Research shows that Coenzyme Q10 or CoQ10 appears to be generally safe with no significant side effects. In rare cases, it may cause upset stomach, diarrhea, nausea or loss of appetite. Other adverse effects may include dizziness, photophobia, irritability and headaches. However, CoQ10 has been known to interact with a variety of prescription medications, causing either a depletion of the drug or interfering in some way with the body's ability to metabolize the medication. The safety of CoQ10 supplementation during pregnancy and breastfeeding is unknown and, therefore, should it is advicable not used CoQ10 during that time until more information is available
Medications that can lower the levels of coenzyme Q10 in the body include statins for cholesterol, fibric acid derivatives for cholesterol, beta-blockers for high blood pressure, and tricyclic antidepressant medications. If you are currently taking any of these prescription drugs, check with your doctor or medically trained nutritionist before taking CoQ10. Because of the potential for side effects and interactions with specific medications, CoQ10 supplements should only be taken under the supervision of a knowledgeable healthcare provider.
| Affected Drug | Interaction | Medical Reference |
Statin / Cholesterol-lowering drugs Generic and trade names: Atorvastatin (Lipitor®, Torvast®) Fluvastatin (Lescol®) Lovastatin (Mevacor®, Altocor®, Altoprev®) Pravastatin (Pravachol®, Selektine®, Lipostat®) Pitavastatin ( Livalo®, Pitava®) Rosuvastatin (Crestor®) Simvastatin (Lipex®, Zocor®) Simvastatin+Ezetimibe (Vytorin®) | Depletion or interferece HMG-CoA (or 3-ydroxy-3-methylglutaryl-coenzyme A) reductase inhibitors such as lovastatin and pravastatin significantly decrease blood concentrations of CoQ10. Biosynthesis of both cholesterol and coenzyme Q (CoQ) requires mevalonic acid as a precursor. Consequently, lovastatin therapy could also result in a lowering of cellular levels of Coenzyme Q10 | Caso G, Kelly P, McNurlan MA, Lawson WE. Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins. Am J Cardiol. 2007 May 15;99(10): 1409-12. Epub 2007 Apr 3 Berthold HK, Naini A, Di Mauro S, Hallikainen M, et al. Effect of ezetimibe and/or simvastatin on coenzyme Q10 levels in plasma: a randomised trial. Drug Saf.2006;29(8):703-12 Mortensen SA, et al. Mol Aspects Med. 1997;18 Suppl:S137-144; Palomaki A, et al. FEBS Lett 1997 Jun 30;410(2-3):254-258. Folkers K, et al. Proc Natl Acad Sci U S A. 1990 Nov;87(22):8931-8934; Willis RA, et al. Proc Natl Acad Sci U S A. 1990 Nov;87(22):8928-8930; Laaksonen R, et al. Eur J Clin Pharmacol 1994;46(4):313-317; Mortensen SA, et al. Mol Aspects Med. 1997;18 Suppl:S137-144; Palomaki A, et al. FEBS Lett 1997 Jun 30;410(2-3):254-258; Palomaki A, et al. J Lipid Res. 1998 Jul;39(7): 1430-1437. Folkers K, Langsjoen P. 1991, 449-452.) Baum H. New Scientist May 24, 1991, 24. Mortensen SA, et al. Mol Aspects Med. 1997;18 Suppl:S137-144; Palomaki A, et al. FEBS Lett 1997 Jun 30;410(2-3):254-258. |
Anti-depressants, Tricyclic Antidepressants Generic and trade names: Amitriptyline: (Elavil®) Desipramine: (Norpramin®) Doxepin: (Sinequan®) Imipramine: (Tofranil®) | Depletion or interference *) Tricyclic antidepressants are known to inhibit CoQ10-dependent enzyme activity. Tricyclic antidepressant drugs, particularly when given in high doses, have been reported to produce arrhythmias, sinus tachycardia, and prolongation of the conduction time. Supplementation with Coenzyme Q10 may prevent cardiac side effects associated with the use of tricyclic antidepressants. | Conklin KA. Coenzyme q10 for prevention of anthracycline-induced cardiotoxicity. Integr Cancer Ther. 2005 Jun;4(2):110-30 Shinozawa S, Gomita Y, Araki Y. Protective effects of various drugs on adriamycin (doxorubicin)-induced toxicity and lipid peroxidation in mice and rats.
Biol Pharm Bull.1993 Nov;16(11):1114-7 |
Anthracycline/ Antineoplastic Generic and trade names: Daunorubicin (Cerubidine®, DaunoXome®) Doxorubicin (Adriamycin®, Doxil®) Pegylated liposomal doxorubicin hydrochloride (Caelyx™, Myocet®) | Reduction/prevention Coenzyme Q10 may help to reduce the toxic effects on the heart caused this chemotherapy medication that is commonly used to treat a variety of cancers. Studies with both animals and humans have found that pretreating with Coenzyme Q10, at levels of 100 mg per day, reduces cardiac toxicity caused by doxorubicin. | |
Lipid regulating agents Generic and trade names: Gemfibrozil (Lopid®) | Depletion or interference | Farswan M, Rathod SP, Upaganlawar AB Protective effect of coenzyme Q10 in simvastatin and gemfibrozil induced rhabdomyolysis in rats Indian J Exp Biol.2005 Oct;43(10):845-8. |
Antipsychotic drugs Generic and trade names Perphenazine (Apo-Perphenazine®) | Reduction/prevention *) | |
Anti-depressants, Tricyclic Antidepressants (TCA) Generic and trade names: Amitriptyline: (Elavil®)
Desipramine: (Norpramin®)
Doxepin: (Sinequan®)
Imipramine: (Tofranil®) | Depletion or interference *) Tricyclic antidepressants inhibit CoQ10-dependent enzyme activity. Tricyclic antidepressants are antagonistic to CoQ10 enzymes. Furthermore these drugs are class I antiarrhythmics.
