What is CoQ10?Heart Energy Engine and More.

Indications and Usage.:

Coenzyme Q10 CAS 303-98-0 photo picture image Coenzyme Q10 may be indicated in cardiovascular disease, particularly in congestive heart failure. It may also be indicated to correct reduced blood levels of CoQ10 that result from the use of HMG-CoA reductase inhibitors used to treat elevated cholesterol levels. It also appears to have usefulness in the management of periodontal disease in some. There is far less evidence to support claims that it has positive effects in cancer, muscular dystrophy and immune dysfunction. Similarly, there is as yet no reliable evidence that it can inhibit obesity or enhance athletic performance.

Chemistry/function:The primary biochemical action of CoQ10 is as a cofactor in the electron-transport chain, a series of oxidation-reduction reactions involved in cellular respiration and the synthesis of ATP. CoQ10 can be synthesized in vivo. However, in some situations the need for CoQ10 may surpass the body's ability to synthesize it. CoQ10 is well-absorbed by oral supplementation as evidenced by significant increases in serum CoQ10 levels after supplementation.

Dietary sources:Broccoli, spinach, meat, nuts and fish.

Deficiency:The deficiency pattern associated with coenzyme Q10 has not been clearly defined. A deficiency may result from impaired synthesis due to nutritional deficiencies; genetic or acquired defect in synthesis or utilization; increased tissue needs resulting from illness. CoQ10 levels decline with advancing age and the elderly are known to generally have lower levels of CoQ10. Likewise, researchers have observed that the patient populations exhibiting many of the conditions CoQ10 is used to treat more often demonstrate low levels of CoQ10; these include cardiomyopathy, gingivitis, heart failure, and HIV/AIDS.

Known or potential therapeutic uses:Allergies, angina, arrhythmias, breast cancer, cardiovascular disease, chemotherapy support, congestive heart failure, diabetes mellitus, gingivitis, HIV/AIDS support, hypertension, male infertility, mitral valve prolapse, muscular dystrophy, obesity, periodontal disease. Supplementation may also enhance aerobic capacity and muscle performance, especially in sedentary individuals.

Research Summary:

There are many studies, spanning more than two decades, reporting positive results from the use of CoQ10 as adjunctive therapy in the treatment of congestive heart failure. CoQ10 has been an approved drug for use in congestive heart failure since 1974. It has also been approved for this use in some other countries. Several studies have demonstrated a strong correlation between severity of heart disease and severity of CoQ10 deficiency. Some have suggested that this deficiency is the primary cause of some variations of heart muscle dysfunction, while others believe it plays a secondary role in the etiology of heart failure.

Early studies of congestive heart failure focused on idiopathic dilated cardiomyopathy, testing CoQ10 against placebo using echocardiography to assess heart function. Echocardiographic improvement seen in these studies was generally slow but sustained and was accompanied by diminished fatigue, chest pain, dyspnea and palpitations. Normal heart size and function were restored in some patients using only CoQ10; this occurred primarily in patients with recent onset of congestive heart failure.

Subsequently, nearly all of the several placebo-controlled studies investigating CoQ10's effects on heart muscle function have reported significant positive results. One multi-center Italian study included 2,664 patients with congestive heart failure. No notable adverse effects on drug interactions have been reported in these studies except for one report that noted a slight diminution in coumadin activity.

Many studies to date have examined CoQ10 as an addition to standard medical treatments. In several studies involving hypertension and other manifestations of cardiovascular disease, there was a significant reduction in the use of concomitant drug therapies when CoQ10 was added to the treatment regimen.

It is now known that the HMG-CoA reductase inhibitors, while very effective in lowering cholesterol levels, also significantly lower levels of CoQ10. This may be particularly hazardous for patients with heart failure, suggesting a possible indication for CoQ10 in many, if not all, individuals using these cholesterol-lowering drugs. There has been some suggestion that CoQ10, especially if it could be more readily absorbed, might be a cholesterol-lowering agent itself. There is, however, no evidence for this.

Significant CoQ10 deficiencies have been noted in diseased gingiva. CoQ10's efficacy in reducing gingival inflammation and periodontal pocket-depth has been demonstrated in placebo-controlled trials. Claims that CoQ10 might be an effective anti-cancer agent are based upon a few suggestive case histories that will require far more rigorous clinical investigation before these claims can be properly evaluated. Similarly, claims that CoQ10 might be useful in AIDS and some other immune dysfunctions are premature.

