Coenzyme Q10 for STATIN intolerance

Some research shows that taking coenzyme Q10 100 mg by mouth twice daily for 3 months, with or without selenium (Antox), reduces muscle pain....
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition, BCNSP

Introduction

As a community pharmacist, patients will ask you more about Coenzyme Q10 for STATIN intolerance. Statin intolerance is present in about 9% of statin-treated patients, according to a recent meta-analysis. This finding is getting a lot of attention and is likely to increase interest in supplements that might help limit statin-induced muscle pain and weakness. Be prepared to answer questions about coenzyme Q10.

NPS-adv

Coenzyme Q10 and statin intolerance

Understanding Coenzyme Q10

Coenzyme Q10 is a compound that has a chemical structure similar to vitamin K. It’s made in the body and found in almost all cells, particularly in the heart, liver, kidney, and pancreas. Coenzyme Q10 and cholesterol share common synthetic pathways, and statins block the synthesis of both. Some believe that statin-induced muscle pain and weakness might be related to lower coenzyme Q10 levels, and that taking a coenzyme Q10 supplement might limit these side effects without hindering the cholesterol-lowering effects of statins. Clinical data supporting this theory is conflicting.

  • Some research shows that taking coenzyme Q10 100 mg by mouth twice daily for 3 months, with or without selenium (Antox), reduces muscle pain and weakness in people with statin intolerance when compared with placebo.
  • However, other research shows no benefit. While the reasons for the conflicting data aren’t exactly clear, the inconsistent findings don’t seem to be related to the dose of coenzyme Q10.

Recommendations for patients

For patients who don’t improve after standard measures to manage statin intolerance, taking coenzyme Q10 supplement for 30 days may be a reasonable option. It’s likely safe for most people and is usually well-tolerated.

  • Gastrointestinal side effects such as nausea and vomiting are most common and can be minimized if daily doses above 100 mg are divided.
  • But explain that if muscle pain and weakness don’t improve after 30 days of taking the supplement, it probably won’t help.

NPS-adv

References

  1. Mancini GB, Baker S, Bergeron J, et al. Diagnosis, Prevention, and Management of Statin Adverse Effects and Intolerance: Canadian Consensus Working Group Update (2016). Can J Cardiol. 2016 Jul;32(7 Suppl):S35-65.
  2. Anderson TJ, Grégoire J, Pearson GJ, et al. 2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult. Can J Cardiol. 2016 Nov;32(11):1263-1282.
  3. Sood B, Keenaghan M. Coenzyme Q10. [Updated 2022 Jan 19]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan.
Mahitab Hany, BS Pharm, PGDipClinPharm, PGDipClinNutrition, BCNSP