CoQ10 supplement benefit and side effects - Review of research information for heart disease, blood pressure, skin and antioxidant, use with statin drugs such as Lipitor and Zocor, by Ray Sahelian, M.D. Available in dosages including 30 mg, 50, 60 and 100 mg. Use higher dosages, such as 200 mg and 300 mg, carefully. Research studies and published clinical trials.

CoQ10 is a naturally occurring nutrient found in each cell of the body. This nutrient was first identified by University of Wisconsin researchers in 1957. It is found in foods, particularly in fish and meats. In addition to playing a significant role in the energy system of each of our cells, CoQ10 is also believed to have antioxidant properties and may play a role in heart health. Many who take this supplement notice that this nutrient enhances physical energy.

Benefit and medical uses, review
Studies with CoQ10 have mostly focused on its benefit involving certain types of cardiovascular diseases, including congestive heart failure and hypertension along with benefits for certain neurodegenerative conditions. However, this nutrient has also been evaluated for high cholesterol and in diabetes. Patients with high cholesterol levels who are placed on statin drugs such as Lipitor and Zocor should take additional CoQ10 in the amount of 10 to 50 mg daily, or a few times a week, to counteract the muscle damage from statin drugs (consult with your doctor). We still have a long way to go to determine the proper clinical role and benefit of this nutrient. Thus far it appears low dose usage a few times a week is reasonable.

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Food sources and daily intake
Meat, fish, nuts, and some oils are the richest nutritional sources, while much lower levels can be found in most dairy products, vegetables, fruits, and cereals. Large variations of CoQ10 content in some foods and food products of different geographical origin have been found. The average dietary intake is only 3-6 mg a day. Coq10 is not a vitamin but a nutrient. It is naturally made in the body. Technically, a vitamin is a substance that the body cannot synthesize or cannot synthesize enough to maintain health and physiological functioning.

Dosage for short term use and long term use
CoQ10 is available in a variety of dosages ranging from 10 mg to 300 mg per capsule. I personally believe that high doses are not needed, and may even be unhelpful or detrimental. I would not feel comfortable recommending to my patients to take more than 50 mg, or maximum 100 mg, a day, for long term use unless as a necessary treatment of a medical condition. For short term use one can take up to 300 mg a day for a few days. More is not necessarily better when it comes to certain supplements. Plus, many people who take it also take other supplements and we don't know what kind of interactions would occur with other herbs, nutrients, and prescription medications. These pills do not have to specifically be taken with oil, taking it with breakfast is a good option.

Prolonged intake of coenzyme Q10 impairs cognitive functions in mice.
Mice were fed a diet containing low dosage or high dosage CoQ10 starting at 4 months of age. This did not affect survivorship of mice through 25 months of age. Prolonged intake in low amounts had no discernable impact on cognitive and motor functions whereas intake at higher amounts exacerbated cognitive and sensory impairments. J Nutrition 2009; Department of Pharmacology and Neuroscience, Institute for Aging and Alzheimer's Disease Research, University of North Texas Health Science Center, Fort Worth, TX, USA.

Benefit and studies

Anti aging and longevity
I have not seen human studies regarding the long term use of this supplement and its effect on the aging process.

Anti-inflammatory
Co-supplementation with vitamin E and coenzyme Q10 reduces circulating markers of inflammation indicated by the CRP concentration in healthy adult baboons. Am J Clin Nutr. 2004.

Cancer
What's your opinion on the use of CoQ10 for cancer treatment or prevention?
    I'm not convinced yet that it is an effective cancer treatment but I'm keeping an open mind until additional research is published.

Cataract formation
One lab study found incubation of lenses with this nutrient reduced oxidative damage. Whether benefits could be achieved through oral supplementation remains to be seen.

Cholesterol drugs, reversing muscle damage
Individuals on cholesterol medicines of the statin class such as Lipitor and others, may consider taking 30 to 50 mg a few times a week since statins decrease blood CoQ10 levels.