It is not unreasonable to hypothesize that CoQ10 might be helpful in muscular dystrophy,and there is some very preliminary animal and clinical data suggesting that it might be. Muscular dystrophy is usually associated with cardiac disease. Research is ongoing but, to date, is inconclusive.

There is also some evidence that CoQ10 might boost energy and speed recovery of exercise-related muscle exhaustion and damage. This work, too, needs more rigorous followup.

There is no evidence that CoQ10 can inhibit obesity.

Warnings and Precautions:

There is one report of CoQ10 decreasing the effectiveness of warfarin. Those taking warfarin should be aware of this possibility.

Because of lack of long-term safety studies, pregnant women and nursing mothers should avoid CoQ10 supplements.

Clinical reports suggest that supplemental CoQ10 may improve beta-cell function and glycemic control in type II diabetics. CoQ10 does not appear to improve glycemic control in type I diabetics. Diabetics should be made aware of this possibility, and those diabetics who do use supplemental CoQ10 should determine by appropriate monitoring if they need to make any adjustments in their diabetic medications.

As of 2004, the safety of CoQ10 for pregnant or breast-feeding women has not been established, and its use is not recommended under these conditions. It is also not recommended for young children. People diagnosed with heart failure, diabetes, kidney problems, or liver disease should use particular care with this supplement, as the dosage of other medications may require adjustment. These individuals should consult a physician before taking coenzyme Q10.

Results from a recent small study done in Italy suggest that coenzyme Q-10 may pass from a mother to her infant in breast milk, but not in blood before birth. Very little other information is available on how coenzyme Q-10 might affect a developing fetus, an infant, or a small child. Therefore, its use is not recommended during pregnancy, while breast-feeding, or during early childhood.

Individuals with diabetes should avoid using large amounts of coenzyme Q-10 because it can lower blood sugar levels, potentially resulting in hypoglycemia (blood sugar that is too low). Symptoms of low blood sugar include shakiness, sweating, confusion, distorted speech, and loss of muscle control. If not corrected, low blood sugar can lead to unconsciousness and even death.

Adverse Reactions:

Mild gastrointestinal symptoms such as nausea, diarrhea and epigastric distress have been reported, particularly with higher doses (200 milligrams or more daily).

Side effects:

Occasional reports of nausea, anorexia, or skin eruptions have been reported with supplementation of CoQ10. Documented adverse effects associated with the use of CoQ10 in humans have been minor and include epigastric discomfort (0.39%), appetite suppression (0.23%), nausea (0.16%) and diarrhea (0.12%).These complaints are dose-related and minimized with dose reduction and/or dose division. Higher than usual doses exceeding 300 mg/day have been associated with elevated serum LDH and SGOT levels, however no hepatic toxicity has been observed. Late night administration has also been reported to cause insomnia.

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.

Reported adverse effects related to supplemental CoQ10 use include diarrhea, irritation of the stomach, poor appetite, and nausea. These effects are rarely reported and are mild. CoQ10 is considered extremely safe for most people. If doses over 300 mg per day are taken, liver enzyme levels may be affected, and may need monitoring.

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

Toxicity:No toxicities have been reported or suspected as being associated with Coenzyme Q10.

Contraindications:None known at this time for healthy individuals. Individuals suffering from congestive heart failure should only discontinue supplementation with CoQ10 under the supervision of their physician.

Interactions with Drugs:

In theory and based on a human case report, coenzyme Q10 may reduce the effectiveness of warfarin (Coumadin), and may limit or prevent effective anticoagulation (blood thinning). CoQ10 may reduce blood pressure and may add to the effects of other blood pressure lowering drugs. In theory, CoQ10 may affect thyroid hormone levels and alter the effects of thyroid drugs such as levothyroxine (Synthroid), although this has not been proven in humans.

Based on theory and human research, a number of drugs may deplete natural levels of CoQ10 in the body. It has not been shown that there are benefits of CoQ10 supplements in people using these agents.

