Coenzyme 10 : A review Part II



In this part we will review the interactions of Co enyme10 and clincical use in various systemic disease and conditions.

Drug Interactions:

CoQ10 has when administered with other drugs have few drug interactions and caution should be exercised with those particular drugs.

The concomitant administration of CoQ10 with HMG-CoA reductase inhibitors has shown to interfere with the endogenous synthesis of CoQ10. HMG-Co A reductase inhibitors block the synthesis of melvalonic acid, a precursor to cholesterol and to CoQ10. Beta-blockers have shown to decrease endogenous serum coQ10 levels by inhibiting coQ10-dependent enzymes. CoQ10 also reduces insulin requirement in diabetes mellitus. Oral hypoglycemic agents like glyburide, acetohexamide, and tolazaide have been shown to decrease endogenous CoQ10 levels. In patients on warfarin care should be maintained with concomitant use of CoQ10 because of the structural similarity to vitamin K.

Table 3 Drug Interactions With CoQ10



Mechanism of Action

HMG-CoA Reductase


decrease endogenous

CoQ10 levels

Blocks pathway to produce CoQ10


decreases endogenous

CoQ10 levels

Inhibits enzymes to produce CoQ10


decreases INR

CoQ10 structurally similar to vitamin K

increasing clotting factors

Oral Hypoglycemics




decreases endogenous

CoQ10 levels

Inhibits enzymes that

produce CoQ10

Clinical Uses:

Various clinical trails have provided evidence supporting the use of CoQ10 in prevention and treatment of various disorders related to oxidative stress. It has been shown to be useful in adjunct therapy for cardiovascular diseases, cancer, periodontal disease, immuno-compromised systems, COPD and muscular dystrophy. Therefore, healthcare professionals are advocating its use as a supplement.

Cardiovascular Diseases:

Several open and controlled studies have examined the efficacy of CoQ10 as adjunctive therapy or treating CHF. The presence of increasing symptoms associated with CHF has been correlated to the severity of CoQ10 deficiency. Patients exhibiting a significantly lower serum free cholesterol-related CoQ10 value had an increased risk of CHF, severe myalgia, concomitant use of cytostatic and lipid-lowering drug therapy, and /or death within a six month follow- up.

CoQ10's proposed mechanism on benefiting CHF is through positive inotropic action. Such action increases the contractile force of the heart to improve cardiac output. Many drugs of conventional CHF therapy also possess this positive inotropic property, yet the increased contractility requires an adequate supply of ATP. Failed hearts are believed to lack ATP, thus this bioenergetic process is the reasoning behind supplementing CHF therapy with CoQ10.

Despite its lack of effect on survival, CoQ10 may improve cardiac function and quality of life in patients with severe CHF. Fewer hospitalizations could reduce the cost of managing patients with NYHA Class III or IV heart failure. It has been postulated that the mechanism for improved exercise tolerance may be attributed to the ability of CoQ10 to maintain oxidative phosphorylation, thereby acting as a direct membrane protectant via the production of ATP.

CoQ10 may improve surgical recovery and lessen the magnitude of surgical insult in heart surgery.CoQ10 plays a protective role during cardiac valve replacement by directly scavenging hydroxyl radicals, thus acting as an antioxidant and membrane stabilizer. Since doxorubicin inhibits CoQ10-dependent enzymes, pretreatment with CoQ10 may mitigate its cardio toxic effects. Proposed mechanisms of cardio protection involve the inhibition of doxorubicin-induced lipid peroxidation and scavenging free radicals. Therefore, CoQ10 may have a potential role in the prevention of doxorubicin-induced cardio toxicity.


Several studies involving small numbers of people suggest that CoQ10 may lower blood pressure. However, it may take 4 to 12 weeks before any beneficial effect is observed. More research with greater numbers of people is needed to assess the value of CoQ10 in the treatment of high blood pressure. CoQ10 is not a typical antihypertensive drug; rather, it seems to correct some metabolic abnormality that is involved in the pathogenesis of hypertension.


Because of its role in enhancing immune function, CoQ10 has been considered as a possible anti-cancer agent. Administration of CoQ10 reduced tumor size and increased survival in mice exposed to a chemical carcinogen. Preliminary studies in humans, though uncontrolled, are promising. CoQ10 prevents metastasis and enhances remission in breast cancer. Mechanisms in cancer include immune system enhancement and antioxidant activity.

Diabetes Mellitus:

The electron transport chain, of which CoQ10 is a component, plays a major role in carbohydrate. CoQ10 was found at decreased level when measured in rats with experimentally induced diabetes. Another study done in humans found that daily dose of 120mg of Coq7 for 2-18 weeks reduced fasting blood sugar by at least 30% in 31% of patients and ketone bodies declined by at least 30% in 59% of the patients.

Immune Modulation:

Cells and tissues that play a role in immune function are highly energy-dependent and therefore require an adequate supply of CoQ10 for optimal function. Several studies have demonstrated immune-enhancing effects of CoQ10 or its analogues. These effects included increased phagocytic activity of macrophages; increased proliferation of granulocytes in response to experimental infections; and prolonged survival in mice infected with Pseudomonas aeruginosa, Staphylococcus aureus, Escherichia coli, Klebsiella pneumonia, or Candida albicans. Studies have demonstrated that the degree of CoQ10 deficiency is correlated with the severity of immune compromised diseases. Patients with acquired immune deficiency syndrome (AIDS) showed statistically significant lower CoQ10 serum concentrations than AIDS-related complex (ARC) patients, who in turn had lower levels than healthy subjects. Its antioxidant activity helps prevent AIDS-related diseases caused by oxidative stress. Blood levels of CoQ10 are lower in AIDS patients and 200 mg/day increased T-helper/suppresser ratios.

Muscular Dystropy:

Research suggests a strong correlation between human myotonic dystrophic conditions and defects in mitochondrial functions, energy metabolism, and oxidative damage. CoQ10 is found in cardiac and skeletal muscle i animals and humans with hereditary muscular dystrophy. In addition, treatment with CoQ10 or its analogues increased survival and improved the performance of dystrophic mice, rabbits, and monkeys, as determined by a reduction of creatinuria, regaining of righting reflex, and weight gain.

Gastric Ulcer:

Susceptibility to gastric ulceration is related to the balance between ulcer promoting factors (such as excessive gastric acidity and infection with Helicobacter pylori), and resistance factors (such as tissue integrity, production of protective mucus, and repair mechanisms). Free-radical damage is believed to be one of the primary mechanisms by which external factors induce gastric injury and peptic ulceration. Since CoQ10 possesses antioxidant activity, it might be capable of preventing ulceration by reducing the amount of free-radical damage. In addition, the production of protective mucus and the rapid cell turnover of gastric mucosa are highly energy-dependent processes, which require the presence of adequate amounts of CoQ10.


Individuals with a family history of obesity have a 50% reduction in thermogenic response to a meal and are often found to have low CoQ10 levels. Since CoQ10 is an essential cofactor for energy production, it is conceivable that CoQ10 deficiency is a contributing factor in some cases of obesity. However one of the studies found other metabolic abnormalities related to CoQ10 deficiency and therefore it may an effect rather than a cause.

Physical Performance:

Supplementation with CoQ10 may enhance aerobic capacity and muscle performance, especially in sedentary individuals. The effect of CoQ10 on the performance of trained athletes has not been studied.


CoQ10 inhibits release of histamines and SRSA in antigen-challenged animal models. This has not yet been proved in clinical trials.

Male Fertility:

CoQ7 (CoQ10 analog) at 10mg/day resulted in significant increase in sperm count and motility.

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