Does coq10 help with muscle pain from statins?

My name is Perter Lembke. I am Food Scientist/-Chemist and have a PhD (Dr.rer.nat.) in Food Chemistry. I have been working in the international pharma- and dietary supplement business for over 30 years and have published various scientific papers and patents. My new book “Omega-3 fatty acids – a scientific approach to healthy aging and optimized nutrition” will be published by Elsevier in November 2024.

As owner and CEO of VitalRemedyMD Inc, a premium dietary supplement company in Florida, founded in 2001, I receive many questions from our customers or simply from health-interested visitors on our website regarding the importance of Co-enzyme Q10 supplementation on its own or in combination with L-carnitine, Alpha-Lipoic Acid and/or Vitamin E during cholesterol-lowering/statin therapy.

In this paper I will try to summarize my answers for you.

Our body produces most cholesterol (and at the same time also co-enzyme Q10) in our liver from saturated fats originating from our diet.

Derivates of these saturated fats get converted by a special enzyme called “HMG-CoA-reductase” into Mevalonic acid (MVA) which then is further transformed either to cholesterol and/or coenzyme Q10.

See Figure 1 below. Most cholesterol-lowering drugs like statins inhibit the activity of HMG-CoA-reductase. Thus, no, or less MVA can be formed and consequently no or less cholesterol and/or coenzyme Q10 is produced.

Coenzyme Q10, also known as CoQ10 or ubiquinone is a very potent naturally occurring antioxidant and “cofactor” enabling numerous important biochemical reactions in our body.

It is essential for the ATP-energy production in our mitochondria and thus has direct impact on our available energy, vitality and muscle strength.

Coenzyme Q10 is essential for the ATP-energy production inside our mitochondria which are known as the “energy-plants” located in every single cell of our body.

As Figure 1 above shows, statins do not only inhibit the new formation of cholesterol but at the same time inhibit the production of coenzyme Q10.

Without Co-Q10 the mitochondria generate less energy. The muscle performance is reduced, the body feels fatigue and often muscle pain is observed.

After taking statins for a couple of weeks, we notice a significant drop in the undesired blood-cholesterol level but unfortunately our coenzyme Q10 deposits also run empty.

Consequently, our mitochondria cannot produce sufficient energy, we feel tired, exhausted and notice muscle pain.

Supplementing our diet with good quality coenzyme Q10 during statin therapy replaces this missing cofactor, we regain energy and vitality.

Supplementing coenzyme Q10 helps to refill empty CoQ10 reservoirs in our body cells and thus energizes our muscles and even our brain performance [1].

Several large meta-analysis indicated that CoQ10 supplementation can significantly improve CoQ10 levels in the body and alleviate statin-induced muscle symptoms [1, 2, 3].

CoQ10 has shown to reduce oxidative stress and improve endothelial function in patients undergoing statin therapy, which is crucial for cardiovascular health [4].

Tillman and Yeung suggested a possible synergistic effect by combining statins and coenzyme Q10, and pointed out that CoQ10 may also reduce cardio toxicity induced by anti-cancer drug therapy [5].

As often observed with human clinical studies the outcomes of these trials are sometimes controversial.

For example, Rosenfeldt and co-workers published a meta-analysis in 2007 investigating the effect of coenzyme Q10 supplementation on hypertension and concluded that CoQ10 has the potential to lower systolic blood pressure by up to 17 mm Hg and diastolic blood pressure by up to 10 mm Hg without showing any side effects [6].

A study published in the Cochraine Library in 2016 found no difference between the blood pressure lowering effect from CoQ10 and the placebo [7].

However, eight years later, in 2024, a new study suggested once again that CoQ10 supplementation may reduce the risk of hypertension [8].

The take-away from such controversial results is that one should look out for meta-analysis publications. Here scientists have evaluated statistically the outcome from many different clinical trials and come to a more reliable conclusion.

Other early studies indicate that a daily supplementation of 60 mg CoQ10 significantly reduced blood viscosity and improves in such way the blood and nutrient flow to the organs including the brain and heart muscle [9].

No. The depletion of CoQ10 in our body cells is not only caused by cholesterol lowering drugs. 

Seniors and people suffering from Parkinson´s Disease, diabetes or certain heart conditions often show low coenzyme Q10 levels.

Low CoQ10 levels observed in the elderly population are the consequence of the natural aging process.

The older we get, the slower and more inefficient are all the chemical reactions taking place in our body and thus also the slower and ineffective is the in vivo coenzyme Q10, the L-carnitine and alpha lipoic acid synthesis.

All three compounds being key substances for a good energy supply to our organs. This explains why we notice a declining energy level with growing age. 

Coenzyme Q10 is also a very strong natural antioxidant, protecting us from oxidative stress and -damage inside all our body organs, especially as we age [10].

