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Coenzyme Q10/Drug Interactions:- Alzheimer's agentsAlzheimer's agents: There is good evidence from randomized controlled trials to support the use of CoQ10 in the treatment of Alzheimer's dementia (AD) (51). Based on its potential efficacy in AD, CoQ10 may have additive effects with other agents taken for Alzheimer's.
- Antiarrhythmic agentsAntiarrhythmic agents: Coenzyme Q10 has been shown to assist in the preservation of myocardial sodium-potassium ATP-ase activity and stabilize myocardial calcium-dependent ion channels; however, evidence is conflicting (86; 87; 21). For instance, a study examining treatment with CoQ10 (33.3mg three times daily) found no effect on the incidence of ventricular arrhythmias (88), but a randomized controlled trial using 120mg daily of CoQ10, showed significant reductions in total arrhythmias (63).
- Anticoagulants and antiplateletsAnticoagulants and antiplatelets: Based on a case report, Coenzyme Q10 may reduce the effectiveness of warfarin (42).
- Antidiabetic agentsAntidiabetic agents: Some oral diabetic medications such as chlorpropamide, glimepiride, glipizide, glyburide, tolazamide, tolbutamide, and acetohexamide, can reduce the levels of Coenzyme Q10 (anecdotal). Biguanides may reduce CoQ10 concentrations (anecdotal). Although one study showed that CoQ10 reduced fasting and two-hour postprandial blood glucose concentrations in patients with diabetes (38), another study showed that CoQ10 did not have effects on blood glucose (39).
- Antidepressant agentsAntidepressant agents: Antidepressants may reduce the natural production of CoQ10, therefore, use of both agents may result in diminished effects of CoQ10 (anecdotal). Specific medications noted in anecdotal reports include amitripyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, and perphenazine.
- AntihypertensivesAntihypertensives: Based on a meta-analysis, Coenzyme Q10 may lower systolic and diastolic blood pressure in hypertensive patients (89). However, in healthy people, these effects are transient and mild (90).
- Antilipemic agents, HMG-CoA reductase inhibitorsAntilipemic agents, HMG-CoA reductase inhibitors: HMG-CoA reductase inhibitors (e.g. lovastatin) leads to a decreased concentration of Coenzyme Q10 (91; 92; 93; 94; 95). In a randomized, double-blind trial, CoQ10 concentrations decreased significantly in patients who were administered pravastatin and lovastatin (96). Other studies have shown similar findings with pravastatin and simvastatin (97; 98). HMG-CoA reductase inhibitors have toxic side effects on skeletal muscle. Additionally, CoQ10 has been administered in case reports to ameliorate the toxic effects of lovastatin (99; 100). Specific medications mentioned in anecdotal reports include atorvastatin, cerivstatin, fluvastatin, lovastatin, pravastatin, and simvastatin. In a clinical trial, CoQ10 supplementation (100mg per day) was found to prevent plasma and platelet CoQ10 decrease, without affecting cholesterol-lowering ability of simvastatin (101).
- Antineoplastic agentsAntineoplastic agents: There is promising evidence to support the use of CoQ10 in the treatment of breast cancer (53; 32; 102), thus concomitant use of CoQ10 with other antineoplastic agents may have additive effects.
- Antipsychotic agentsAntipsychotic agents: Antipsychotics may reduce the natural production of CoQ10, therefore, use of both agents may result in diminished effects of CoQ10. Specific antipsychotics mentioned in anecdotal reports include chlorpromazine, fluphenazine, haloperidol, mesoridazine, prochlorperazine, promethazine, thioridazine, trifluoperazine and trimipramine. Supplementation of CoQ10 may also reduce the cardiac side effects from the use of phenothiazine and tricyclic antidepressants (anecdotal).
- Antiretroviral agentsAntiretroviral agents: Based on a case report, supplementation with CoQ10 may reduce symptoms of "ragged-red"' fiber myopathy associated with zidovudine (103).
- Beta blockersBeta blockers: Beta-blockers can reduce serum concentrations of CoQ10.
- Cardiovascular agentsCardiovascular agents: Based on a meta-analysis, CoQ10 enhances systolic function in chronic heart failure (CHF), but its effectiveness may be reduced with concomitant use of current standard therapies (40). Based on a review, Coenzyme Q10 may be a cardioprotective agent (41).
- ClonidineClonidine: Clonidine may reduce CoQ10 concentrations (anecdotal).
