Health Care Professional Information

Scientific Name
2,3 dimethoxy-5 methyl-6-decaprenyl benzoquinone
Common Name

Ubiquinone, ubidecarenone, ubiquinol, CoQ, CoQ10

Brand Name

UbiQgel™

Clinical Summary

Coenzyme Q10 (CoQ10), also known as ubiquinone, is involved in cellular respiration and energy production. It is found in all human cells, with higher concentrations in the liver, kidney, heart, and pancreas. It is also consumed as a dietary supplement for its antioxidant effects and is often promoted as a preventive agent for cardiovascular diseases, Parkinson's disease, infertility and cancer.
Studies done in mice indicate antioxidant and neuroprotective effects (17) (18).
Data from clinical trials suggest beneficial effects of CoQ10 in patients with coronary artery disease (2) and congestive heart failure (21).
CoQ10 supplementation may increase sperm motility in asthenozoospermic men (8) and reduce fatigue induced by physical exertion (9).
Putative neuroprotective effects of CoQ10 were reported in patients with progressive supranuclear palsy (5) as well as those with early Parkinson's disease (6) (33), but not with midstage Parkinson's disease (7). A mixture of antioxidants, including CoQ10, vitamins C, E, and lipoic acid was found ineffective against Alzheimer's disease (20).
There may be a role for CoQ10 in the prevention of migraine (22). A small study showed a reduction in the frequency of migraine headaches with CoQ10 supplementation (23), but a randomized trial failed to find benefit (24). More research is warranted.
The observation that patients who receive statin therapy have decreased concentrations of CoQ10 in muscle cells (25) resulted recently in studies to evaluate the benefit of CoQ10 in alleviating statin-induced myalgias. The data are inconclusive (26) (27) (28).
CoQ10 has also been investigated for anticancer effects. A few case reports suggest that CoQ10 supplementation may be useful in the treatment of breast cancer (3) (4). However, a randomized trial did not find any effectiveness in improving self-reported fatigue or quality of life in breast cancer patients (29). Further study is needed.
CoQ10 is structurally similar to vitamin K and can antagonize the effects of warfarin (11) (12).
And because of its antioxidant property, CoQ10 may also reduce effectiveness of chemotherapy and radiation therapy (13).

Purported Uses
  • Angina
  • Cancer prevention
  • Cardiovascular disease
  • Chemotherapy side effects
  • Congestive heart failure
  • HIV and AIDS
  • Hypertension
  • Infertility
  • Migraine prophylaxis
  • Parkinson's disease
  • Periodontal disease
  • Strength and stamina
Mechanism of Action

CoQ10 is known to have antioxidant and membrane stabilizing properties and is the only endogenously produced lipid with a redox function in mammals. All cells are capable of synthesizing CoQ10 and no redistribution between organs occurs through the blood. CoQ10 is necessary for adenosine triphosphate (ATP) production. Its role as a mobile electron carrier in the mitochondrial electron-transfer processes of respiration and coupled phosphorylation is well established. It has a direct regulatory role on succinyl and NADH dehydrogenases (1). CoQ10 has been demonstrated to scavenge free radicals produced by lipid peroxidation and prevent mitochondrial deformity during episodes of ischemia, and it may have some ability to maintain the integrity of myocardial calcium ion channels during ischemic insults (2).
CoQ10 may also be capable of stabilizing cellular membranes and preventing depletion of metabolites required for ATP resynthesis (10), and suppressing age-related inflammatory reactions and osteoclast differentiation by inhibiting oxidative stress (30).
CoQ10 was shown to prevent the reduction of glucose transporter-4 (GLUT4) protein levels in adipocytes caused by simvastatin, which may be one of the mechanisms underlying statin-induced diabetes (31).

In a study of rats, CoQ10 protected against doxorubicin-induced testicular toxicity by ameliorating oxidative stress, reducing apoptosis and by up-regulating testicular P-glycoprotein (32).