Examples include: diabetes drugs such as chlorpropamide, glimepiride, glipizide, glyburide, metformin, tolazamide, tolbutamide, acetohexamide; methyldopa; clonidine; gemfibrozil; tricyclic antidepressant drugs such as amitriptyline, clomipramine, doxepin, imipramine, trimipramine; antipsychotic medications such as chlorpromazine, fluphenazine, haloperidol, mesoridazine, prochlorperazine, promethazine, thioridazine, trifluoperazine, trimipramine; beta-blocker drugs such as acebutolol, atenolol, betaxolol, bisoprolol, carvedilol, esmolol, labetalol, metoprolol, nadolol, penbutolol, pindolol, propanolol, sotalol, timolol; HMG-CoA reductase inhibitors ("statins") such as atorvastatin, cerivastatin (no longer available in U.S.), fluvastatin, lovastatin, pravastatin, simvastatin; and diuretic drugs (water pills) such as benzthiazide, hydralazine, chlorthiazide, hydrochlorothiazide, indapamide, methyclothiazide, metolazone, polythiazide.

Due to its possible blood sugar-lowering effects, coenzyme Q-10 may interfere with insulin and oral drugs for diabetes, such as:

Actos,Avandia,glimepiride (Amaryl),glipizide (Glucotrol XL),glyburide (Glynase),Glyset,metformin (Glucophage),Prandin,Precose.

Due to its potential ability to lower blood pressure, coenzyme Q-10 may increase the effects of drugs that also lower blood pressure. Some blood pressure-lowering drugs are:
ACE inhibitors such as captopril, enalapril, fosinopril, and lisinopril
Beta blockers such as atenolol, metoprolol, and propranolol
Calcium channel blockers such as nifedipine, Norvasc, and verapamil
Diuretics such as Dyazide, furosemide, and hydrochlorothiazide

Because coenzyme Q-10 is similar in structure to vitamin K, which increases the blood's ability to clot, coenzyme Q-10 may interfere with anti-clotting medications such as warfarin or heparin.

Coenzyme Q-10 may increase the effects of dopamine, so taking it may also increase the effectiveness of drugs that increase dopamine. Dopamine-enhancing drugs often are used to treat Parkinson's disease. They include:
bromocriptine (Parlodel),cabergoline (Dostinex),carbidopa-levodopa (Dopar, Sinemet),Mirapex,pergolide,Requip

Taking certain cholesterol-lowering drugs known as HMG Co-A reductase inhibitors or statins, seems to lower coenzyme Q-10 levels in the body. The consequences of this effect are not completely understood, but this interaction may account in part for severe muscle deterioration that is rarely associated with taking statins. Statins thought to affect coenzyme Q-10 include:

lovastatin (Mevacor),pravastatin (Pravachol),simvastatin (Zocor)

Propranolol (Inderal), a drug often used to treat hypertension, and doxorubicin (Adriamycin, Doxil, Rubex), an anticancer drug; may also limit or block the energy-producing activity of coenzyme Q-10.

Warfarin:

There is one report of CoQ10 decreasing the effectiveness of warfarin.Concomitant use of warfarin (Coumadin) and coenzyme Q10 supplements has been reported to decrease the anticoagulant effect of warfarin in at least 4 cases.An individual on warfarin should not begin taking coenzyme Q10 supplements without consulting the health care provider that is managing his or her anticoagulant therapy. If warfarin and coenzyme Q10 are to be used concomitantly, blood tests to assess clotting time (prothrombin time; PT/INR) should be monitored frequently, especially in the first two weeks.

HMG-CoA reductase inhibitors (statins):

HMG-CoA reductase is an enzyme that plays a critical role in the regulation of cholesterol synthesis as well as coenzyme Q10 synthesis, although it is now recognized that there are additional rate-limiting steps in the biosynthesis of cholesterol and coenzyme Q10. HMG-CoA reductase inhibitors, also known as statins, are widely used cholesterol-lowering medications that may also decrease the endogenous synthesis of coenzyme Q10. A number of studies have observed decreases in plasma or serum coenzyme Q10 levels in people on HMG-CoA reductase inhibitor therapy, especially those taking simvastatin (Zocor). In contrast to most earlier studies, a randomized cross-over trial in healthy individuals found no significant changes in serum coenzyme Q10 levels after 4 weeks of pravastatin (Pravachol) and atorvastatin (Lipitor) therapy despite significant decreases in total and LDL-cholesterol levels on both medications. In rats, high doses of lovastatin for 4 weeks decreased blood, liver, and heart concentrations of coenzyme Q. However, it is not clear whether HMG-CoA reductase inhibitor therapy decreases tissue coenzyme Q10 concentrations in humans. Although simvastatin treatment for 6 months lowered serum coenzyme Q10 levels in patients with high serum cholesterol, skeletal muscle concentrations of coenzyme Q10 were not decreased compared to baseline or healthy controls. At present, more controlled research is needed to determine whether coenzyme Q10 supplementation is beneficial for those taking HMG-CoA reductase inhibitors.