Statin drugs, such as Lipitor and Zocor, lower cholesterol levels but at the same time they interfere with the making of coenzyme Q10 in the body. Scientists now suspect that CoQ10 deficiency may partly or fully contribute to the development of muscle damage in those on these cholesterol lowering drugs.

Diabetes and high blood sugar
CoQ 10 may be of slight benefit in diabetics. It helps improve the function of endothelial cells lining blood vessels and may slightly help with blood sugar control.

Fatigue reduction
Small doses are beneficial to fight fatigue, but high amounts may be counterproductive.

Antifatigue effect of coenzyme Q10 in mice.
Male mice were orally given CoQ10 in the form of Bio-Quinone (Pharma Nord, Vejle, Denmark) for 4 weeks and made to perform swimming exercise with loads attached to their tails. Treated mice treated showed a significantly prolonged exhaustive swim time, increased liver glycogen contents compared to control animals. J Med Food. 2010.

Gum health
Although a couple of studies have indicated that it may be helpful in gum disease, the most important way to keep healthy gums is to remove the food particles that are stuck between teeth. This is best accomplished by brushing and flossing after every meal. You may wish to keep your toothbrush and floss by your bed at night or near your favorite sofa while watching TV before bed and thus have a reminder to floss at night. My dentist thinks it is preferable to brush before flossing.

Heart attack patients
In a trial of patients with recent myocardial infarction, CoQ10 -- used in addition to aspirin and cholesterol-lowering drugs -- decreased the likelihood of further cardiac events for at least one year after the heart attack. Effect of coenzyme Q10 on risk of atherosclerosis in patients with recent myocardial infarction. Singh RB. Mol Cell Biochem. 2003.

Heart failure benefit
CoQ10 may be helpful in heart failure, but more research is needed to find the ideal dosage range. For the time being I would suggest those with heart failure not to exceed 50 mg a day.

Coenzyme Q10 and exercise training in chronic heart failure.
Eur Heart J. 2006.
There is evidence that plasma CoQ10 levels decrease in patients with advanced chronic heart failure (CHF). We studied 23 patients in NYHA class II and III with stable CHF secondary to ischemic heart disease [ejection fraction 37%]. Patients were assigned to each of the following treatments: oral CoQ10 100 mg tid, CoQ10 plus supervised exercise training (ET) five times a week), placebo, and placebo plus ET. Each phase lasted 4 weeks. Oral CoQ10 improves functional capacity, endothelial function, and LV contractility in CHF without any side effects. The combination resulted in higher plasma levels and more pronounced effects on all the abovementioned parameters.

CoQ10 in patients with end-stage heart failure awaiting cardiac transplantation: a randomized, placebo-controlled study.
Clin Cardiol. 2004.
Thirty-two patients with end-stage heart failure awaiting heart transplantation were randomly allocated to receive either 60 mg U/day of Ultrasome--CoQ10 (special preparation to increase intestinal absorption) or placebo for 3 months. All patients continued their regular medication regimen. The administration of CoQ10 to heart transplant candidates led to a significant improvement in functional status, clinical symptoms, and quality of life. However, there were no objective changes in echo measurements and TNF blood levels.

Hypertension
CoQ10 may help lower blood pressure by a small amount in some people.

Randomized, double-blind, placebo-controlled trial of coenzyme Q10 in isolated systolic hypertension.
South Med J. 2001.
We conducted a 3 month randomized, double-blind, placebo-controlled trial with twice daily administration of 60 mg of oral CoQ10. The mean reduction in systolic blood pressure was 17 mm Hg. None of the patients exhibited orthostatic blood pressure changes.

Migraine headache
It is possible that a few individuals may benefit from taking these pills, but there are many factors that influence migraine headaches and taking this supplement pill alone is not likely to have a major effect.

Efficacy of coenzyme Q10 in migraine prophylaxis: a randomized controlled trial.
Neurology. 2005.
We compared CoQ10 (3 x 100 mg/day) and placebo in 42 migraine patients. It was superior to placebo for attack-frequency, headache-days and days-with-nausea in the third treatment month and well tolerated.