Contraindications
Adverse Reactions

Infrequent: Nausea, diarrhea, and appetite suppression.
(11)

Herb-Drug Interactions

HMG-CoA reductase inhibitors: Endogenous levels of CoQ may be reduced by lovastatin, atorvastatin and simvastatin. The HMG-CoA reductase enzyme is responsible for catalyzing the conversion of acetyl CoA to cholesterol and synthesis of CoQ10 (14).
Warfarin: CoQ may antagonize the effects of warfarin. CoQ is structurally similar to vitamin K (11).
Theophylline: CoQ delays the clearance of theophylline, which can cause persistent vomiting, cardiac arrhythmias, and intractable seizures (19).

Literature Summary and Critique

Balercia G, Buldreghini E, Vignini A, et al. Coenzyme Q(10) treatment in infertile men with idiopathic asthenozoospermia: a placebo-controlled, double-blind randomized trial Fertil Steril. 2009 May;91(5):1785-92.
Because semen concentrations of coenzyme Q10 and ubiquinol are reduced in infertile men, this randomized, placebo-controlled, double-blind study of 60 infertile participants sought to determine if coenzyme Q10 supplementation (200 mg/day) for 6 months could influence fertility. Compared to placebo, coenzyme Q10 increased sperm motility, an effect that was reversed after a 3-month washout period. Participants with the lowest baseline coenzyme Q10 and ubiquinol concentrations as well as sperm motility were most likely to receive benefits of coenzyme Q10 supplementation. The authors propose that coenzyme Q10's antioxidant properties may be responsible for the increase in sperm motility; however, whether coenzyme Q10 enhances overall fertility has yet to be determined.