Statins:CoQ10 and cholesterol share the same metabolic pathways. Inhibition of the enzyme 3-hydroxyl-3-methylglutonyl coenzyme A (HMG-CoA) reductase would be expected to decrease CoQ10 levels. The statin drugs lovastatin, simvastatin and pravastatin are known to decrease CoQ10 levels in humans. It is likely that all statins have this effect.

Doxorubicin:CoQ10 may help ameliorate the cardiotoxicity of doxorubicin.

Antidiabetic medications:CoQ10 may improve glycemic control in some type II diabetics. If this were to occur, antidiabetic medications might need appropriate adjusting.

Beta Blockers:Some beta blockers, in particular propanolol, have been reported to inhibit some CoQ10-dependent enzymes

Piperine:Piperine, found in black pepper, may increase plasma levels of CoQ10.

Nutrient affected by drug: Beta-adrenergic Blockers

mechanism:Many beta-blockers are antagonistic to CoQ10 enzymes, enzymes which are indispensable for the bioenergetics of the myocardium. Kishi et al found that adrenergic blockers for beta-receptors inhibited mitochrondrial CoQ10-enzymes to varying degrees. Propranolol is frequently used to treat hypertension; in some patients, it depresses myocardial function as an adverse reaction. Timolol showed negligible inhibition of the CoQ10-enzyme, NADH-oxidase, and exerted pharmacologically low cardiac depressant effects. Metoprolol was less inhibitory than propranolol. Five alprenolols showed inhibition which approached that of propranolol. The 1-isomer of alprenolol showed weak inhibition of another CoQ10-enzyme, succinoxidase, but the other beta-blockers were essentially non-inhibitory to this enzyme. (Kishi T, et al. Res Commun Chem Pathol Pharmacol. 1977 May;17(1):157-164; Folkers K.Coenzyme Q. 1985.)

nutritional support:Individuals taking beta-blockers should consult with their prescribing physician and/or a healthcare provider trained in nutritional therapies about the potential benefits of supplementing with coenzyme Q10. However, it would be advisable to consult with the prescribing physician, a pharmacist, and/or a healthcare professional trained in nutritional therapies before starting supplementation with Coenzyme Q10. Nutritionally oriented physicians and other healthcare providers commonly prescribe Coenzyme Q10 for patients with cardiovascular conditions, or to prevent the occurrence of such in those concerned with or predisposed to such diseases. Therapeutic dosages of CoQ10 for cardiovascular conditions range from 50 mg per day to 80 mg or more three times daily. (Folkers K, Langsjoen P. 1991: 449-452.)

Nutrient affected by drug: Calcium Channel Blockers

mechanism:Many beta-blockers are antagonistic to CoQ 10 enzymes, enzymes which are indispensable for the bioenergetics of the myocardium. Kishi et al found that adrenergic blockers for beta-receptors inhibited mitochrondrial CoQ10-enzymes to varying degrees. Propranolol is frequently used to treat hypertension; in some patients, it depresses myocardial function as an adverse reaction. Timolol showed negligible inhibition of the CoQ10-enzyme, NADH-oxidase, and exerted pharmacologically low cardiac depressant effects. Metoprolol was less inhibitory than propranolol. Five alprenolols showed inhibition which approached that of propranolol. The 1-isomer of alprenolol showed weak inhibition of another CoQ10-enzyme, succinoxidase, but the other beta-blockers were essentially non-inhibitory to this enzyme. (Kishi T, et al. Res Commun Chem Pathol Pharmacol. 1977 May;17(1):157-164; Folkers K.Coenzyme Q. 1985.)

Nutrient affecting drug toxicity: Doxorubicin (Adriamycin?)

mechanism:CoQ10 reduces free radical formation induced by doxorubicin. (Folkers K. 1985; Gaby, AR. 1987; Anonymous. Nutr Rev 1988;46:1367.)

research:Studies with both animals and humans have found that pretreating with Coenzyme Q10, at levels of 100 mg per day, reduces cardiac toxicity caused by doxorubicin. (Gaby, AR.1987; Judy WV, et al. 1984,231-241; Ogura R, et al. J Appl Biochem 1979,1:325.)

