Coenzyme Q10 has promise, needs study

Dear Doctor K: I’m a 61-year-old man. My doctor is prescribing a statin to cut my cholesterol, but I’m worried about muscle damage. I have read claims that coenzyme Q10 would help. Is that right?

Answer: It might be, but coenzyme Q10 has not been well studied. It surely should be: Tens of millions of people take statins in the United States alone. They powerfully lower total cholesterol and LDL (“bad”) cholesterol levels in the blood. More important, they reduce the risk of heart attacks.

Although the current crop of statins is relatively safe, they can have side effects. Muscle aches are among the most common complaints: About one of every 10 to 20 people gets them after starting statins. Serious muscle injury is rare, about one in 1,000.

When muscle aches occur, they are usually mild, but can be really bothersome. They usually resolve quickly when the statin dose is reduced or therapy is halted. A switch to a different statin can stop the aches. The two statins that seem to have the least tendency to produce serious muscle injury (more than aches and pains) are pravastatin (Pravachol) and fluvastatin (Lescol).

People on statins who also have an underactive thyroid or kidney problems are more prone to muscle aches. Some drugs can interact with statins to cause muscle problems. Calcium- channel blockers diltiazem and verpamil and the antidepressant sertraline are the most common.

It makes sense that coenzyme Q10 could help, since there is good evidence that statin therapy depletes it in muscle.

Coenzyme Q10 is a com- pound the body produces. Depleted levels can be restored by taking it as a dietary supplement, no prescription needed.

But before doing so, it’s good to have evidence it will help, since most medicines have the potential for side effects. The evidence I would like to see is the result of a randomized trial in which large numbers of people on statins are treated either with coenzyme Q10 or a sugar pill. They would report whether they had muscle aches, and blood tests for muscle injury would be done.

When I have a patient who keeps having muscle aches on different statins, including pravastatin and fluvastatin, I sometimes add coenzyme Q10, and it sometimes seems to help. In doses of 250 mg a day or less, it appears safe. Questions? Go to AskDoctorK. com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115