Open label trial of coenzyme Q10 as a migraine preventive.
Cephalalgia. 2002.
Thirty-two patients (26 women, 6 men) with a history of episodic migraine with or without aura were treated at a dose of 150 mg per day. 61% of patients had a greater than 50% reduction in number of days with migraine headache.

I am 32 years old with a 10 month old daughter. My menstrual period returned about a month after her birth and has remained on a regular 28 day cycle. I started to take CoQ10 about a month ago 120 mg a day after reading articles about its role in possibly preventing migraine headaches. I haven’t had a migraine since taking it, however I have missed my period this month. I am currently 15 days late and have had a negative pregnancy test today. I am wondering if it could have affected my cycle in anyway or is it just a coincidence?
   We have not had such reports regarding menstrual changes or a shift in cycles.

Parkinson's disease
A small but promising study found that it may help stop the nerve cell death that characterizes Parkinson's. disease. The study involved just 80 people. Half ate maple-nut flavored wafers containing various doses, half took a placebo for up to 16 months. By the study's end, the 23 patients on the highest daily doses had less decline in mental function, movement and ability to perform daily living tasks than the placebo group. Research has suggested that energy-supplying structures inside cells called mitochondria may be impaired in Parkinson's disease. Patients studied had early-stage Parkinson's and took a placebo or CoQ10 in doses of 300 milligrams, 600 mgs or 1,200 mgs daily. Their symptoms were evaluated for up to 16 months. By the eighth month, the 23 patients on the highest dose showed significantly less impairment than the others. Side effects, including back pain, headaches and dizziness, were mostly mild.
   Comments: I'm surprised these patients could tolerate these very high doses of CoQ10. I have had feedback from those using high doses that, in some people, there is excessive stimulant-like effect and high levels of alertness that may cause insomnia.

Pilot trial of high dosages of CoQ10 in patients with Parkinson's disease.
Exp Neurol. 2004.
The safety and tolerability of high dosages of coenzyme Q10 were studied in 17 patients with Parkinson's disease in an open label study. The subjects received an escalating dosage -- 1200, 1800, 2400, and 3000 mg per day with a stable dosage of vitamin E 1200 IU/day. The plasma level reached a plateau at the 2400 mg/day dosage and did not increase further at the 3000 mg/day dosage. Our data suggest that in future studies of CoQ10 in Parkinson's disease, a dosage of 2400 mg/day (with vitamin E/alpha-tocopherol 1200 IU per day) is an appropriate highest dosage to be studied.

Prader-Willi Syndrome treatment
My son was born in 2001 with Prader-Willi Syndrome. At the age of 3 months William was still sleeping 20 plus hours a day had no normal wake / sleep pattern when I ordered coq10 and began giving William 90 mg daily, he almost immediately responded with a normal wake / sleep pattern.
   We have not evaluated this condition, however we will mention it on our website and maybe others may try it and give us feedback.

Pre-eclampsia
Supplementation reduces the risk of developing pre-eclampsia in women at risk for the condition.

Coenzyme Q10 supplementation during pregnancy reduces the risk of pre-eclampsia.
Int J Gynaecol Obstet. 2009.
Women at increased risk of pre-eclampsia were enrolled in a randomized, double-blind, placebo-controlled trial. Women were assigned to receive 200 mg of CoQ10 or placebo daily from 20 weeks of pregnancy until delivery. Thirty women (25%) in the placebo group developed pre-eclampsia compared with 14% in the treatment group.

Dr. Sahelian’s experience
The effect from 30 mg is mild, mostly consisting of a slightly higher energy level. The effects become more noticeable with 50 mg. I have taken up to 100 mg in the morning. On this dose, I notice an increase in energy as the day goes on, with an urge to take a long walk or be physically active. There is enhanced focus, motivation, and productivity, along with the desire to talk to people. The 100-mg dose, though, is too much since I feel too energetic and alert even in late evening when I want to slow down and get ready for sleep. I usually do not recommend more than 10 to 50 mg on a long term basis without medical supervision.