- CorticosteroidsCorticosteroids: Based on a clinical study of patients with bronchial asthma, CoQ10 may reduce the corticosteroids needed to control asthma symptoms (104).
- DiureticsDiuretics: Diuretics may reduce CoQ10 concentrations (anecdotal). Specific diuretics mentioned in anecdotal reports include benzthiazide, chlorthiazide, hydrochlorothiazide, indapamide, methyclothiazide, metolazone, and polythiazide.
- DoxorubicinDoxorubicin: Based on an animal study, CoQ10 may affect the tissue concentration of doxorubicin and its major metabolite aglycone 1 (105).
- EzetimibeEzetimibe: Based on a randomized controlled trial, the combination simvastatin and ezetimibe may significantly decrease plasma CoQ10 levels, although ezetimibe monotherapy does not (94).
- FenofibrateFenofibrate: Based on a clinical study, fenofibrate may increase plasma CoQ10 concentrations (7).
- HydralazineHydralazine: Hydralazine may reduce CoQ10 concentrations (anecdotal).
- ImmunosuppressantsImmunosuppressants: In theory, CoQ10 may have positive effects on immune response based on its antioxidant effects (12; 13; 14; 5; 15).
- MethyldopaMethyldopa: Methyldopa may reduce CoQ10 concentrations (anecdotal).
- SimvastatinSimvastatin: Based on a randomized controlled trial, simvastatin and the combination simvastatin and ezetimibe may significantly decrease plasma CoQ10 levels (94).
- StatinsStatins: Based on clinical trials in hypercholesterolemic patients, statins may reduce serum CoQ10 levels (91; 92; 93; 94; 95).
- Thyroid hormonesThyroid hormones: In theory, CoQ10 may affect thyroid hormone levels and alter the effects of thyroid drugs such as levothyroxine (Synthroid®), although this has not been proven in humans.
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Coenzyme Q10/Herb/Supplement Interactions:- Alzheimer's herbsAlzheimer's herbs: There is good evidence from randomized controlled trials to support the use of CoQ10 in the treatment of Alzheimer's dementia (AD) (51). Based on its potential efficacy in AD, CoQ10 may have additive effects with other herbs taken for Alzheimer's.
- AntiarrhythmicsAntiarrhythmics: Coenzyme Q10 has been shown to assist in the preservation of myocardial sodium-potassium ATP-ase activity and stabilize myocardial calcium-dependent ion channels, however evidence is conflicting (86; 87; 21). For instance, a study examining treatment with CoQ10 (33.3mg three times daily) found no effect on the incidence of ventricular arrhythmias (88), but a randomized controlled trial using 120mg daily of CoQ10 showed significant reductions in total arrhythmias (63).
- Anticoagulants and antiplateletsAnticoagulants and antiplatelets: In theory, Coenzyme Q10 may reduce the effectiveness of blood-thinning agents (42), such as garlic (Allium sativum), Ginkgo biloba, or saw palmetto (Serenoa repens)
- AntilipemicsAntilipemics: Based on a clinical trial in hypercholesterolemic patients, atorvastatin may reduce serum CoQ10 levels (91).
- AntineoplasticsAntineoplastics: There is promising evidence to support the use of CoQ10 in the treatment of breast cancer (53; 32; 102), thus concomitant use of CoQ10 with other antineoplastic agents may have additive effects.
- AntioxidantsAntioxidants: Many of the therapeutic benefits of CoQ10 are attributed to its role in the generation of adenosine triphosphate (ATP) and its antioxidant effects (5). In the treatment of cardiovascular diseases the mechanism may be in the prevention of oxidative damage, increased ATP synthesis, reduction of free radicals, and membrane protection. A high membrane concentration may increase membrane fluidity and increase the efficiency of the electron transport chain.
- AntiviralsAntivirals: Based on a case report, supplementation with CoQ10 may reduce symptoms of "ragged-red"' fiber myopathy associated with zidovudine (103).
- Cardiac herbs and supplementsCardiac herbs and supplements: Based on a meta-analysis, CoQ10 enhances systolic function in patients with chronic heart failure (CHF), but its effectiveness may be reduced with concomitant use of current standard therapies (40). Based on a review, Coenzyme Q10 may also be a cardioprotective agent (41).
- DiureticsDiuretics: Herbs and supplements with diuretic activity may reduce CoQ10 concentrations (anecdotal).