Dosage (Inside MSKCC Only)
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References
  1. Greenberg S, Frishman WH. Co-enzyme Q10: a new drug for cardiovascular disease. J Clin Pharmacol 1990;30:596-608.
  2. Tiano L, Belardinelli R, Carnevali P, Principi F, Seddaiu G, Littarru GP. Effect of coenzyme Q10 administration on endothelial function and extracellular superoxide dismutase in patients with ischaemic heart disease: a double-blind, randomized controlled study. Eur Heart J. Sep 2007;28(18):2249-2255.
  3. Lockwood K, et al. Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochem Biophys Res Comm 1994;199:1504-8.
  4. Lockwood K, et al. Progress on therapy of breast cancer with vitamin Q10 and the regression of metastasis. Biochem Biophys Res Comm 1995;212:172-7.
  5. Stamelou M, Reuss A, Pilatus U, et al. Short-term effects of coenzyme Q10 in progressive supranuclear palsy: a randomized, placebo-controlled trial. Mov Disord. May 15 2008;23(7):942-949.
  6. Shults CW, Oakes D, Kieburtz K, et al. Effects of coenzyme Q10 in early parkinson disease. Arch Neurol 1998;4:505-6.
  7. Storch A, Jost WH, Vieregge P, et al. Randomized, double-blind, placebo-controlled trial on symptomatic effects of coenzyme Q(10) in Parkinson disease. Arch Neurol. Jul 2007;64(7):938-944.
  8. Balercia G, Buldreghini E, Vignini A, et al. Coenzyme Q(10) treatment in infertile men with idiopathic asthenozoospermia: a placebo-controlled, double-blind randomized trial. Fertil Steril. 2009 May;91(5):1785-92.
  9. Mizuno K, Tanaka M, Nozaki S, et al. Antifatigue effects of coenzyme Q10 during physical fatigue. Nutrition. Apr 2008;24(4):293-299.
  10. Dallner G, Sindelar PJ. Regulation of ubiquinone metabolism. Free Radic Biol Med 2000;29:285-94.
  11. Fuke C, Krikorian SA, Couris RR. Coenzyme Q10: a review of essential functions and clinical trials. US Pharmacist 2000;25:28-41.
  12. Shalansky S, Lynd L, Richardson K, et al. Risk of warfarin-related bleeding events and supratherapeutic international normalized ratios associated with complementary and alternative medicine: a longitudinal analysis. Pharmacotherapy 2007;27(9):1237-47.
  13. Lund EL, Quistorff B, Spang-Thomsen M, Kristjansen PE. Effect of radiation therapy on small-cell lung cancer is reduced by ubiquinone intake. Folia Microbiol 1998;4:505-6.
  14. Pronsky ZM. Power's and Moore's Food-Medication Interactions, 11th ed. Pottstown (PA): Food Medication Interactions; 2000.
  15. Khatta M, Alexander BS, Krichten CM, et al. The effect of coenzyme Q10 in patients with congestive heart failure. Ann Intern Med 2000;132:636-40.
  16. Watson PS, Scalia GM, Galbraith A, et al. Lack of effect of coenzyme Q on left ventricular function in patients with congestive heart failure. J Am Coll Cardiol 1999;33:1549-52.
  17. Kalayci M, Unal MM, Gul S, et al. The effect of Coenzyme Q10 on ischemia and neuronal damage in an experimental traumatic brain injury model in rats. BMC Neurosci. 2011 Jul 29;12(1):75.
  18. Dumont M, Kipiani K, Yu F, et al. Coenzyme Q10 Decreases Amyloid Pathology and Improves Behavior in a Transgenic Mouse Model of Alzheimer's Disease. J Alzheimers Dis. 2011 Jul 28. [Epub ahead of print]
  19. Baskaran R, Shanmugam S, Nagayya-Sriraman S, et al. The effect of coenzyme Q10 on the pharmacokinetic parameters of theophylline. Arch Pharm Res. 2008 Jul;31(7):938-44.
  20. Galasko DR, Peskind E, Clark CM, et al; for the Alzheimer's Disease Cooperative Study. Antioxidants for Alzheimer Disease: A Randomized Clinical Trial With Cerebrospinal Fluid Biomarker Measures. Arch Neurol. 2012 Mar 19. [Epub ahead of print]
  21. Fotino AD, Thompson-Paul AM, Bazzano LA. Effect of coenzyme Q10 supplementation on heart failure: a meta-analysis. Am J Clin Nutr. 2013 Feb;97(2):268-75.
  22. Hershey AD, Powers SW, Vockell AL, et al. Coenzyme Q10 deficiency and response to supplementation in pediatric and adolescent migraine. Headache. 2007 Jan;47(1):73-80.
  23. Rozen TD, Oshinsky ML, Gebeline CA, et al. Open label trial of coenzyme Q10 as a migraine preventive. Cephalalgia. 2002 Mar;22(2):137-41.
  24. Slater SK, Nelson TD, Kabbouche MA, et al. A randomized, double-blinded, placebo-controlled, crossover, add-on study of CoEnzyme Q10 in the prevention of pediatric and adolescent migraine. Cephalalgia. 2011 Jun;31(8):897-905.
  25. Mabuchi H, Nohara A, Kobayashi J, et al. Effects of CoQ10 supplementation on plasma lipoprotein lipid, CoQ10 and liver and muscle enzyme levels in hypercholesterolemic patients treated with atorvastatin: a randomized double-blind study. Atherosclerosis. 2007 Dec;195(2):e182-9.
  26. Bookstaver DA, Burkhalter NA, Hatzigeorgiou C. Effect of coenzyme Q10 supplementation on statin-induced myalgias. Am J Cardiol. 2012 Aug 15;110(4):526-9.
  27. Bogsrud MP, Langslet G, Ose L, et al. No effect of combined coenzyme Q10 and selenium supplementation on atorvastatin-induced myopathy. Scand Cardiovasc J. 2013 Apr;47(2):80-7.
  28. Fedacko J, Pella D, Fedackova P, et al. Coenzyme Q(10) and selenium in statin-associated myopathy treatment. Can J Physiol Pharmacol. 2013 Feb;91(2):165-70.
  29. Lesser GJ, Case D, Stark N, et al. A randomized, double-blind, placebo-controlled study of oral coenzyme Q10 to relieve self-reported treatment-related fatigue in newly diagnosed patients with breast cancer. J Support Oncol. 2013 Mar;11(1):31-42.
  30. Yoneda T, Tomofuji T, Ekuni D, et al. Anti-aging effects of co-enzyme Q10 on periodontal tissues. J Dent Res. 2013 Aug;92(8):735-9.
  31. Ganesan S, Ito MK. Coenzyme Q10 ameliorates the reduction in GLUT4 transporter expression induced by simvastatin in 3T3-L1 adipocytes. Metab Syndr Relat Disord. 2013 Aug;11(4):251-5.
  32. El-Sheikh AA, Morsy MA, Mahmoud MM, Rifaai RA. Protective mechanisms of coenzyme-Q10 may involve up-regulation of testicular P-glycoprotein in doxorubicin-induced toxicity. Environ Toxicol Pharmacol. 2014 Feb 19;37(2):772-781.
  33. Seet RC1, Lim EC, Tan JJ, et al. Does high-dose coenzyme Q10 improve oxidative damage and clinical outcomes in Parkinson's disease? Antioxid Redox Signal. 2014 Jul 10;21(2):211-7.

