Ask the Pharmacist

Q) My doctor told me to take some coenzyme Q10 to help with my muscle pain. Is there anything I should know about this supplement?

A) Actually coenzyme Q10 (CoQ10) is not a vitamin but is instead considered to be a natural remedy or nutraceutical. It is produced naturally by our body and can be found within each cell’s mitochondria which are considered the battery of the cell as this part is responsible for producing the energy the cell requires to function. 

CoQ10 levels are highest in our heart, kidney, liver and muscles. We can also acquire CoQ10 through various food sources including beef, broccoli, fish (specifically rainbow trout, herring and mackerel), chicken, peanuts, sesame seeds, cauliflower, oranges, strawberries and boiled eggs.

This supplement has been looked at for years in the treatment of various conditions including heart failure, migraine prevention, Parkinson’s disease, aging skin and to reduce side effects from cholesterol lowering drugs as well as some cancer treatments.

It is CoQ10’s use with the statin class of cholesterol drugs that typically generates most of our sales and inquiries. Statins are the most important and effective drug treatments we currently have for lowering cholesterol levels and in doing so thereby substantially reducing the risk of suffering a heart attack or stroke. They are amongst the most heavily prescribed drugs in North America.

Unfortunately, some people are unable to tolerate this class of drugs due to the muscle pain or weakness that the statins seem to cause in susceptible individuals. This side effect should always be checked out with your physician first as there is an extremely small chance that the muscle issues could be related to rhabdomyolysis, a condition in which your muscles break down which could eventually lead to kidney failure or worse. However, most people who seem to suffer from muscle pain related to the statins have what is best termed a benign pain. While this pain can be in some cases somewhat debilitating, it isn’t going to put one in the hospital or morgue.

For those people, it has been suggested that taking CoQ10 in a dose of 50-100mg a day might help prevent this pain since it is well known that the statins reduce our naturally occurring levels of this nutraceutical. While the evidence supporting this practice has been somewhat conflicting, a 2018 study that looked at the combined results of 12 different studies concluded that CoQ10 seemed to make a statistically relevant improvement in the reported levels of muscle pain, cramps and weakness when compared to a placebo in those who were taking the cholesterol lowering drugs.

There is also fairly good early evidence that CoQ10 might help those suffering from migraines fare a little better. In 31 people who took 150mg per day of CoQ10, 61% of the participants reported a 50% reduction in the number of days they had a migraine and none reported any sign of side effects.

A second study using a much higher dose (100mg three times a day) found that the supplement was three times more likely than a placebo to reduce the number of migraine attacks. It also looks like there’s a chance it might be an effective option in at least some our youth as a large study (1,550 people ages 3 to 22 years old) found that 33% of migraine sufferers had lower than normal CoQ10 levels in their bodies. When these particular subjects were given the supplement, it was found that the group as a whole had fewer migraine attacks and reported less disability.

CoQ10, an antioxidant, is also found in a large number of skin care products as it has the ability to neutralize free radicals which can damage our skin and hasten the aging process. New research is being done to see if taking it orally can help the skin as well.

One study, which must be taken with a large grain of salt, as it was only conducted in 8 people, found that taking CoQ10 at a dose of 60mg a day reduced wrinkle area by 33%, wrinkle depth by 7% and wrinkle volume by a whopping 38% in only 2 weeks time.

Its effects on Parkinson’s seem to be largely unproven as a couple of studies have concluded it is no better than a placebo in helping to control this nasty disorder. The evidence for the use of CoQ10 to treat heart failure has been contradictory so it is not really used by North American cardiologists for this purpose since failure to control this disease can result in a premature death.

In general, side effects of CoQ10 are mild and infrequent. Most commonly are what is termed GI issues (upset stomach, nausea, diarrhea, heartburn and a loss of appetite), headaches, irritability and very rarely it has been linked to a racing heart beat and an elevation of liver enzymes. It may be taken either with or without food but immediately following a meal probably is best to help minimize those aforementioned stomach side effects. It can lower blood pressure and sugars so those receiving treatment for high blood pressure or diabetes should keep an eye on their numbers when starting this supplement in case their normal therapies may need to be adjusted.

There are a number of potential interactions with drugs (including possibly warfarin) so please consult your pharmacist before starting this supplement if you are currently on other medications. All in all, CoQ10 shows much promise for its role in helping people stay on their cholesterol medication as well as reducing migraines and wrinkles, all at a fairly low cost.