Coenzyme Q10 - Medicinal Uses, Interactions, Side Effects, Dosage
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<strong>Coenzyme Q10</strong></p>
<p>Coenzyme Q10 is known by a variety of names, including CoQ, CoQ10, and ubiquinone. It is found in the mitochondria of many organ tissues such as the heart, kidney, and Iiver.The name coenzyme Q10 refers to the coenzyme Q enzyme containing 10 isoprenoid subunits. The reduced form of coenzyme Q10 is called ubiquinol and this form predominates in the systemic circulation. Most supplement companies obtain CoQ10 from plant sources. </p>
<p><strong>Uses and Benefits:</strong></p>
<p>CoQ10 has antioxidant properties, and it has been used primarily for cardiovascular conditions such as congestive heart failure (CHF), hypertension, ischemic heart disease, and cardiomyopathies. It is also used as a general antioxidant supplement. </p>
<p><strong>Pharmacology: </strong></p>
<p>CoQ10 has been described as one of the most metabolically active molecules present in the body. It circulates in the blood in the reduced form, ubiquinol, and is involved in many cell processes (mitochondrial electron transport) and in the gen­eration of adenosyl triphosphate (ATP), which powers processes that create energy.1 It serves as an endogenous antioxidant, scavenging free radicals. CoQ10 may also have a protective action on cell membranes by inhibiting the action of phospholi­pase A 2 ·2 All of these actions suggest that it has an important role in vital processes, including cardiac muscle performance. CoQ10 is structurally similar to menaquinone, also known as vitamin K 2 . </p>
<p><strong>Clinical Trials: </strong></p>
<p>. Hypertension-Various clinical trials (open label and con­trolled studies), mostly published by the same research group, </p>
<p><em>Editor's Note: </em>Although not an herb, Coenzyme Q10 is a dietary supplement that is included because of its current popularity. CoQ1 a significantly decreases blood pressure in with mild-moderate hypertension. Statistically significant reductions in systolic and diastolic blood pressures (10 mmHg) wnre observed after 10 weeks; however, these studies were not Illrnded and lacked a placebo comparison group One random­I/ed, double-blind, comparative trial and one randomized, Illacebo-controlled, crossover trial have suggested similar reduc­lions in systolic and diastolic blood pressures. In one of these Irials, a reduction in systolic and diastolic blood pressure (7-10 I nmHg) was observed after 8-10 weeks of CoQ1 a therapy com­pared to placebo. These latter studies, however, suffer from inad­()quate treatment allocation and a lack of statistical power to detect differences. Thus, the clinical evidence for CoQ1 a's value in hypertension is inadequate. </p>
<p>. Congestive Heart Failure-Older studies suggested that CoQ10 was effective as adjunctive therapy in the treatment of CHF.8.9 A meta-analysis of eight clinical trials concluded that, while more evidence was required, CoQ10 could playa useful role in the management of this condition. 10 Many of the clinical trials included in the meta-analysis lacked control groups, and used crude estimates of heart muscle function. Two recent, well­conducted clinical trials used objective assessments of heart muscle function in patients with CHF. One was a randomized, double-blind, placebo-controlled trial and the other was a ran­domized, double-blind, placebo controlled, crossover trial. In pa­tients with CHF (NYHA III and IV), CoQ10, at a dose of 100-200 mg daily for 3-6 months, was not significantly more effective than placebo. These trials used Swan-Ganz measurements as well as echocardiography to assess left ventricular function. </p>
<p> Ischemic Heart Disease-Results from two randomized, double-blind, placebo-controlled trials found that CoQ1 a supple­mentation improved a number of clinical measures in patients di­agnosed with chronic stable angina or coronary artery disease, and in those patients who had a history of acute myocardial in­farction. These trials suggest improvements in the markers for atherosclerosis (lipoprotein (a) and HDL-cholesterol); in exercise tolerance and in delaying the time to develop ischemic changes on electrocardiograph (ECG) tracings. Other improvements in­clude a reduction in cardiac deaths and rate of reinfarction in those recovering from acute myocardial infarction, compared to placebo. This trial suggests that the relative risk reduction of </p>
<p>sudden cardiac death with CoQ10 is 27%; however, the absolute risk reduction of sudden cardiac death when compared to placebo is only 1.5%, suggesting a very small improvement in risk with CoQ10. Furthermore, these trials were of short duration (::; 1 month), and clinical reliability is unknown. </p>
<p> Cardiomyopathy-Two small crossover trials that were ran­domized, double-blind, and placebo-controlled assessed the ef­fects of CoQ10 on moderate to severe cardiomyopathy.15,16In one trial, 25 patients with NYHA class I, II, and III received CoQ10 (100 mg daily) or placebo. At the end of 4 months, no statistically significant differences were observed in ventricular function, ejec­tion fraction, and calculated cardiac outpUt. Additionally, no im­provements in exercise tolerance or ECG tracings were observed. In the second trial, in 19 patients diagnosed with NYHA class 1/1 or IV cardiomyopathy, CoQ10 supplementation (100 mg daily) significantly improved cardiac function. 16 However, this study failed to account for any carry-over of effects in the crossover design. </p>
<p><strong>Adverse Effects:</strong></p>
<p>CoQ10 is well tolerated. In clinical trials, nausea, anorexia, and gastrointestinal upset have rarely been reported. Some patients have experienced maculopapular rash and thrombocytopenia. Other rare side effects include irritability, headache, and dizziness. </p>
<p><strong>Side Effects and Interactions:</strong> </p>
<p>A decrease in endogenous levels of CoQ10 has been observed following administration of HMG-CoA reductase inhibitors. The clinical significance of this effect is unknown. Patients beginning statin therapy should not require CoQ10 supplementation, as the benefits of statin therapy likely outweigh any potential risk associated with low CoQ10 levels. Given the chemical similarity between vitamin K and CoQ10, the potential exists for an interaction with warfarin. CoQ10 has decreased the effects of warfarin in various case reports. Until more is known, CoQ10 should be used with caution or not at all in patients receiving warfarin therapy. </p>
<p><strong>Cautions:</strong></p>
<p><em>In vitro </em>studies suggested that CoQ10 may interfere with glucose regulation. Randomized placebo-controlled trials in diabetics, however, have shown no effect on blood glucose or metabolic control. Safety in pregnancy and lactation has yet to be determined. </p>
<p><strong>Preparations </strong><strong>& </strong><strong>Doses: </strong></p>
<p>A minimum of 30 mg daily appears to be necessary to increase blood levels. The clinical significance of increasing blood levels is unknown. For cardiac indications, typical doses are 100-150 mg daily in 2 or 3 divided doses. These doses increase baseline CoQ10 levels to 2-3 mcg/ml (normal in adults is 0.7-1 mcg/ml). </p>
<p><strong>Summary Evaluation: </strong></p>
<p>The value of CoQ1 0 shows promise in adequately controlled trials ,of ischemic heart disease, although trials are limited. Clinical for other cardiovascular disorders (heart failure, cardiomypathy, and hypertension) are inadequate or provide mixed , and do not currently support the use of CoQ10 for these indications. CoQ10 does have antioxidant activity, but the clinical significance of this effect is unknown.</p>
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