Consumer Information

How It Works

Bottom Line: Coenzyme Q10 has not been shown to treat or prevent cancer.

Coenzyme Q10 (CoQ10) is produced naturally by all cells in the body. It is necessary for production of adenosine triphosphate (ATP), the “fuel” of all living cells. During periods of ischemia (lack of oxygen), such as occurs during a heart attack, CoQ10 has been shown to reduce damage to heart tissue and its mitochondria (where ATP production takes place). It is known to be an antioxidant and to stabilize cell and organelle membranes. In animal studies, coenzyme Q10 is able to neutralize free radicals, which can damage DNA and cells. However, absorption of oral coenzyme Q10 through the intestine is low. Due to its antioxidant activity, CoQ10 may interfere with the actions of certain chemotherapy drugs and radiation therapy.

Purported Uses
  • As an antioxidant
    Laboratory studies show that CoQ10 has antioxidant effects.
  • To treat breast cancer
    A few case reports describe remission of breast cancer when treated with high doses of CoQ10, but this is insufficient evidence to support this use.
  • To manage cardiovascular disease
    Several studies show CoQ10 improves left ventricular function and reduce hypertension. Other studies yielded negative results.
  • To reduce high cholesterol
    Clinical trials show inconsistent results: two indicate an increase in HDL, one shows a decrease in LDL, while two others indicate that coenzyme Q10 has no effect on LDL oxidation (which contributes to the development of atheroclerotic plaques in the blood vessels).
  • To prevent cardiac toxicity from anthracyclines
    One clinical trial supports this use, but additional studies are needed.
  • To improve athletic performance
    Clinical trials do not support this use.
  • To prevent the progression of Parkinson's disease
    One clinical trial showed that high doses of coenzyme Q10 slowed the progression of Parkinson's disease, but larger clinical trials are needed to support this use.
  • To treat Huntington's disease
    Data from a single clinical trial do not support this use.
  • To treat periodontal disease (disease of the gum, teeth, and underlying bone)
    One study supports this use, but additional clinical trials are needed.
Research Evidence

Male Infertility:
Because semen concentrations of coenzyme Q10 and ubiquinol are reduced in infertile men, this randomized, placebo-controlled, double-blind study of 60 infertile men sought to determine if coenzyme Q10 supplementation (200 mg/day) for 6 months could influence fertility.  Compared to placebo, coenzyme Q10 improved sperm motility; however, whether coenzyme Q10 can enhance overall fertility has yet to be determined.

Do Not Take If
  • You are taking Warfarin (CoQ10 may lessen its effects).
  • You are undergoing chemotherapy (Theoretically, because it is an antioxidant, CoQ10 may decrease the effectiveness of chemotherapy; patients should consult with their oncologist).
  • You are taking Theophylline (CoQ delays the clearance of theophylline, which may cause persistent vomiting, cardiac arrhythmias, and intractable seizures).
Side Effects
  • Nausea
  • Diarrhea
  • Loss of appetite
Special Point

A study conducted in mice showed that high intake of CoQ10 reduced the effectiveness of radiation therapy against non-small cell lung cancer. Patients considering use of CoQ10 during radiation therapy should consult with their physician.

E-mail your questions and comments to aboutherbs@mskcc.org.