How does it work?
Each cell in the body needs a source of energy to survive, so cells break down sugars, fats, and amino acids to make energy. Small enclosures within cells that make this energy are called mitochondria. CoQ10 exists naturally in our mitochondria and carries electrons involved in energy metabolism. CoQ10 is essential in the production of adenosine triphosphate (ATP), the basic energy molecule of each cell.
   In the bloodstream, CoQ10 is mainly transported by lipoproteins such as LDL (low-density lipoprotein) and HDL (high-density lipoprotein). It is thought that CoQ10 is one of the first antioxidants to be depleted when LDL is subjected to oxidation. Hence, it is an important nutrient that prevents the oxidation of lipoproteins, thus potentially reducing the risk of arteries from forming plaques and getting damaged. In healthy individuals, it is found in high concentrations in the heart, kidneys, and liver.

Absorption
Serum coenzyme Q10 concentrations in healthy men supplemented with 30 mg or 100 mg coQ10 for two months in a randomized controlled study.
Biofactors. 2003.
Serum CoQ10 concentrations were evaluated in healthy male volunteers supplemented with 30 mg or 100 mg CoQ10 or placebo as a single daily dose for two months. Median baseline serum CoQ10 concentration in 99 men was 1.2 mg/l. Supplementation with 30 mg or 100 mg resulted in median increases in serum concentration of 0.55 mg/l and 1.3 mg/l, respectively, compared with a median decrease of 0.2 mg/l with placebo. The change in serum CoQ10 concentration did not depend on baseline serum CoQ10 concentration, age, or body weight.

Is CoQ10 available in liquid form? Does it offer any additional benefit in liquid as opposed to capsules or softgels?
    Yes, some companies do sell it in liquid form. I don't see any reason to take CoQ10 liquid unless a person has difficulty swallowing pills. Plus, the liquid form is more expensive and could be less stable in terms of storage.

Does the effectiveness matter if it is taken in capsule form or if emulsified in an oil like alpha tocopherol.  I read an advertising leaflet that said not to waste money on CoQ10 tablets or capsules, because they cannot be absorbed into blood stream.
   There are probably differences in absorption between different CoQ10 products, and perhaps oil emulsified products are better absorbed, however, most supplements contain 30, 60 or 100 mg which are dosages far greater than normally needed by the body. Hence, even if 100 percent of the CoQ10 is not absorbed, practically speaking it should not make too much difference.

I’ve read conflicting articles regarding the amount of CoQ10 absorbed from the intestines depending on its form.
   Studies of the effectiveness of coenzyme Q10 have been confusing due to the variable bioavailability of numerous preparations. Researchers at the Alfred Hospital and Baker Medical Research Institute, in Melbourne, Australia evaluated two different preparations: a soybean oil-based preparation and a complex micelle emulsion. Twelve healthy individuals received 300 mg daily of either preparation for 7 days in a double-blind cross-over design. Both preparations induced significant increases in serum levels and there was were no differences between CoQ10 levels for the two preparations at either time point. Since most people take a large dose of coQ10, such as 60 or 100 mg, even if one preparation were not absorbed as well, there should still be plenty to be helpful.

Prescription drug interactions

Statin drugs
These include atorvastatin (Lipitor and Torvast), fluvastatin (Lescol), lovastatin (Mevacor, Altocor), pitavastatin (Livalo, Pitava), pravastatin (Pravachol, Lipostat), rosuvastatin (Crestor) and simvastatin (Zocor, Lipex).

Atorvastatin decreases the CoQ10 level in the blood of patients at risk for cardiovascular disease and stroke.
Arch Neurol. 2004.
Widespread inhibition of CoQ10 synthesis may explain the most commonly reported adverse effects of statins, especially exercise intolerance, myalgia, and myoglobinuria.

Warfarin - Coumadin blood thinner
The administration of CoQ10 and warfarin does not significantly affect the anticoagulant effect of warfarin in rats. A Human trial shows Co Q10 and Ginkgo biloba do not have a strong influence on the clinical effect of warfarin.

