Can I take coenzyme Q10 (CoQ10) with statins?

Coenzyme Q10 (CoQ10) is a substance in the body that, among other things, fights cell damage.¹ CoQ10 is also widely available as an over-the-counter supplement. Levels of naturally occurring CoQ10 may be depleted in people taking statins.² Some researchers have proposed this depletion may be a factor in the development of statin-associated muscle symptoms (SAMS)³ and supplemental CoQ10 has been suggested as a therapy to prevent SAMS. Studies that examine whether supplemental CoQ10 reduces the incidence of SAMS have shown variable results.⁴ The best available evidence does not support the use of CoQ10 to reduce SAMS.^4,5 The benefits of CoQ10 supplementation have also been considered for patients with heart failure^6–8 and blood vessel disease.⁹ While available evidence for its value in these patients is also not strong, the use of CoQ10 has continued to increase.¹⁰ As the use of both statins and CoQ10 continues to rise, the safety of co-administered CoQ10 and statins is an important consideration.

Coenzyme Q10 has few reported adverse effects.^1,11 However, while prescription and over-the-counter medication manufacturers must provide high-quality evidence to the Food and Drug Administration (FDA) that their products are safe and effective before they can be sold, the FDA does not review herbal remedies or dietary supplements for safety and effectiveness before they are marketed.^12,13 For this reason, high-quality randomized controlled trials often do not exist for dietary supplements. In addition, although the FDA does provide guidance for good marketing practice to help ensure the substance’s identity, purity, strength, and composition, some supplements have been found to contain hidden prescription drugs or other compounds because the FDA has no regulatory oversight for the manufacturing process. There is no guarantee that the actual contents of any given bottle of herbs or supplements contains what it claims to contain or may not contain the dose it claims. In addition, some supplements are known to interfere with the pharmacokinetics of other medications.

McMurray and other investigators of the CORONA trial evaluated CoQ10 levels in 1,191 patients on statin therapy.^8,14 Their primary interest was in evaluating the effect of a lowered CoQ10 on cardiovascular outcome. Although a significant reduction of CoQ10 levels was associated with statin therapy,¹⁴ this reduction was not an independent predictor of adverse outcomes, including cardiovascular mortality, nonfatal myocardial infarction, nonfatal stroke, and heart failure. Adverse outcomes of co-administration of statins and CoQ10 was not discussed.

Flowers et al. conducted a 2014 systematic review and meta-analysis of randomized control trials that investigated CoQ10 use in patients at risk of cardiovascular disease.¹⁵ Four studies examined CoQ10 use among patients taking statins. Again, unfortunately, none of these studies provided data on adverse outcomes.

Grober et al. explored the drug-micronutrient reactions between a selection of commonly co-prescribed medications and determined the coadministration of statins and CoQ10 (100 mg/day) appeared to be safe¹⁶ and is an effective alternative to statin discontinuation for people at high risk of cardiovascular disease.

CoQ10 has been suggested as a way to reduce the muscle-related side effects of statins and also for use in patients with heart failure and blood vessel disease. While it has not been consistently shown to be effective for these purpose in all studies, its use is on the rise. CoQ10 appears to be safe to take with statins, but supplements should always be used with caution.

^References

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12. National Institutes of Health. National Center for Complementary and Integrative Health. https://nccih.nih.gov/. Accessed January 2, 2019. 
13. US Food and Drug Administration. Dietary supplements. https://www.fda.gov/food/dietarysupplements/. Accessed January 2, 2019. 
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15. Flowers N, Hartley L, Todkill D, Stranges S, Rees K. Co-enzyme Q10 supplementation for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev 2014;(12): CD010405.
16. Gröber U, Schmidt J, Kisters K. Important drug-micronutrient interactions: a selection for clinical practice. Crit Rev Food Sci Nutr 2018: 1-19.