Drugs that deplete Coenzyme Q10

There are surprisingly many prescription drugs that inhibit the body’s bio-synthesis of Coenzyme Q10 or inhibit the body’s absorption of Coenzyme Q10 from supplements or both.  Of course, there are many drugs that inhibit the uptake of other nutrients as well, but it is difficult to think of any one supplement that is more important to us as we age.

Coenzyme Q10 is “the essential bio-nutrient” (in the words of the chemist Dr. Karl Folkers), and our bodies produce less and less of it as we get older.  It is practically impossible to make up for the decreased bio-synthesis from food alone.  We, all of us, need a well-formulated Coenzyme Q10 supplement.

Coenzyme Q10 is everywhere in our bodies
Coenzyme Q10 is a fat-soluble vitamin-like substance that is needed almost everywhere in our bodies.  It is present in all of our cells with the exception of the red blood cells.

The names for Coenzyme Q10’s oxidized form (ubiquinoneUbiquinone, the oxidized form of Coenzyme Q10, expressed as Q10 or CoQ10, is absolutely essential for the mitochondrial ATP energy production process. Ubiquinone is the form of Coenzyme Q10 that the body synthesizes, and ubiquinone is the form of Coenzyme Q10 that has been extensively tested for safety, absorption, and efficacy in clinical trials.... Read more about this term) and its reduced form (ubiquinol) derive from Coenzyme Q10’s ubiquitous nature.  Consequently, low Coenzyme Q10 status and Coenzyme Q10 deficiency are found in patients with congestive heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... Read more about this term, high blood pressure, stroke, some cancers, low-energy syndromes, and general weakness of the immune system [Pelton].

The biological functions of Coenzyme Q10
There are a number of health-related reasons why adequate absorption of Coenzyme Q10 is important in the years when our bodies produce less of the substance:

• Coenzyme Q10 is critically involved in the process of the production of cellular energy [Folkers].  Just think how dependent the heart muscle cells are on the production of ATPATP (adenosine triphosphate) molecules are the high-energy molecules with easily broken phosphate bonds that release energy to the energy-requiring processes in the cells. Coenzyme Q10 is essential to the process of ATP production.... Read more about this term energy.
• Coenzyme Q10 is a fat-soluble antioxidantAntioxidants are substances that protect the cells and lipoproteins against the harmful effects of free radicals. They are substances that prevent the oxidation of other molecules and compounds. There are two broad categories of antioxidants: enzymatic and non-enzymatic. Non-enzymatic antioxidants are substances like Coenzyme Q10, vitamin C, vitamin E, glutathione, and various carotenoids. Prominent enzymatic antioxidants include catalase, glutathione peroxidase,... Read more about this term that provides protection against the damage caused by harmful free radicalsFree radicals are unstable and highly reactive molecules that are produced in the body during normal oxygen metabolism. Free radicals derived from oxygen are known as reactive oxygen species. Free radicals play both helpful and harmful roles in the body. Free radicals steal electrons from other substances in order to become stable. In so doing, the free radicals oxidize those... Read more about this term [Littarru].
• Coenzyme Q10 has been shown, in randomized controlled trials, to improve symptoms and survival in chronic heart failure patients [Mortensen], in live-at-home elderly adults [Alehagen], and in veterans diagnosed with Gulf War Syndrome [Golomb].
• Coenzyme Q10 helps to protect against the toxic side effects of prescription drugs such as Adriamycin, beta-blockers, and drugs used for psychiatric disorders [Pelton].

The bio-synthesis of Coenzyme Q10
Our bodies’ own production of Coenzyme Q10 involves a complicated 17-step process that requires the availability of several B vitamins, vitamin C, and numerous trace elements, including seleniumSelenium (symbol Se, atomic number 34) is a trace element that is an essential nutrient and an essential component of some of the most important antioxidants in the body, in particular the selenoproteins glutathione peroxidase, thioredoxin reductase, and selenoprotein P. Selenium is involved in the optimal functioning of the immune system. Professor Alehagen has pointed out that there exists a... Read more about this term.  Given the complex nature of the bio-synthesis of Coenzyme Q10, there are many ways for the process to go wrong and for the cells to produce less than optimal amounts of Coenzyme Q10 endogenously [Pelton].

Even without the interference of nutrient depleting prescription drugs, human bio-synthesis of Coenzyme Q10 will have a pattern of continuous decrease with further ageing after the age of 20 years [Kalén].  Adequate Coenzyme Q10 status is important to good heart health [Folkers] and to graceful ageing [Alehagen].

The absorption of Coenzyme Q10
Formulation of the Coenzyme Q10 supplement is paramount to the successful absorption in the small intestine.  The Coenzyme Q10 in the soft-gel capsules must be dissolved in a lipid carrier and must stay dissolved until ingestion of the supplement.

