Huntington’s disease.	D

Key to grades
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)
Grading rationale

Uses based on tradition or theory The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Abnormal heart rhythms, amyotrophic lateral sclerosis (ALS), antioxidant, asthma, atherosclerosis, Bell’s palsy, blood flow disorders, breathing difficulties, cancer, cerebellar ataxia, chronic fatigue syndrome, chronic obstructive pulmonary disease (COPD), deafness, gingivitis, hair loss (and hair loss from chemotherapy), heart irregular beats, hepatitis B, high cholesterol, immune system diseases, infertility, insomnia, kidney failure, leg swelling (edema), life extension, liver enlargement or disease, lung cancer, lung disease, macular degeneration, MELAS syndrome, metastatic disease, MIDD (maternally inherited diabetes mellitus and deafness), muscle wasting, nutrition, obesity, Papillon-Lefevre Syndrome, physical performance, prevention of muscle damage from “statin” cholesterol-lowering drugs, psychiatric disorders, QT-interval shortening; reduction of phenothiazine drug side effects, reduction of tricyclic antidepressant (TCA) drug side effects, stomach ulcer, swelling.

Dosing

The below doses are based on scientific research, publications, traditional use, or expert opinion. Many herbs and supplements have not been thoroughly tested, and safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients, even within the same brand. The below doses may not apply to all products. You should read product labels, and discuss doses with a qualified healthcare provider before starting therapy.

Standardization

Standardization involves measuring the amount of certain chemicals in products to try to make different preparations similar to each other. It is not always known if the chemicals being measured are the “active” ingredients. CoQ10 products sold in stores have been found to contain variable amounts of claimed ingredients. Early studies used low doses, while more recent research suggests that higher doses may be safe and have greater effects.

Adults (18 years and older)

By mouth (oral) :

General : 50-1200 milligrams of CoQ10 have been taken in divided doses by mouth daily.

On the skin (topical) :

Gum disease (periodontitis) : 85 milligrams of CoQ10 per milliliter of soybean oil suspension has been applied to the surface of affected areas once weekly using a plastic syringe, in one study.

Through the veins (intravenous) :

Heart protection during surgery : Most studies of CoQ10 for heart protection during bypass surgery have used CoQ10 taken by mouth. One study used intravenous CoQ10, 5 milligrams per kilogram of body weight, given 2 hours prior to surgery. Safety is not clear. Any therapies used close to the time of surgery should be discussed with the surgeon and a pharmacist prior to starting.

Children (younger than 18 years)

There is not enough scientific information to recommend the safe use of Coenzyme Q10 in children. A qualified healthcare provider should be consulted before considering use.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy. Consult a healthcare provider immediately if you experience side effects.

Allergies

In theory, allergic reactions to supplements containing CoQ10 may occur.

Side Effects and Warnings

There are few serious reported side effects of CoQ10. Side effects are typically mild and brief, stopping without any treatment needed. Reactions may include nausea, vomiting, stomach upset, heartburn, diarrhea, loss of appetite, skin itching, rash, insomnia, headache, dizziness, irritability, increased light sensitivity of the eyes, fatigue, or flu-like symptoms.

CoQ10 may lower blood sugar levels. Caution is advised in patients with diabetes or hypoglycemia, and in those taking drugs, herbs, or supplements that affect blood sugar. Serum glucose levels may need to be monitored by a healthcare provider, and medication adjustments may be necessary.

Low blood platelet number was reported in one person taking CoQ10. However, other factors (viral infection, other medications) may have been responsible. Lowering of platelets may increase the risk of bruising or bleeding, although there are no known reports of bleeding from CoQ10. Caution is advised in people who have bleeding disorders or who are taking drugs that increase the risk of bleeding. Dosing adjustments may be necessary.

CoQ10 may decrease blood pressure, and caution is advised in patients with low blood pressure or taking blood pressure medications. Elevations of liver enzymes have been reported rarely, and caution is advised in people with liver disease or taking medications that may harm the liver. CoQ10 may lower blood levels of cholesterol or triglycerides. Thyroid hormone levels may be altered based on one study.

