Thursday, July 22, 2010
Tuesday, July 6, 2010
Uses and Efficacy/ Contra Indication
Coenzyme Q10’s wide-ranging cellular properties implicate it for the potential treatment of numerous conditions that may improve with mitochondrial and antioxidant support.
NEUROLOGIC AND METABOLIC INDICATIONS
Parkinson’s Disease
A randomized, double-blind, placebo-controlled, multicenter study of 80 patients found that 1,200 mg per day of coenzyme Q10 was associated with up to 44 percent less functional decline in patients with Parkinson’s disease, including activities of daily living. A study of 28 patients with Parkinson’s disease also demonstrated mild symptom improvement with daily oral dosing of 360 mg of coenzyme Q10. These results are awaiting confirmation.
Mitochondrial Encephalomyopathies
In studies with eight to 44 patients, coenzyme Q10 also has demonstrated positive trends in reducing symptoms associated with selected mitochondrial abnormalities including the mitochondrial encephalopathy, lactic acidosis, and stroke-like episodes (MELAS) syndrome, Kearns-Sayre syndrome, and the myoclonus epilepsy with ragged-red fibers (MERRhF) syndrome. Maximum effect often requires six or more months of therapy. One type of coenzyme Q10, UbiQGel, was granted U.S. Food and Drug Administration (FDA) orphan drug status for treatment of mitochondrial cytopathies based on several small trials.
Migraine
A preliminary open label trial of 32 patients taking 150 mg of coenzyme Q10 daily demonstrated efficacy in reducing the frequency of migraine attacks. A recent randomized double-blind, placebo-controlled trial of 42 patients taking coenzyme Q10 at 300 mg a day found similar benefit. The response rate (i.e., decrease in headache frequency by 50 percent or more) was 47.6 percent in the coenzyme Q10 group and 14.4 percent in the placebo group. The number needed to treat was three.
Other Neurologic Indications
Coenzyme Q10 at 600 mg or less did not delay progression of decline in functional ability in Huntington’s disease, but it also has FDA orphan drug status for this disease.
CARDIOVASCULAR INDICATIONS
CHF
A number of randomized controlled trials, including those in a 1997 meta-analysis, found improvement in several clinical parameters related to CHF, including frequency of hospitalization, dyspnea, and edema. These trials were weakened by small numbers (only two of 14 trials had more than 25 participants) and older techniques for calculating ejection fraction. Of the more recent randomized trials using ventriculography and echocardiography, two found coenzyme Q10 at 100 to 200 mg daily no more effective than placebo in improving ejection fraction, peak oxygen consumption, exercise duration, or quality of life. A more recent trial using coenzyme Q10 in combination with carnitine and taurine did find modest clinical improvement. The recently released Agency for Healthcare Research and Quality (AHRQ) report that examined cardiovascular trials with more than 60 participants followed for at least six months concluded that coenzyme Q10’s role is still an open question. The planned SYMptoms, BIomarker status (BNP), and long-term Outcome trial with more than 500 patients with New York Heart Association class III and IV CHF followed over two years, should help answer this question.
Hypertension
A systematic review of eight trials using coenzyme Q10 at various doses for essential hypertension, typically as adjuvant therapy, found a mean decrease in systolic and diastolic blood pressure of 16 and 10 mm Hg, respectively. Several of these trials demonstrated confounding variables or were weakened by low statistical power.
Other Indications
The evidence for coenzyme Q10 use in other cardiovascular settings is promising and requires larger, longer-term trials. In placebo-controlled trials, the coenzyme’s use following cardiopulmonary resuscitation demonstrated improvement in three-month survival (n = 49), and its use following cardiac surgery demonstrated improvements in myocardial isoenzyme levels, left ventricular function, and postoperative recovery time (n = 20).
Preliminary data also imply benefit in the setting of atherosclerosis. This includes a randomized, placebo-controlled trial of 73 patients who were randomized to 120 mg a day of coenzyme Q10 following myocardial infarction. At one year, the coenzyme Q10 group demonstrated a significant decrease in total cardiac events including nonfatal myocardial infarctions and cardiac deaths. This improvement has been attributed to possible attenuation of endothelial dysfunction. Research in other conditions, including angina pectoris, cardiomyopathy and physical exercise capacity, demonstrate conflicting results and require additional study.