Nutrient affected by drug: Lovastatin

mechanism:Lovastatin functions by inhibiting the enzyme HMG-CoA, 3-hydroxy-3-methylglutaryl-coenzyme A reductase, that is required for the conversion of 3-hydroxy-3-methylglutaryl-coenzyme A to mevalonic acid. Biosynthesis of both cholesterol and coenzyme Q (CoQ) requires mevalonic acid as a precursor. Consequently, lovastatin therapy could also result in a lowering of cellular levels of Coenzyme Q10.

metabolic/nutrient concern:In 1990 Folkers et al suggested liver dysfunction, among the many known side effects of lovastatin, can be caused by the lovastatin-induced deficiency of CoQ10. Coenzyme Q10 is a component of the LDL + VLDL fractions of cholesterol which plays a key role as an essential mitochondrial redox-component and endogenous antioxidant. Much attention has been given to its role in reducing the risk of atherosclerosis based on the theory that the pathological changes result from oxidative processes. Likewise Q10 is often used in the treatment of cardiovascular disease.

research:Folkers et al conducted a small study on the depletion of CoQ10 by lovastatin and concluded that oral administration of CoQ10 increased blood levels of CoQ10 and was generally accompanied by an improvement in cardiac function. In 1994 Laaksonen et al conducted the further inquiries into the effects of statin drugs, specifically the HMG-CoA reductase inhibitors lovaststain and simvastatin, upon serum ubiquinone concentrations. They found that after short-term lovastatin treatment, and after long-term simvastatin treatment, average serum ubiquinone levels were similar to those observed in a group of apparently healthy middle-aged men. However, in 1997 Mortensen et al conducted a randomized, double-blind clinical trial where serum levels of Coenzyme Q10 were measured over a period of eighteen weeks in forty-five hypercholesterolemic individuals who had been prescribed the statin drugs lovastatin and pravastatin. A dose-related significant decline of the total serum level of coenzyme Q10 was found in both groups, with those taking lovastatin, at 20-80 mg/day, demonstrating the more pronounced decline. Likewise Palomaki et al conducted a double-blinded, placebo-controlled cross-over trial with twenty-seven hypercholesterolemic men suffering from coronary heart disease. During the 6-week treatment period using lovastatin (60 mg/day) ubiquinol content diminished by 13% as measured per LDL phosphorus. However, in a later randomized, double-masked, placebo-controlled cross-over trial Palomaki et al found that supplementation with 180 mg of Coenzyme Q10 daily did not convincingly correct impaired defence against initiation of oxidation of low density lipoprotein (LDL) due to lovastatin treatment at 60 mg per day. They concluded that supplementation with Coenzyme Q10 only partially restored the drug-induced depletion of LDL ubiquinol. (Folkers K, et al. Proc Natl Acad Sci U S A. 1990 Nov;87(22):8931-8934; Willis RA, et al. Proc Natl Acad Sci U S A. 1990 Nov;87(22):8928-8930; Laaksonen R, et al. Eur J Clin Pharmacol 1994;46(4):313-317; Mortensen SA, et al. Mol Aspects Med. 1997;18 Suppl:S137-144; Palomaki A, et al. FEBS Lett 1997 Jun 30;410(2-3):254-258; Palomaki A, et al. J Lipid Res. 1998 Jul;39(7):1430-1437.)

nutritional support:Individuals taking lovastatin may often benefit from supplementing with Coenzyme Q10. Supplementation with vitamin E may also be beneficial - see below. However, it would be advisable to consult with the prescribing physician, a pharmacist, and/or a healthcare professional trained in nutritional therapies before starting supplementation with Coenzyme Q10. Nutritionally oriented physicians and other healthcare providers commonly prescribe Coenzyme Q10 for patients with cardiovascular conditions, or to prevent the occurrence of such in those concerned with or predisposed to such diseases. Therapeutic dosages of CoQ10 for cardiovascular conditions range from 50 mg per day to 80 mg or more three times daily. (Folkers K, Langsjoen P. 1991, 449-452.)

Vitamin E interaction affecting drug toxicity: Lovastatin

mechanism:Lovastatin has been found to deplete Coenzyme Q10.
nutritional support:Vitamin E supplementation may offset the loss of Coenzyme Q10. (Baum H. New Scientist May 24, 1991, 24.)

