ONCOLOGY Nurse Edition. Vol. 25 No. 10

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INTEGRATIVE ONCOLOGY

Coenzyme Q10

By Glenn J. Lesser, MD, FACP¹, Mara Z. Vitolins, DrPH, MPH, RD² | October 19, 2011

Guest Editors: Debra Barton, PhD, RN, AOCN, FAAN, Mayo Clinic, Rochester, Minnesota; Susan Bauer-Wu, PhD, RN, FAAN, Emory University, Atlanta, Georgia
¹Professor of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina ²Professor and Vice Chair, Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest School of Medicine

What Are the Potential Risks?

Data from preclinical and clinical studies indicate that dietary supplementation with CoQ10 is safe, well tolerated, and free of any significant toxicities.[44] A large number of patients with cardiovascular disorders, including hypertension, heart failure, and hyperlipidemia have been treated with 100 to 300 mg per day of CoQ10 for up to 6 years without experiencing significant adverse events.[11,45] A meta-analysis of 12 studies and 362 patients with hypertension treated with 30 to 225 mg per day of CoQ10 for up to 56 weeks failed to identify significant drug-related toxicities.[15]

The safety of escalated doses of CoQ10 was evaluated in a randomized, double-blinded, placebo-controlled trial in early Parkinson’s disease. A total of 80 patients received 300 to 1,200 mg per day of CoQ10 for up to 16 months, and there was no difference in the incidence of adverse events between the placebo and treatment arms.[22]

In a randomized, placebo-controlled trial of 300 mg of CoQ10 twice daily for 30 months in patients with early Huntington’s disease, CoQ10 was generally well tolerated; a small increase in stomach upset was observed in the treated patients.[23] CoQ10 dosages of up to 3,000 mg per day for 8 months have also been well tolerated in small numbers of patients with Parkinson’s disease and amyotrophic lateral sclerosis.[46,47]

Treated patients in all of these trials had a low incidence of primarily gastrointestinal symptoms including nausea, vomiting, diarrhea, and abdominal discomfort.These symptoms do not appear to be dose-related and occurred at identical frequencies in both groups of patients treated in placebo-controlled trials.[11,22,23,48]

In light of its demonstrated hypotensive effects, CoQ10 could further decrease the blood pressure of patients on antihypertensive medications. In the meta-analysis previously described, CoQ10 supplementation decreased systolic and diastolic pressures by 17 mmHg and 10 mmHg, respectively.[23]

Limited anecdotal data suggest CoQ10 could reduce the anticoagulation effects of warfarin(Drug information on warfarin). It is hypothesized that the structural similarity of CoQ10 to Vitamin K might produce procoagulant effects.[49–51] Regular monitoring of the INR (International Normalized Ratio) should be considered in patients taking CoQ10 supplements while on warfarin anticoagulation therapy.

What’s the Bottom-Line Message?

Over the past three decades, the safety of CoQ10 has been convincingly demonstrated over a wide range of doses and schedules and in patients with a variety of medical conditions. There is evidence to support a role for CoQ10 supplementation as an adjunct in patients with congestive heart failure and hypertension, and there are some data that suggest a benefit of high doses in patients with Parkinson’s disease. The rare patient with a genetic defect in CoQ10 biosynthesis will also clearly benefit from exogenous CoQ10 administration. There are minimal data to support a beneficial effect of CoQ10 supplementation in patients with cancer, except for limited observations in patients receiving anthracycline-containing chemotherapy.

Online Information About CoQ10

• International Coenzyme Q10 Association > A nonprofit group formed in 1997 to promote research and educational activities related to coenzyme Q10—http://www.icqa.org/ICQA/home.html

• Linus Pauling Institute Micronutrient Information Center > CoQ10—http://lpi.oregonstate.edu/infocenter/othernuts/coq10/

• Mayo Clinic > monograph on CoQ10—http://www.mayoclinic.com/health/coenzyme-q10/NS_patient-coenzymeq10/METHOD=print

• Memorial Sloan-Kettering Cancer Center > About Herbs, Botanicals, and Other Products > CoQ10—http://www.mskcc.org/mskcc/html/69186.cfm

• Drugs.com > CoQ10 information—http://www.drugs.com/mtm/coenzyme-q10.html

• University of Maryland Medical Center > Coenzyme Q10 overview—http://www.umm.edu/altmed/articles/coenzyme-q10-000295.htm

• Natural Medicines Comprehensive Database > Coenzyme Q10—http://naturaldatabase.therapeuticresearch.com/nd/Search.aspx?cs=&s=ND&pt=9&Product=coenzyme+q10&btnSearch.x=15&btnSearch.y=3

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Financial Disclosure: The authors have no significant financial interest or other relationship with the manufacturers of any products or providers of any service mentioned in this article.

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Coenzyme Q10

What Are the Potential Risks?

What’s the Bottom-Line Message?

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