Organ damage due to lack of oxygen/blood flow during intense exercise has been reported in a study of patients with heart disease, although the specific role of CoQ10 is not clear. Vigorous exercise is often discouraged in people using CoQ10 supplements.

Pregnancy and Breastfeeding

There is not enough scientific evidence to support the safe use of CoQ10 during pregnancy or breastfeeding.

Methodology

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Monograph methodology

Selected references

1. Berman, M., Erman, A., Ben Gal, T., Dvir, D., Georghiou, G. P., Stamler, A., Vered, Y., Vidne, B. A., and Aravot, D. Coenzyme Q10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized, placebo-controlled study. Clin.Cardiol. 2004;27(5):295-299.
2. Bresolin, N., Doriguzzi, C., Ponzetto, C., Angelini, C., Moroni, I., Castelli, E., Cossutta, E., Binda, A., Gallanti, A., Gabellini, S., and . Ubidecarenone in the treatment of mitochondrial myopathies: a multi- center double-blind trial. J Neurol.Sci 1990;100(1-2):70-78.
3. Chen, R. S., Huang, C. C., and Chu, N. S. Coenzyme Q10 treatment in mitochondrial encephalomyopathies. Short-term double-blind, crossover study. Eur.Neurol. 1997;37(4):212-218.
4. Eaton, S., Skinner, R., Hale, J. P., Pourfarzam, M., Roberts, A., Price, L., and Bartlett, K. Plasma coenzyme Q(10) in children and adolescents undergoing doxorubicin therapy. Clin Chim.Acta 2000;302(1-2):1-9.
5. Feigin, A., Kieburtz, K., Como, P., Hickey, C., Claude, K., Abwender, D., Zimmerman, C., Steinberg, K., and Shoulson, I. Assessment of coenzyme Q10 tolerability in Huntington’s disease. Mov Disord. 1996;11(3):321-323.
6. Folkers, K. and Simonsen, R. Two successful double-blind trials with coenzyme Q10 (vitamin Q10) on muscular dystrophies and neurogenic atrophies. Biochim.Biophys.Acta 5-24-1995;1271(1):281-286.
7. Ghirlanda, G., Oradei, A., Manto, A., Lippa, S., Uccioli, L., Caputo, S., Greco, A. V., and Littarru, G. P. Evidence of plasma CoQ10-lowering effect by HMG-CoA reductase inhibitors: a double-blind, placebo-controlled study. J Clin Pharmacol 1993;33(3):226-229.
8. Gutzmann, H. and Hadler, D. Sustained efficacy and safety of idebenone in the treatment of Alzheimer’s disease: update on a 2-year double-blind multicentre study. J Neural Transm.Suppl 1998;54:301-310.
9. Hodgson, J. M., Watts, G. F., Playford, D. A., Burke, V., and Croft, K. D. Coenzyme Q(10) improves blood pressure and glycaemic control: a controlled trial in subjects with type 2 diabetes. Eur J Clin Nutr 2002;56(11):1137-1142.
10. Langsjoen, P., Langsjoen, P., Willis, R., and Folkers, K. Treatment of essential hypertension with coenzyme Q10. Mol.Aspects Med 1994;15 Suppl:S265-S272.
11. Langsjoen, P. H., Vadhanavikit, S., and Folkers, K. Effective treatment with coenzyme Q10 of patients with chronic myocardial disease. Drugs Exp.Clin Res 1985;11(8):577-579.
12. Langsjoen, P. H., Langsjoen, P. H., and Folkers, K. A six-year clinical study of therapy of cardiomyopathy with coenzyme Q10. Int J Tissue React. 1990;12(3):169-171.
13. Sandor, P. S., Di Clemente, L., Coppola, G., Saenger, U., Fumal, A., Magis, D., Seidel, L., Agosti, R. M., and Schoenen, J. Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial. Neurology 2-22-2005;64(4):713-715.
14. Singh RB, Khanna HK, and Niaz MA. Randomized, double-blind placebo-controlled trial of coenzyme Q10 in chronic renal failure: discovery of a new role. J Nutr Environ Med 2000;10:281-288.
15. The Huntington Study Group. A randomized, placebo-controlled trial of coenzyme Q10 and remacemide in Huntington’s disease. Neurology 8-14-2001;57(3):397-404.

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