Nutrient affected by drug: Pravastatin

metabolic/nutrient concern:Coenzyme Q10 is a component of the LDL + VLDL fractions of cholesterol which plays a key role as an essential mitochondrial redox-component and endogenous antioxidant. Much attention has been given to its role in reducing the risk of atherosclerosis based on the theory that the pathological changes result from oxidative processes. Likewise Q10 is often used in the treatment of cardiovascular disease.

research:Mortensen et al conducted a randomized, double-blind clinical trial where serum levels of Coenzyme Q10 were measured over a period of eighteen weeks in forty-five hypercholesterolemic individuals who had been prescribed the statin drugs pravastatin and lovastatin. A dose-related significant decline of the total serum level of coenzyme Q10 was found in both groups, with those taking pravastatin, at 10-40 mg/day, demonstrating a significant decline. Likewise Palomaki et al conducted a double-blinded, placebo-controlled cross-over trial with 27 hypercholesterolemic men suffering from coronary heart disease. During the 6-week treatment period using lovastatin (60 mg/day) ubiquinol content diminished by 13% as measured per LDL phosphorus. However, in a later randomized, double-masked, placebo-controlled cross-over trial Palomaki et al found that supplementation with 180 mg of Coenzyme Q10 daily did not convincingly correct impaired defence against initiation of oxidation of low density lipoprotein (LDL) due to lovastatin treatment at 60 mg per day. They concluded that supplementation with Coenzyme Q10 only partially restored the drug-induced depletion of LDL ubiquinol. (Mortensen SA, et al. Mol Aspects Med. 1997;18 Suppl:S137-144; Palomaki A, et al. FEBS Lett 1997 Jun 30;410(2-3):254-258; Palomaki A, et al. J Lipid Res. 1998 Jul;39(7):1430-1437.)

nutritional support:Individuals taking pravastatin may often benefit from supplementing with Coenzyme Q10. However, it would be advisable to consult with the prescribing physician, a pharmacist, and/or a healthcare professional trained in nutritional therapies before starting supplementation with Coenzyme Q10. Nutritionally oriented physicians and other healthcare providers commonly prescribe Coenzyme for patients with cardiovascular conditions, or to prevent the occurrence of such in those concerned with or predisposed to such diseases. Therapeutic dosages of CoQ10 for cardiovascular conditions range from 50 mg per day to 80 mg or more three times daily.

Nutrient affected by drug: Tricyclic Antidepressants

mechanism:Tricyclic antidepressants are antagonistic to CoQ10 enzymes. Furthermore these drugs are class I antiarrhythmics. (Folkers K. 1985; Glassman AH, Roose SP. Gerontology 1994;40 Suppl 1:15-20.)

research:Tricyclic antidepressant drugs, including amitriptyline, particularly when given in high doses, have been reported to produce arrhythmias, sinus tachycardia, and prolongation of the conduction time. Myocardial infarction and stroke have also been reported with tricyclic antidepressant drugs. (Scahill L, Lynch KA. J Child Adolesc Psychiatr Nurs 1994 Jan-Mar;7(1):37-39; Pinto J, et al. Biochem Pharmacol 1982 Nov 1;31(21):3495-3499.)

nutritional support:Supplementation with Coenzyme Q10 may prevent cardiac side effects associated with the use of tricyclic antidepressants. Individuals undergoing therapy with tricyclic antidepressants should consult their prescribing physician and/or a nutritionally trained healthcare professional concerning potential benefits from supplementing with Coenzyme Q10. Dosages of 20-100 mg of Coenzyme Q10, three times daily, can offset depletion due to the use of tricyclic antidepressants and reduce attendant cardiac risks. (Kishi T, et al. 1980: 139-157.)

