CoQ10 for Fibromyalgia

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Coenzyme Q10 (CoQ10) is a compound produced naturally by the human body and is required for the basic functioning of cells. CoQ10 levels have been reported to decrease with age and are also frequently low in individuals with a variety of chronic diseases, such as various heart conditions, degenerative muscular conditions, Parkinson’s disease, cancer, diabetes, and HIV/AIDS. In addition, some medications may also inadvertently lower CoQ10 levels.

CoQ10 has been widely investigated for its use in treating and preventing a variety of conditions, including congestive heart failure, HIV/AIDS, Huntington’s disease, high blood pressure, surgical-related heart damage, migraine headaches, muscular dystrophy, heart attacks, and Parkinson’s disease. The most substantial evidence exists to support the use of CoQ10 in treating various genetic and acquired disorders of cellular dysfunction, in particular those collectively referred to as mitochondrial encephalomyopathies. As such, a specific formulation of CoQ10 (called UbiQGel) has been approved by the US Food and Drug Administration (FDA) to treat various forms of mitochondrial encephalomyopathies. Dosages for this indication typically range from 150-160mg per day, however doses up to 3,000 have also been reported in some studies. For other indications, doses typically range from 100 to 300mg, divided, per day.

When taken orally, CoQ10 generally has few side effects and is usually well-tolerated. It does, however, have the potential to cause various gastrointestinal side effects including nausea, vomiting, diarrhea, decreased appetite, heartburn, and stomach upset. In addition, allergic rashes have also been reported in some patients. In addition to these potential side effects, CoQ10 can also interact negatively with a number of natural products and prescription medications. In particular, herbs and other natural products that have the potential to lower blood pressure (which is also characteristic of CoQ10) should not be combined with CoQ10 supplementation due to the increased risk of low blood pressure related to their additive effects. These include andorgraphis, casein peptides, cat’s claw, fish oil, L-arginine, lyceum, stinging nettle and theanine, among others. Furthermore, individuals taking CoQ10 should also avoid the concurrent use of red yeast supplements and vitamin K.

Much like the herbs and natural products that can lower blood pressure, CoQ10 should not be used in conjunction with prescription medications that lower blood pressure, commonly referred to as antihypertensive drugs. In addition, CoQ10 may exacerbate the side effects of some anti-cancer chemotherapy drugs, such as doxorubicin. Furthermore, individuals who take blood clotting preventive medications such as warfarin (Coumadin®) should also use CoQ10 with caution. In addition to the medication interactions, some research suggests that CoQ10 supplementation may interfere with laboratory tests design to screen for and monitor diabetes, cholesterol, and liver function, as well as affect certain immunological tests often given to individuals with HIV.

Finally, as previously described, CoQ10 may have additive effects with medications that are used to lower blood pressure, and can interfere with blood pressure control following surgery. As such, individuals who are taking CoQ10 supplements are advised to discontinue their use at least two weeks prior to any surgical procedure.

CoQ10 and Fibromyalgia

There is increasing mention in the scientific literature of a relationship between fibromyalgia and CoQ10, both in terms of CoQ10 deficiency as well as therapy with CoQ10 supplementation.

A recently-published case report described a 41 year old female who presented with symptoms consistent with a diagnosis of fibromyalgia, including fatigue, exercise intolerance, headache, and multiple muscular trigger points. Following unsuccessful treatment with a variety of mainstream fibromyalgia treatment methods (including anti-inflammatory drugs, antidepressant medications, gapabentin, and pregabalin), the patient underwent a muscle biopsy and was found to have mitochondrial myopathy. The patient then began treatment with 200mg CoQ10, 1,000mg creatine, 200mg carnitine, and one mg folic acid, four times a day. The patient’s symptoms gradually improved over the course of several months. Based on this case report, the authors suggest that some adults with fibromyalgia may in fact have adult onset mitochondrial myopathy (Abdullah et al., 2012). Other researchers have also found therapeutic benefit of CoQ10 supplementation for fibromyalgia related symptoms, although mitochondrial myopathy was not an outcome of interest in this particular study (Lister, 2002).

Another group of authors also recently reported a series of cases in which oral supplementation with CoQ10 was found to dramatically improve the symptoms of fibromyalgia patients. Cordero et al. (2011) reported on five patients, four of whom were females between the ages of 43 and 66, and one of whom was a 21 year old male. All met the 1990 American College of Rheumatology diagnostic criteria for fibromyalgia, and experienced daily widespread pain, fatigue, stiffness, anxiety, sleep disturbances, and depression. Following three daily doses of 100mg CoQ10 for a period of nine months, the researchers found significant reductions in the number of tender points, pain severity, and frequency of headaches, as well as improvement in overall impact of fibromyalgia and markedly increased blood levels of CoQ10. The authors end their case reports with a brief discussion of the biological rational for the relationship between CoQ10 and fibromyalgia symptoms, and point to the need for additional research to investigate it has a potential treatment (Cordero et al, 2011).

A previous case report by researchers from this same group reported mitochondrial dysfunction and CoQ10 deficiency in various tissues from two female fibromyalgia patients. They further suggest that CoQ10 deficiency may be a useful screening tool and/or diagnostic marker for fibromyalgia (Cordero et al., 2010), a recommendation that builds on additional findings from their previous research (Cordero et al., 2009).

Additional research suggests that CoQ10 deficiency may have a causal role in the development of other conditions that are frequently experienced by fibromyalgia patients, including depression and fatigue (Maes et al., 2011; Maes et al., 2009)

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References

1.        Abdullah M, Vishwanath S, Elbalkhi A, Ambrus JL Jr. Mitochondrial myopathy presenting as fibromyalgia: a case report. J Med Case Reports. 2012;6(1):55.

2.        Lister RE. An open, pilot study to evaluate the potential benefits of coenzyme Q10 combined with Ginkgo biloba extract in fibromyalgia syndrome. J Int Med Res. 2002;30(2):195-199.

3.        Cordero MD, Alcocer-Gomez E, de Miguel M, Cano-Garcia FJ, Luque CM, Fernandez-Riejo P, Moreno-Fernandez AM, Sanchez-Alcazar JA. Coenzyme Q10: A novel therapeutic approach for fibromyalgia? Case series with 5 patients. Mitochondrion. 2011;11(4):623-625.

4.        Cordero MD, Moreno-Fernandez AM, Carmona-Lopez MI, Sanchez-Alcazar JA, Rodriguez AF, Navas P, de Miguel M. Mitochondrial dysfunction in skin biopsies and blood mononuclear cells from two cases of fibromyalgia patients. Clin Biochem. 2010;43(13-14):1174-1176.

5.        Cordero MD, Moreno-Fernandez AM, deMiguel M, Bonal P, Campa F, Jimenez-Jimenez LM, Ruiz-Losada A, Sanches-Dominguez B, Sanchez Alcazar JA, Salviati L, Navas P. Coenzyme Q10 distribution in blood is altered in patients with fibromyalgia. Clin Biochem. 2009;42(7-8):732-735.

6.        Maes M, Galecki P, Chang YS, Berk M. A review on the oxidative and nitrosative stress (O&NS) pathways in major depression and their possible contribution to the (neuro)degenerative processes in that illness. Prog Neruopsychopharmacol Biol Psychiatry. 2011;35(3):676-692.

7.        Maes M, Mihaylova I, Kubera M, Uytterhoeven M, Vrydags N, Bosmans E. Lower plasma coenzyme Q10 in depression: a marker for treatment resistance and chronic fatigue in depression and a risk factor to cardiovascular disorder in that illness. Neuro Endocrinol Lett. 2009;30(4):462-469.

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