Natural Products

Coenzyme Q10

ubiquinone, ubidecarenone

Efficacy

• Indications with proven efficacy:
  Coenzyme Q10 deficiency
  Mitochondrial encephalomyopathy
• Indications with possible, but poorly documented efficacy - the use of this product cannot be recommended:
  Angina (to improve symptoms)
  Congestive heart failure
  Hypertension
  Migraine prevention
  Muscular Dystrophy
  Myocardial infarction, recurrence prevention
  Parkinson's disease
  To improve the immune function in patients with HIV
  To prevent doxorubicin-induced cardiotoxicity (chemotherapy)
• Indications with proof that it is not effective:
  Periodontal diseases (topically)
  To enhance athletic performances
• Also used for these other indications, but with no proof of efficacy:
  Chronic fatigue syndrome
  Huntington's disease
  Male infertility
  To improve blood glucose control in diabetics

Security

• Risk of Drug Interactions: High
• Adverse Effects: Rare

What is it?

Coenzyme Q10 (CoQ10) is a potent antioxidant possibly capable of protecting the body against free radicals and carcinogenic substances. It is implicated in energy formation and has an immunostimulant activity. It is related to vitamin K.

Coenzyme Q10 is produced by the body and absorbed from food. It is found in spinach, broccoli, nuts, meat and fish. In the body, it is found in every cell, but highest concentrations are found in the heart, kidneys and pancreas. In general, the body produces sufficient CoQ10 but levels tend to decrease with age.

The consequences of CoQ10 deficiency are not well documented. Some believe that CoQ10 deficiency is not the result of insufficient dietary intake but rather of excessive elimination. People with heart or cardiovascular disease, gengiva disease, macular degeneration, hyperthyroidism, muscular disease, some cancers and AIDS have been found to have low blood levels of CoQ10.

CoQ10 is obtained from the fermentation of beet or sugar cane using specific strains of yeast.

CoQ10 has been approved by the Japanese government for the treatment of congestive heart failure since 1974.

Warning

In 2004, Canada adopted new regulations that control the manufacturing, packaging, labeling and importing of natural health products. The new regulations also include an adverse reaction reporting system. Products that conform to the regulation's criteria are identified with a natural product number (NPN) or homeopathic medicine number (DIN-HM) and can be legally sold in Canada. This number indicates that the product meets specific criteria for safety and purity, not that it is effective for any indication.

Medicinal plants content varies naturally from plant to plant – just as fruits from the same package may vary in taste and texture. There is no standard to measure the active content of each plant. Thus, efficacy of natural products should be expected to vary from brand to brand as well as from bottle to bottle of the same brand.

For more information about the Natural Health Products Regulations, or to check if a product has been assessed, visit the Health Canada website at http://www.hc-sc.gc.ca/dhp-mps/prodnatur/index-eng.php.

Does it work?

Data are limited and insufficient to clearly establish it's usefulness in the treatment of most medical problems.

• Angina (to improve symptoms):
  Taking 150 to 600 mg daily may reduce exercise-induced pain and increase the duration of exercise in stable chronic angina.
• Coenzyme Q10 deficiency:
  The recommended dose is 150 mg daily to reduce symptoms of weakness, fatigue and seizures.
• Congestive heart failure:
  The recommended dose is 50 to 150 mg daily in divided doses to improve the symptoms of this disease. Most users will see their functioning capacity improve. Those already taking this product for congestive heart failure should not discontinue its use without proper medical supervision.
• Hypertension:
  Taking 60 to 100 mg twice a day may reduce blood pressure.
• Migraine prevention:
  150 to 300 mg daily in divided doses has been used.
• Mitochondrial encephalomyopathy:
  The recommended dose is 150 to 160 mg or 2 mg/kg daily. Doses may be gradually increased to 3000 mg daily.
• Muscular dystrophy:
  Taking coenzyme Q10 has been associated with some benefits in people with certain forms of muscular dystrophy. Available data are limited, but doses of 100 mg daily, in divided doses, have been used.
• Myocardial infarction, recurrence prevention:
  The recommended dose is 60 mg twice a day.
• Parkinson's disease:
  300, 600 and 1200 mg per day seem to slow functional decline in people with early disease.
• To improve the immune function in patients with HIV:
  Coenzyme Q10 appears to enhance the immune system by increasing the serum levels of CD4+ cells and some antibodies. In HIV-positive patients, blood levels of coenzyme Q10 seem to gradually decrease during the course of the disease. Doses of 200 mg daily, in divided doses, have yielded encouraging results.
• To reduce doxorubicin-induced cardiotoxicity (chemotherapy):
  Available data are still limited, but doses of 50 mg daily have been used.

There is insufficient reliable information to conclude that coenzyme Q10 is effective in any other indication, including topical use.

Is it safe?

• CoQ10 is not associated with any specific toxicity and recommended doses appear to be safe. A few rare cases of stomachache, loss of appetite, nausea, diarrhea and skin rash have been reported. To minimize those effects, divided doses are recommended when it exceed 100 mg per day. Administering more than 300 mg daily may cause liver injury.
• Since no safety data are available concerning its use during pregnancy and breast-feeding, pregnant and lactating women should not take CoQ10.
• Some drugs may reduce blood CoQ10 levels and reduce the effects of supplementation:
  - oral hypoglycemic agents (Diabeta, Diamicron, etc.)
  - statins (Lipitor, Pravachol, Zocor, etc.)
  - β-blockers (Inderal, Lopresor, Tenormin, etc.)
  - antipsychotics (Largactil, Mellaril, Stemetil, etc.)
  - tricyclic antidepressants (Elavil, Sinequan, Tofranil, etc.)
• CoQ10 can reduce the effect of Coumadin, an anticoagulant. People using this drug should be closely monitored while taking CoQ10 supplements.

Before taking CoQ10, check with your pharmacist to make sure that there are no interactions with your regular medication.

Clinical notes

• Taking this supplement with a small amount of fat, for example olive oil or peanut butter, may increase its absorption.

References

1. Pharmacist's Letter, CE Booklet: Nonherbal Dietary Supplements, Fall 1998
2. Natural Medicines Comprehensive Database, Therapeutic Research Faculty, 2007
3. Lininger S. et Al. The Natural Pharmacy, Prima Health, 1998
4. Passeportsanté.net. Coenzyme Q10. http://www.passeportsante.net
5. Herbal Companion to AHFS DI, American Society of Health-System Pharmacists, 2001
6. Rotblatt M. et Ziment I. Evidence-Based Herbal Medicine, Hanley & Belfus, 2002
7. Mason, P. Potential uses for coenzyme Q10. The Pharmaceutical Journal, 24 September 2005