- HypoglycemicsHypoglycemics: Although one study showed that CoQ10 reduced fasting and two-hour postprandial blood glucose concentrations in patients with diabetes (38), another study showed that CoQ10 did not have effects on blood glucose (39).
- HypotensivesHypotensives: Based on a meta-analysis, Coenzyme Q10 may lower systolic and diastolic blood pressure in hypertensive patients. (89). However, in healthy people, these effects are transient and mild (90).
- ImmunostimulantsImmunostimulants: In theory, CoQ10 may have positive effects on immune response based on its antioxidant effects (12; 13; 14; 5; 15).
- L-carnitineL-carnitine: CoQ10 may have synergistic effects when used with L-carnitine.
- Red yeast rice Red yeast rice (Monascus purpureas): Based on a case report, Chinese red rice may deplete muscle Coenzyme Q10 after discontinuation of statin treatment (106).
- SteroidsSteroids: Based on a clinical study of patients with bronchial asthma, CoQ10 may reduce the corticosteroids needed to control asthma symptoms (104).
- Thyroid agentsThyroid agents: In theory, CoQ10 may affect thyroid hormone levels and alter the effects of thyroid drugs such as levothyroxine (Synthroid®), although this has not been proven in humans.
- Vitamin EVitamin E: One study found that supplementation with d-?-tocopherol (vitamin E) attenuates the elevation of plasma CoQ10 concentration in patients given supplemental CoQ10 (107).
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Coenzyme Q10/Food Interactions:- Insufficient available data.
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Coenzyme Q10/Lab Interactions:- Beta caroteneBeta carotene: CoQ10 was shown to increase plasma beta carotene (63).
- Blood glucoseBlood glucose: Although one study showed that CoQ10 reduced fasting and two-hour postprandial blood glucose concentrations in patients with diabetes (38), another study showed that CoQ10 did not have effects on blood glucose (39).
- Blood pressureBlood pressure: CoQ10 was shown to reduce systolic and diastolic blood pressure (38).
- Coagulation panelCoagulation panel: Based on the stural similarity of CoenzymeQ10 to vitamin K, CoQ10 may reduce the effectiveness of warfarin (42).
- Creatinine clearanceCreatinine clearance: CoQ10 was shown to increase creatinine clearance (73).
- HDL concentrationsHDL concentrations: CoQ10 significantly increased HDL-cholesterol in patients with essential hypertension (108; 38).
- LDHLDH: CoQ10 at doses of 300mg daily or greater may result in elevations in LDH concentrations (37). Ninety mg of CoQ10 daily does not increase the oxidation resistance of VLDL+LDL (109).
- Lipoprotein (a)Lipoprotein (a): CoQ10 significantly decreased serum lipoprotein (a) (110).
- Plasma insulin concentrationsPlasma insulin concentrations: CoQ10 was shown to reduce fasting and 2-h plasma insulin (38).
- Serum CoQ10Serum CoQ10: Based on clinical study, HMG-CoA reductase inhibitors (e.g. lovastatin) leads to a decreased concentration of CoQ10 (91; 92; 93; 94; 95; 96; 97; 98; 99; 100; 101).
- Serum lactateSerum lactate: CoQ10 was shown to decrease post-exercise levels of lactate (10).
- Serum transaminaseSerum transaminase: CoQ10 was shown to increase serum transaminase (51).
- SGOTSGOT: CoQ10 at doses of 300mg daily or greater may result in elevations in SGOT concentrations (37).
- T4:T8 ratioT4:T8 ratio: CoQ10 can increase the T4:T8 ratio in HIV patients.
- TriglyceridesTriglycerides: CoQ10 was shown to reduce triglycerides (38).
- Vitamin AVitamin A: CoQ10 was shown to increase plasma vitamin A levels (63).
- Vitamin CVitamin C: CoQ10 was shown to increase plasma vitamin C levels (63).
- Vitamin EVitamin E: CoQ10 was shown to increase plasma vitamin E levels (63).
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Coenzyme Q10/Treatment Interactions:- Therapeutic hypothermiaTherapeutic hypothermia: Based on a clinical trial, CoQ10 combined with mild hypothermia immediately after cardiopulmonary resuscitation post-cardiac arrest may improve survival and neurological outcome in survivors (111).
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Copyright © 2011 Natural Standard (www.naturalstandard.com)
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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.
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