DIABETES
Coenzyme Q10 has been considered for improving glycemic control through various mechanisms, including a decrease in oxidative stress. Two earlier randomized controlled trails using 100 to 200 mg of coenzyme Q10 in patients with type 1 or 2 diabetes found no difference in glycemic control and insulin requirement. A more recent randomized controlled trial (n = 74) using 200 mg per day for 12 weeks found modest improvements in A1C levels (−0.37 ± 0.17 percent,P = .32).
OTHER INDICATIONS
Although it is used for the prevention and treatment of cancer, the AHRQ found no evidence to assess the efficacy of coenzyme Q10 for this use. Research continues with several phase II trials underway to clarify its potential contribution in the treatment of conditions, such as Duchenne’s muscular dystrophy, breast cancer, human immunodeficiency virus and acquired immunodeficiency syndrome, periodontal disease, and Alzheimer’s disease.
Contraindications, Adverse Effects, and Interactions
No absolute contraindications are known for coenzyme Q10, although reliable information about its use in pregnant or breastfeeding mothers or in young children is not available. Adverse effects with coenzyme Q10 are rare. On average, mild gastrointestinal discomfort is reported in less than 1 percent of patients in clinical trials. Potential interactions with warfarin (Coumadin) causing decreased international normalized ratio (INR) have been reported in case studies. However, a prospective placebo-controlled trial of 24 stable patients taking warfarin and 100 mg of coenzyme Q10 over four weeks found no significant change in prothrombin time and INR levels. Because of coenzyme Q10’s potential hypoglycemic and hypotensive effects, monitoring is advised, especially when using adjunctively with prescription medications.
Several trials demonstrate coenzyme Q10 depletion subsequent to statin initiation. There is conjecture about this depletion as the cause of statin–associated adverse effects (e.g., myopathy) with exogenous coenzyme Q10 supplementation as a possible mediating treatment. This assertion is refuted by a more recent crossover trial that found no significant coenzyme Q10 drop after initiation of selected statins. Several doxorubicin (Adriamycin) trials, mostly in animal models, have noted a reduction in cardiac coenzyme Q10 depletion and cardiotoxicity associated with coadministration of coenzyme Q10. The clinical implications on disease state and adverse reaction profile with coenzyme Q10 supplementation in depleted states requires further evaluation.
General Description of CoQ10
GENERAL DESCRIPTION:
Coenzyme Q10 (CoQ10) was discovered by scientists at the University of Wisconsin in 1957. It is also known as ubiquinone, from the word ubiquitous meaning "everywhere". CoQ10 is a powerful antioxidant found in every cell of the body, where it has important functions within the mitochondria - the "powerhouses" of cells.
ROLE FOR ANTI-AGING:
CoQ10 is popular as a supplementary treatment for several heart conditions in Europe, Israel, and Japan. Researchers believe that CoQ10 aids the heart during times of stress, possibly by helping it to use energy in a more efficient manner. It is most commonly used for congestive heart failure (CHF), however research has showed that it may be of benefit in other illnesses, including AIDS, angina, cancer, diabetes, male infertility, muscular dystrophy, obesity, and Parkinson’s disease. However there is no clinical proof of its effectiveness in treating these conditions. CoQ10 is also known to help prevent aging of the skin, and is a common ingredient in many moisturizers.
DEFICIENCY SYMPTOMS: None known
THERAPEUTIC DAILY AMOUNT:
The recommended dosage of CoQ10 ranges from 30 to 300 mg daily, usually taken in 2-3 doses. The majority of research on CoQ10 for the treatment of heart conditions has used doses ranging between 90 and 150mg. No RDA has been established.
MAXIMUM SAFE LEVEL: Not established
SIDE EFFECTS / CONTRA-INDICATIONS:
CoQ10 can interact with many different types of drugs; therefore, anyone taking any form of medication, especially cholesterol-lowering drugs, should consult their doctor before taking CoQ10. Pregnant and breastfeeding women should check with their physician before taking CoQ10.
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