Nutrient affecting drug performance and toxicity: Warfarin

mechanism:Warfarin exerts its therapeutic effect by interfering with vitamin K metabolism. Coenzyme Q10, also known as Ubiquinone or Ubidecarenone, has a chemical structure similar to the various forms of vitamin K.

research:The research literature has contains some reports of Coenzyme Q10 interfering with the activity of warfarin. A decline in responsiveness to warfarin has been observed among patients using warfarin who have added CoQ10 to their supplement intake. When the individuals stopped taking the CoQ10 their previous responsiveness to warfarin resumed. (Spigset O. Lancet 1994;344:1372-1373; Landbo C, Almdal TP. Ugeskr Laeger. 1998 May 25;160(22):3226-3227; Combs AB, et al. Res Commun Chem Pathol Pharmacol. 1976 Jan;13(1):109-114.)

nutritional concerns:The clinical significance and frequency of occurrence of this interaction are uncertain even though the theoretical foundation for this interaction is sound and some case reports have come forth. Grounds for concern are amplified because of the high probability of overlap among the patient populations interested in benefits of coenzyme Q10 for cerebrovascular benefits and those being treated for the disorders for which warfarin is often prescribed. Individuals using warfarin should be aware of the possible risk of treatment failure when taking coenzyme Q10 and should consult their prescribing physician before beginning supplementation with CoQ10.

Interactions with Herbs and Dietary Supplements:

CoQ10 may reduce blood pressure and may result in additive effects when taken with other herbs or supplements that also lower blood pressure. Herbs that may lower blood pressure include aconite/monkshood, arnica, baneberry, betel nut, bilberry, black cohosh, bryony, calendula, california poppy, coleus, curcumin, eucalyptol, eucalyptus oil, ginger, goldenseal, green hellebore, hawthorn, Indian tobacco, jaborandi, mistletoe, night blooming cereus, oleander, pasque flower, periwinkle, pleurisy root, shepherd's purse, Texas milkweed, turmeric, and wild cherry. Diuretic herbs such as licorice and horsetail may also decrease blood pressure and therefore interact with CoQ10.

Based on human study, vitamin E may reduce CoQ10 blood levels. In theory, red rice yeast may decrease CoQ10 levels. CoQ10 may add to the effects or side effects of L-carnitine.

Because coenzyme Q-10 may decrease blood sugar levels, taking it with other blood sugar-lowering herbal products may result in hypoglycemia -- blood sugar that is too low. Herbals that may reduce blood sugar include:
Eleuthero,Fenugreek,Ginger (in high amounts),Kudzu,Panax Ginseng.

Dosage Suggestions and Administrations:

Maintenance dose:30-90 mg per day.

Therapeutic dose:Ranging from 30-60 mg twice daily to 50-100 mg two to three times daily, depending on condition and in concert with a healthcare professional trained in nutritional therapies.

Note:

There is some evidence that CoQ10 in oil suspension has the highest bioavailability. Some experts suggest taking coQ10 with a small amount of olive oil to increase absorption.

CoQ10 is available in different formulations: oil-based capsules, powder-filled capsules, and tablets and solubilized softgels (microemulsions and others). The solubilized softgels are claimed to give higher absorption.

Daily doses of CoQ10 range from 5 to 300 milligrams. Those who use CoQ10 for periodontal health take 100 to 150 milligrams daily. Effectiveness, if any, is thought to be obtained with doses of 50 to 200 milligrams daily. The same dose range applies to those who take statin drugs for treatment of hypercholesterolemia.
CoQ10 is best taken with food. About three weeks of daily dosing are necessary to reach maximal serum concentrations of CoQ10.
CoQ10 is also available topically in some toothpastes and skin creams.

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.

Formulations and Dosage:

Exogenous supplies of CoQ10 are found in foods such as fish and fish oils, organ meats and germ of whole grains. However, in some cases dietary intake may be inadequate to meet the body's needs. The average diet is estimated to provide approximately 10 mg/day of CoQ10. Commercially available CoQ10 is produced by the fermentation of beets and sugar cane, using special strains of yeast. Dosage forms currently available include powder-filled capsules, powder-based tablets, softgel capsules, fully solubilized softgel capsules, chewable wafers, intravenous solution, and intra-oral spray. Assessment of the bioavailability of various dosage formulations demonstrated that the fully solubilized softgel capsule (Q-gel) achieved the highest serum CoQ10 concentration.

Doses of 30~60 mg/day (approximately 1 mg/kg of body weight) are generally recommended to prevent CoQ10 deficiency and to maintain normal serum concentrations of 0.7~1.0 mg/mL. However, therapeutic doses of 100~200 mg/day are advocated for the treatment of chronic heart disease. These higher doses may achieve serum concentrations of 2.0~3.0 mg/mL, reported by some investigators to have a positive impact on cardiovascular health. Doses used in the treatment of breast cancer range from 90~390 mg/day (Table 2). Divided doses are recommended to minimize adverse effects when doses exceed 100 mg/day. Maximum absorption of CoQ10 can be achieved if taken with meals that contain fat.