Side effects, safety, caution, danger, risk
High dosages of CoQ10, such as more than 100 or 200 mg, can induce restlessness, insomnia and fatigue. Long term side effects of high dose intake are not clear at this time. I usually do not recommend more than 20 to 60 mg daily on a long term basis without medical supervision or a good reason to take it.

I have found your web site very helpful. It seems to provide a very realistic approach to vitamins and supplements. I must be very sensitive because I had terrible insomnia on daily 30 mg doses. It was only through your web site that I finally figured out that correlation.
    Most of the time it takes 60 to 100 mg or more to cause the insomnia side effect, but some people are much more sensitive than others.

I am male, 52 year old from India with mild CHF and hypertension. After several trials of medications I started feeling better with a combination of lisinopril and atenolol and an addition of an Ayurvedic compound the ingredients of which I am not very sure. Soon I started feeling better and even started exercising on my Bullworker. It so happened that I read about CoQ10 in a pharmacy ad here and started taking initially 30 mg and then went up to 100 mg. For the first couple of days I felt better, soon I felt quite sick, by BP seemed to increase, my heart seemed to pound and my heart rate seemed to increase. Since none of such side-effects is documented on the internet I continued to take them and continued to feel sick. Soon I reduced the dosage to only 30 mg. Yesterday night I took one 100 mg capsule and again right from today morning I have started feeling sick with increased hypertension, a feeling of heart pounding etc. I read your article on your site that COQ10 had a very energising effect on you. On the contrary, any dose above 30 mg makes me extremely drowsy.
    Different people have different reactions to medications and supplements, and much depends on dosage and interaction with other medications. Perhaps 100 mg is too high a dose for you or it is interacting with the lisinopril and/or atenolol. Some people may do better with a dosage of 10 mg to 30 mg daily or every other day.

I am a medical doctor and have been taking 100mg for several years--originally for GI dysmotility (Hollow Visceral Neuropathy) and have not yet noticed any untoward reactions.

My doctor told me to take 100mg every day, and I am feeling worse than ever: tired, no get up and go, difficulty concentrating, waking up more tired than when I got to bed, falling asleep during the day, you name it. I feel as if I had aged 10 years in a month.
   Too high a dose can cause insomnia or shallow sleep resulting in tiredness the next day.

Testimonial
I recently began taking COQ10 and noticed that there was a significant change in my health. I've felt so much better physically and mentally. My ability to focus had been lacking in the past year or so but now I think clearer. My energy levels are higher.

I am a nurse and well acquainted with traditional medicine. I was diagnosed with breast cancer. My younger sister was diagnosed several years ago. Our cancers were IDC and strongly ER and PR positive. Her cancer involved lymph nodes, mine non nodal. She went through chemo and radiation treatments, tried anti-hormonal (but too many adverse side effects). I have just finished radiation and will be encouraged to take tamoxifen. I started using "natural" progesterone cream when my sister was diagnosed after reading Dr John R. Lee's book on progesterone and his comment on his breast cancer patients maintaining remission while using the cream, my sister started at this time as well, I used the cream in hopes of deterring breast cancer and estrogen dominance...she used it to deter a breast cancer recurrence. My sister used many other supplements as well, has taken 100mg CoQ10 and other supplements. When my excisional biopsy lumpectomy came back positive with unclear margins, I asked my sister about her supplements and she mentioned the CoQ10, so I googled it and found about Dr. Folkers study in Denmark, using 390 mg and other supplements. I increased daily until I reached a 400 mg dose. MRI with CAD determined no other noticeable breast cancer, so partial mastectomy was scheduled for 3 weeks later to get clear margins and sentinel node biopsy. Well I took 400mg all the way until the night before surgery. The fairly large resected area came back with only a single 2.5mm cribiform cancer and at least a 5mm clear margin from there, initially the surgeon told me the first path report the cancer went to the edge of the margins, so to only find a single area on the whole resection made me think the supplement may have helped clear things up, Just as the women in the Denmark study experienced.

See a YouTube information video on CoQ10 health benefit