Tricyclic antidepressant drugs, including amitriptyline, particularly when given in high doses, have been reported to produce arrhythmias, sinus tachycardia, and prolongation of the conduction time. Myocardial infarction and stroke have also been reported with tricyclic antidepressant drugs.
Supplementation with Coenzyme Q10 may prevent cardiac side effects associated with the use of antidepressants, may offset depletion due to the use of tricyclic antidepressants and reduce attendant cardiac risks. | Folkers K. 1985; Glassman AH, Gerontology 994;40 Suppl 1:15-20. Scahill L, Lynch KA. Child Adolesc Psychiatr Nurs Jan-Mar;7(1):37-39; Pinto J, et al. Biochem Pharmacol 1982 Nov 1;31(21):3495-3499 Kishi T, et al. 1980: 139-157 |
Beta-adrenergic Blocking Agents
Generic and trade names: Acebutolol
Atenolol
Betaxolol
Carteolol
Labetalol
Metoprolol (Lopressor®)
Nadolol (Corgard®)
Oxprenolol
Penbutolol
Pindolol (Visken®)
Propranolol (Inderal®)
Sotalol
Timolol (Blocadren®)
| Depletion or interference *) / reduction/prevention Beta-adrenergic Blocking Agents can inhibit CoQ10-dependent enzymes. CoQ10 supplementation may reduce the heart-related side effects of timolol drops, a beta-blocker medication used to treat glaucoma, without decreasing the effectiveness of the medication. Many beta-blockers are antagonistic to CoQ10 enzymes, enzymes which are indispensable for the bioenergetics of the myocardium. Kishi et al found that adrenergic blockers for beta-receptors inhibited mitochrondrial CoQ10-enzymes to varying degrees. Propranolol is frequently used to treat hypertension; in some patients, it depresses myocardial function as an adverse reaction. Timolol showed negligible inhibition of the CoQ10-enzyme, NADH-oxidase, and exerted pharmacologically low cardiac depressant effects. Metoprolol was less inhibitory than propranolol. Five alprenolols showed inhibition which approached that of propranolol. The 1-isomer of alprenolol showed weak inhibition of another CoQ10-enzyme, succinoxidase, but the other beta-blockers were essentially non-inhibitory to this enzyme. | Harinstein ME, Berliner JI, Shah SJ Normalization of ejection fraction and resolution of symptoms in chronic severe heart failure is possible with modern medical therapy: clinical observations in 11 patients. Am J Ther. 2008 May-Jun;15(3):206-13 Kishi T, et al. Res Commun Chem Pathol Pharmacol. 1977 May;17(1):157-164; Folkers K.Coenzyme Q. 1985. Folkers K, Langsjoen P. 1991: 449-452. |
Calcium Channel Blocking Agents
Generic and trade names:
Amlodipine besylate (Norvasc®)
Bepridil (Bepadin®, Vascor®)
Diltiazem (Cardizem®, Cardizem SR®, Cardizem CD®, Dilacor XR®)
Felodipine (Plendil®)
Funarizine (Sibelium®)
Isradipine (DynaCirc®)
Nicardipine (Cardene®)
Nifedipine (Adalat®, Procardia®, Procardia XL®)
Nimodipine (Nimotop®)
Verapamil (Calan®, Calan SR®, Isoptin®, IsoptinSR®)
| CoQ 10 enzymes play a crucial role in the bioenergetics of the myocardium, the heart muscle tissue. | Folkers K.Coenzyme Q. 1985. Folkers K, Langsjoen P. 1991: 449-452. |
Anticoagulant drugs Generic and trade names: Warfarin (Coumadin®, Jantoven® , Marevan, Waran) | Reduced drug absorption/bioavailability CoQ10's physical structure is similar to vitamin K. Vitamin K can interfere with the action of blood-thinning drugs such as Warfarin. Based on medical reports and patient observation, CoQ10 may interfere or decrease the effectiveness of anticoagulant medications. This may lead to the need for increased doses of wafarin. Because medication requires close monitoring for maintenance of appropriate levels and steady blood thinning, make sure to use CoQ10 in combination of warfarin only under careful supervision by your doctor or professional healthcare provider. | Spigset O. Lancet 1994;344:1372-1373; Landbo C, Almdal TP. Ugeskr Laeger. 1998 May 25;160(22):3226-3227; Combs AB, et al. Res Commun Chem Pathol Pharmacol. 1976 Jan;13(1):109-114.
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Diabetes medicines Generic and trade names: Glyburide (Micronase), Acetohexamide (Dymelor) Tolazamide (Tolinase), | If you are diabetic you should talk to your doctor before taking this drug because it can lower the body's blood sugar levels. | |
Blood Pressure Medications Generic and trade names: Diltiazem, Metoprolol, Enalapril | In a study of individuals taking blood pressure medications CoQ10 supplementation allowed the individuals to take lower dosages of these drugs. This suggests that CoQ10 may enhance the effectiveness of certain blood pressure medications, but more research is needed to verify these results. | |
| | Explanation |
| Depletion or interference | The drug may deplete or interfere with the absorption or function of the supplement or herb |
Adverse interaction | The supplement or herb used together with the drug may result in undesirable effects |
Reduction/prevention | The supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug |
Supportive interaction | The supplement or herb may support or aid the function of the drug. |
Reduced drug absorption / bioavailability | The supplement or herb may decrease the absorption and/or activity of the drug in the body |
| (*) | The interaction is supported only by weak and or contradictory scientific evidence. |