Coenzyme Q-10 supplements are available in a number of oral dosage forms, including capsules and tablets made from dried, powdered coenzyme Q-10. However, only a small percentage of oral coenzyme Q-10 supplements are thought to be absorbed from the intestines, with large percentages eliminated in the bile. Because coenzyme Q-10 dissolves in fats, soft gelatin capsules that contain coenzyme Q-10 in soybean oil may be absorbed more easily and more completely than dried, powdered forms of coenzyme Q-10 by the body. Taking coenzyme Q-10 with a meal that includes fats may also increase its absorption. For topical application, usually a soft gelatin capsule of coenzyme Q-10 is opened and the contents applied to the gums with a cotton swab.

Oral dosage recommendations for coenzyme Q-10 supplementation range from 100 mg per day to 3,000 mg (0.1 gram to 3 grams) per day or more, depending on the condition being treated. For HF, a common oral dose is 100 mg per day, taken as two or three doses. Individuals who decide to take coenzyme Q-10 should follow the directions on the package that is purchased.
Coenzyme Q10 CAS 303-98-0 photo picture image

Adults (18 years and older) By mouth (oral):

High blood pressure:Studies have used 30 to 360 milligrams of CoQ10 per day. The ideal starting dose is not known. Some people appear to respond more than others for unclear reasons.

Alzheimer's disease:Research has used doses of CoQ10 ranging from 60 milligrams once per day up to 120 milligrams three times a day. A preliminary study reports that higher doses may be more beneficial, although these effects are have not been proven.

Angina:60 milligrams daily for up to four weeks has been studied.

Anthracycline chemotherapy heart toxicity:Preliminary research has used 50 to 100 milligrams of CoQ10 per day in children and adults receiving doxorubicin (Adriamycin?) chemotherapy.

Breast cancer:90 milligrams of CoQ10 per day in combination with multivitamin/multi-mineral supplementation has been studied.

Congestive heart failure/cardiomyopathy:Studies have used 100 to 200 milligrams of CoQ10 per day, or 2 milligrams per kilogram of body weight per day. Limited research suggests that up to 600 milligrams per day may be tolerated. CoQ10 has been tested alone or as an addition to prescription drugs for these conditions. It is recommended that patients with these conditions speak with a doctor before starting new therapies.

Exercise performance:90 to 150 milligrams per day of CoQ10 has been studied.

Gum disease (periodontitis):5 milliliters (1 teaspoonful) per day, concentrated to 200 milligrams of CoQ10 per milliliter of corn oil, taken by mouth in divided doses has been used in one study.

Heart attack:120 milligrams of CoQ10 per day started three days after a heart attack has been studied, although safety and effectiveness are not known. It is recommended that patients speak with a doctor before starting new therapies.

Heart protection during surgery:Several studies in the 1980s and early 1990s used 30 to 150 milligrams of CoQ10 per day, starting one to two weeks prior to surgery, continuing for up to one month after surgery. Patients should speak with their surgeons before starting new therapies.

HIV/AIDS:200 milligrams of CoQ10 per day has been studied, although effectiveness has not been proven.

Mitochondrial diseases:120 to 160 milligrams per day, or 2 milligrams per kilogram of body weight per day, has been studied.

Muscular dystrophy:100 milligrams of CoQ10 per day divided into three doses was used in one study.

On the skin (topical):Cosmetics

Coenzyme Q10 On the skin Cosmetics 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.

Ubiquinone (CoQ10) is an antioxidant actions that neutralize free radicals, assists in the production of Adenosine Triphosphate (ATP) to optimize energy components of the cell

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 your surgeon.

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. One small study used 100 milligrams of CoQ10 by mouth twice daily to reduce the heart toxicity of anthracycline (doxorubicin) chemotherapy. A different small study used 3 to 3.4 milligrams per kilogram of body weight per day in children with mitral valve prolapse.

Reference:

What is CoQ10?Heart Energy Engine and More.

This article written and edited via herbalist of MDidea Extracts Professional. They run a range of online descriptions about this herb,including general information related and summarized updating discoveries from findings of professional scientisits this field related.Describe style aimed to form a useful detecting literature space where the intertwined threshold and related questions raise out and visualize themselves.

♣ last edit date:2nd,Dec.2010.