CoQ10 supplementation has been linked to improvements in cognitive function and overall mitochondrial health in ageing populations [11, 12].

Regular supplementation with CoQ10 has been associated with improved cardiovascular function in seniors, reducing their risk of heart failure and other cardiovascular diseases.

The Q-SYMBIO study demonstrated that CoQ10 supplementation significantly reduces major adverse cardiovascular events and mortality in patients with chronic heart failure [12].

The best natural sources for coenzyme Q10 are found in oily fish (sardines, anchovies, salmon, tuna, …) and organs, such as liver and kidneys.

Chicken meat is also a reasonably good source. Some vegetables (broccoli, spinach, cauliflower), lentils, soybeans, nuts (pistachio & peanuts) and a few fruits like strawberries and oranges contain small amounts of coenzyme Q10.

The CoQ10 quantity found in the above listed food varies between 0,5 and 10 milligram per 100g or serving.

Unfortunately, neither fatty fish, nor organs (liver/kidneys) are the most popular dishes in our country. Additionally, we tend to eat less quantity of these foods as we age. Thus, premium quality dietary supplements are a good alternative source to replace these important nutrients.

The recommended CoQ10 dose during statin therapy varies from individual to individual. However, many studies, such as the paper published by Caso et.al. [13] and Marcoff et. al. [14] did report significant reduction in muscle pain (myopathy) and improved energy levels using a daily dose of 100 mg coenzyme Q10.

Most clinical studies applied a daily dose of 100-300 mg CoQ10.

As coenzyme Q10 increases your energy levels and vitality it is recommended to take this supplement early in the morning together with your breakfast.

I have not found any problem reported in the scientific literature taking statin drugs together with a coenzyme Q10 supplement.

However, statins are often taken in the evening because our body produces most of the cholesterol at night while we sleep.

Coenzyme Q10 on the other hand is an energy-booster and under normal circumstances would have been produced together with the cholesterol during the night so that in the morning sufficient energy is available for the day.

As the CoQ10 production is suppressed by the statins during the night, it is recommendable to take the coenzyme Q10 supplement in the morning together with your breakfast.

Being a natural product produced in our own body coenzyme Q10 has very few reported side effects.

They may lower your blood sugar levels. Hence, if you are diagnosed with diabetes and decide to take CoQ10 you should at least initially monitor more frequently your blood sugar levels.

CoQ10 supplementation may also interfere with some antidepressants, beta-blockers, and chemotherapy drugs.

Therefore, if you are on a medication, it is always better to consult your physician before taking coenzyme Q10 supplements.

No, although CoQ10 plays an essential role in our energy production, other natural compounds such as L-carnitine, and Alpha-Lipoic Acid (ALA)and Vitamin E also have shown to be very beneficial during statin/cholesterol lowering therapy or simply during our normal aging process.

Here are the key reasons for supplementing each of these compounds:

L-carnitine is essential for the transport of long-chain fatty acids into the mitochondria for beta-oxidation, thus, cellular energy production, especially in muscle cells.

Just like CoQ10 L-carnitine is a true energy booster and additionally may help alleviate muscle pain by enhancing fatty acid oxidation and reducing the accumulation of lipid intermediates [15, 16].

Alpha-Lipoic Acid (ALA) is a potent antioxidant that regenerates in your body other important antioxidants such as vitamin C and E. It helps in protecting cells from oxidative stress, which is crucial for patients on statin therapy.

Just like CoQ10 and L-carnitine, ALA is involved in mitochondrial energy metabolism and can enhance the function of mitochondria, which may be compromised during statin therapy [17, 18].

A daily 100-300 mg CoQ10 supplementation, especially in combination with L-carnitine, alpha-lipoic acid, and vitamin E, offers numerous benefits during cholesterol-lowering therapy and as part of general anti-aging strategies.

Several published studies mentioned here in this paper have shown that these natural ingredients may help to mitigate statin-induced muscle pain, improve endothelial function, support cognitive and mitochondrial health, enhance skin health, and may help to improve cardiovascular health in the elderly.

As always, supplementation should be tailored to individual health needs and done in consultation with a healthcare provider.

[1] Banach, M., Serban, C., Sahebkar, A., Mikhailidis, D. P., Howard, G., Muntner, P., ... & Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group. (2015). Statin therapy and plasma coenzyme Q10 concentrations--A systematic review and meta-analysis of placebo-controlled trials. Pharmacological Research, 99, 329-336. doi: 10.1016/j.phrs.2015.06.008.

