CoQ10 and L-carnitine for Statin Myalgia?

James J DiNicolantonio

Disclosures

Expert Rev Cardiovasc Ther. 2012;10(10):1329-1333. 

In This Article

CoQ10 for Treating Statin Myalgia

Marcoff et al. randomized 41 patients with statin-induced myalgia to CoQ10 100 mg/day or vitamin E 400 IU/day for 30 days.[3] There was no significant change in the pain score for vitamin E (3.9/10 reduced to 3.1/10). However, there was a highly significant decrease in pain score for the CoQ10 group (6.2/10 reduced to 3.1/10 [p < 0.001]). Out of 21 people in the CoQ10 group, 18 reported a decrease in the severity of their muscle symptoms compared with only three out of 20 people in the vitamin E group.[3]

Caso et al. randomized 32 patients in a double-blind fashion to CoQ10 100 mg/day (n = 18) patients versus vitamin E 400 IU/day (n = 14).[16] After 30 days the CoQ10 group had a 38% reduction in "pain interfering with daily activities" and a 40% reduction in "pain intensity". No change was seen in any of these measures for the vitamin E group.

Young et al. randomized 44 patients to CoQ10 200 mg/day or placebo for 12 weeks in combination with an upward dose titration of simvastatin, from 10 to 40 mg/day, doubling every 4 weeks if tolerated.[17] Myalgia was assessed using a visual analog scale. Despite an increased percentage of patients tolerating simvastatin 40 mg/day in patients on CoQ10 versus placebo (73 vs 59%, p = 0.63), the number of patients remaining on statin therapy with CoQ10 (73%) versus placebo (82%) was not improved (p = 0.47). The authors concluded that 12 weeks of CoQ10 did not significantly improve statin tolerance or myalgia but that further studies were warranted.[17]

The rationale for using CoQ10 to treat statin myalgias was so overwhelming that Merck & Co, Inc. (NJ, USA) decided to pursue a patent for a CoQ10-statin combination product.[101,102] Merck & Co, Inc. was eventually issued two patents for this product, which was meant to counteract the statin-associated myopathy and to reduce the elevated transaminase levels produced by the statin.[101,102] However, there are only a few small, randomized, trial showing that CoQ10 is effective at reducing statin-induced myalgias. Larger randomized trial should be performed to confirm these results. In current day practice, with the lack of large randomized trials, CoQ10 seems to be a reasonable approach for treating statin-induced muscle pains.

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