Does Coenzyme Q10 Relieve Statin-Induced Myopathy?

Gayle Nicholas Scott, PharmD, BCPS, ELS

Disclosures

September 18, 2009

Question

Does coenzyme Q10 alleviate muscle tenderness or spasm associated with statins?

Response from Gayle Nicholas Scott, PharmD, BCPS, ELS
Assistant Professor, Eastern Virginia Medical School, Norfolk, Virginia; Clinical Pharmacist, Chesapeake Regional Medical Center, Chesapeake, Virginia

Coenzyme Q10 (CoQ10) is a vitamin-like compound synthesized by the body and obtained from dietary fat. Another name for CoQ10 is ubiquinone, implying its ubiquity in the body. Coenzyme Q10 is present in almost all cells, where it functions as a cofactor in adenosine triphosphate production and as an antioxidant.[1]

Although adverse effects of statins are relatively rare -- considering that millions of prescriptions are dispensed each year -- the most common adverse effect is myopathy, ranging from mild muscle pain to the rare fatal rhabdomyolysis. The mechanism of statin myopathy is unclear; however, statins reduce the synthesis not only of cholesterol but also of CoQ10. One theory suggests that statin myopathy results from mitochondrial dysfunction in muscle caused by CoQ10 deficiency. Insufficient CoQ10 might limit mitochondrial energy production, disrupt normal cellular respiration, and result in the development of myopathy.[1]

Thus, supplemental CoQ10 has become a popular treatment for statin myopathy. It is well tolerated, and serious adverse effects have not been reported.[2]

CoQ10 is regulated as a dietary supplement in the United States, so manufacturers are not required to demonstrate efficacy or safety before marketing. However, several small studies addressing the effectiveness of CoQ10 for statin myopathy have been published.

In a randomized controlled trial of 32 patients with hypercholesterolemia and statin-associated myopathy, Caso and colleagues[3] treated 18 patients with CoQ10, 100 mg (Q-Sorb®; Nature's Bounty; Bohemia, New York) daily, and 14 patients with vitamin E, 400 IU (chosen to control for the antioxidant effects of CoQ10) daily for 30 days. Compared with the vitamin E group, the CoQ10 group showed a 40% decrease in pain severity and a 38% reduction in pain interference with daily activities.[3]

Young and colleagues[4] conducted a randomized controlled trial of 44 patients with previous statin myopathy. Patients were randomly assigned to CoQ10, 200 mg (Q-Gel®; Tishcon Corporation; Salisbury, Maryland) daily, or placebo for 12 weeks, combined with simvastatin, titrated every 4 weeks from 10 mg to a maximum of 40 mg daily. Although CoQ10 serum levels increased in the treatment group and decreased in the placebo group, myalgia scores, number of patients continuing to receive simvastatin, and number of patients titrated to simvastatin, 40 mg daily, were the same in both groups.[4]

Mabuchi and colleagues[5] studied 49 patients with hypercholesterolemia (but no history of myopathy) who were randomly assigned to CoQ10, 100 mg (Kaneka; Osaka, Japan) daily, or placebo in combination with atorvastatin, 10 mg daily for 16 weeks. CoQ10 serum levels increased in the treatment group and decreased in the placebo group, but indicators of muscle injury, including serum aspartate aminotransferase, alanine aminotransferase, and creatine kinase, did not differ between groups.

In summary, more research is needed to determine whether CoQ10 is useful for treatment of statin myopathy. Coenzyme Q10 might be worth a try (with careful monitoring) in patients with mild statin-induced myopathy. No research is available to support the use of CoQ10 for prevention of statin myopathy.

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