[2] Hua Qu, Ming Guo, et.al. Effects of Coenzyme Q10 on Statin-Induced Myopathy: an updated meta-analysis of randomized controlled trials. JAHA (Journal of the American Heart Association), (2018) Vol. 7, No.19.. DOI 10.1161/JAHA.118.009835

[3] Jorat, M., Tabrizi, R., Mirhosseini, N. et al. The effects of coenzyme Q10 supplementation on lipid profiles among patients with coronary artery disease: a systematic review and meta-analysis of randomized controlled trials. Lipids Health Dis 17, 230 (2018). https://doi.org/10.1186/s12944-018-0876-4

[4] Tiano, L., & Littarru, G. P. (2009). Clinical trials on CoQ10 and oxidative stress in cardiovascular diseases. Biofactors, 35(1), 112-118. doi: 10.1002/biof.8.

[5] Tillman P., Yeung P., Coenzyme Q10 for Cardiovascular Prevention. Cardiol Pharmacol 2013, 3(1). DOI 10.4172/2329-6607.1000e125

[6] Rosenfeldt FL, et.al., Coenzyme Q10 in the treatment of hypertension: a meta-analysis of the clinical trials. Journal of Human Hypertension (2007) 21, 297-306. DOI: 10.1038/sj.jhh.1002138

[7] Ho MJ, Li EC, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev. 2016 Mar 3;3(3):CD007435. doi: 10.1002/14651858.CD007435.pub3.

[8] Dai S, Tian Z, Zhao D, Liang Y, Zhong Z, Xu Y, Hou S, Yang Y. The Association between the Diversity of Coenzyme Q10 Intake from Dietary Sources and the Risk of New-Onset Hypertension: A Nationwide Cohort Study. Nutrients. 2024 Mar 31;16(7):1017. doi: 10.3390/nu16071017. PMID: 38613050; PMCID: PMC11013836.

[9] Kato T, Yoneda S, Kako T, Koketsu M, Hayano I, Fujinami T. Reduction in blood viscosity by treatment with coenzyme Q10 in patients with ischemic heart disease. Int J Clin Pharmacol Ther Toxicol. 1990 Mar;28(3):123-6. PMID: 2318549.

[10] Oyewole A., Birch-Machin A., Mitochondria-targeted antioxidants. The FASEB Journal (2015) Vol.29, pp  4766- 4771. DOI 10.1096/fj.15-275404

[11] Hernández-Camacho JD, Bernier M, López-Lluch G, Navas P. Coenzyme Q₁₀ Supplementation in Aging and Disease. Front Physiol. 2018 Feb 5;9:44. doi: 10.3389/fphys.2018.00044. PMID: 29459830; PMCID: PMC5807419.

[12] Mortensen, S. A., Rosenfeldt, F., Kumar, A., Dolliner, P., Filipiak, K. J., Pella, D.  Q-SYMBIO Study Investigators. (2014). The effect of coenzyme Q10 on morbidity and mortality in chronic heart failure: results from Q-SYMBIO: a randomized double-blind trial. JACC: Heart Failure, 2(6), 641-649. doi: 10.1016/j.jchf.2014.06.008.

[13] Caso, G., Kelly, P., McNurlan, M. A., & Lawson, W. E. (2007). Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins. American Journal of Cardiology, 99(10), 1409-1412. doi: 10.1016/j.amjcard.2006.12.063.

[14] Marcoff, L., & Thompson, P. D. (2007). The role of coenzyme Q10 in statin-associated myopathy: a systematic review. Journal of the American College of Cardiology, 49(23), 2231-2237. doi: 10.1016/j.jacc.2007.02.049.

[15] DiNicolantonio, J. J., Lavie, C. J., & Fares, H. (2013). L-carnitine in the secondary prevention of cardiovascular disease: systematic review and meta-analysis. **Mayo Clinic Proceedings**, 88(6), 544-551. doi: 10.1016/j.mayocp.2013.02.007.

[16] Rebouche, C. J. (2004). Kinetics, pharmacokinetics, and regulation of L-carnitine and acetyl-L-carnitine metabolism. **Annals of the New York Academy of Sciences**, 1033(1), 30-41. doi: 10.1196/annals.1320.003.

[17] Shay, K. P., Moreau, R. F., Smith, E. J., Smith, A. R., & Hagen, T. M. (2009). Alpha-lipoic acid as a dietary supplement: molecular mechanisms and therapeutic potential. **Biochimica et Biophysica Acta (BBA) - General Subjects**, 1790(10), 1149-1160. doi: 10.1016/j.bbagen.2009.07.026.

[18] Gomes, M. B., & Negrato, C. A. (2014). Alpha-lipoic acid as a pleiotropic compound with potential therapeutic use in diabetes and other chronic diseases. **Diabetology & Metabolic Syndrome**, 6(1), 80. doi: 10.1186/1758-5996-6-80.