There is little if any persuasive evidence to date that the ubiquinol form of Coenzyme Q10 supplements is better absorbed than the best formulated ubiquinone Coenzyme Q10 supplements.  Nor is there any persuasive evidence that the ubiquinol in supplements is actually absorbed as ubiquinol.  There is evidence indicating that the ubiquinol in supplements is converted in the stomach and the small intestine to the ubiquinone form prior to absorption [Judy].

Prescriptions drugs likely to reduce Coenzyme Q10 status
Dr. Ross Pelton, editor of the naturalpharmacist.net, has compiled a useful list of prescription medications that may inhibit either the bio-synthesis of Coenzyme Q10 or the absorption of exogenous Coenzyme Q10 or both.  With his permission, I am presenting an outline of his list.

Drugs that deplete Coenzyme Q10 in humans

1. StatinsStatins are a class of medications that effectively block the body’s synthesis of cholesterol. In so doing, statins also block the body’s synthesis of Coenzyme Q10.... Read more about this term = cholesterol lowering drugs that may also “function as mitochondrial toxins that impair muscle function in the heart and blood vessels through the depletion of Coenzyme Q10 and ‘heme A’, and thereby (decrease) ATP generation” [Okuyama]

2. Thiazide diuretics (HCTZ) = high blood pressure medications that may inhibit the bio-synthesis of Coenzyme Q10 [Kishi 1975]

3. Hydralazine vasodilators = high blood pressure medications

4. Adrenergic agonists (clonidine, methyldopa) = agents that have adrenaline-like effects but that may inhibit the action of Coenzyme Q10 in the heart muscle cells [Kishi 1977]

5. Beta-blockers = drugs prescribed for high blood pressure, angina, and some abnormal heart rhythms … over 20 different beta-blockers are implicated in the depletion of Coenzyme Q10 [Pelton]

6. Oral contraceptives and hormone replacement therapy drugs = both forms of medication have been shown to reduce serum Coenzyme Q10 concentrations [Palan 2005 & 2006]

7. Sulfonylurea & Biguanide medications for diabetes patients = may inhibit Coenzyme Q10 action to the extent of having a further adverse effect on insulin bio-synthesis in diabetics [Hechtman]

8. Tricyclic antidepressants = medications to restore the balance among various neurotransmitters and thus alleviate depression but also medications that can deplete the body’s levels of Coenzyme Q10 [Sinatra]

9. Major tranquilizers = calming medications that may deplete the body’s supply of Coenzyme Q10 [Pelton]

Coenzyme Q10 is a must-have supplement
As Dr. Pelton has enumerated in his Drug-induced Nutrient Depletion Handbook, there are numerous prescription drugs that can have a deleterious effect on the body’s Coenzyme Q10 concentrations.

Coenzyme Q10 is a substance that the body makes itself to provide for cellular energy production and cellular antioxidant protection.  Unfortunately, our bodies produce less and less as we age, and, equally unfortunately, other medications can inhibit the production and absorption of Coenzyme Q10.

Properly formulated, Coenzyme Q10 is a miracle supplement.  Please excuse my enthusiasm, but Coenzyme Q10 is number one on my list of daily supplements.

Sources:

Alehagen, U., Aaseth, J., & Johansson, P. (2015). Reduced Cardiovascular Mortality 10 Years after Supplementation with Selenium and Coenzyme Q10 for Four Years: Follow-Up Results of a Prospective Randomized Double-BlindA double-blind study is a study in which neither the investigators nor the study participants know which participants are receiving the active treatment and which participants are receiving the control treatment until the study has been completed and the seal on the code has been broken.... Read more about this term Placebo-Controlled Trial in Elderly Citizens. Plos One, 10(12), e0141641.

Folkers, K., Vadhanavikit, S., & Mortensen, S. A. (1985). Biochemical rationale and myocardial tissue data on the effective therapy of cardiomyopathy with coenzyme Q10. Proceedings of The National Academy of Sciences of The United States of America, 82(3), 901-904.

Golomb, B.  (2014).  Coenzyme Q10 and gulf war illness.  Neural Computation, 26(11), 2594-651.

Hechtman, Leah.  (2014).  Clinical Naturopathic Medicine.  London: Churchill Livingstone.

Judy, W. V., Stogsdill, W. W., Judy, D. S., & Judy, J. S. (2007). Coenzyme Q10: Facts or Fabrications? Natural Products Insider.  Retrieved from http://www.zmc-usa.com/docs/CoQ10_Facts_or_Fabrications.pdf.

Kalén A, Appelkvist EL, Dallner G. Age-related changes in the lipid compositions of rat and human tissues. Lipids. 1989;24(7):579–584.

Kishi, H.  (1975).  Bioenergetics in clinical medicine III. Inhibition of Coenzyme Q10-enzymes by clinically used anti-hypertensive drugs.  Res Commun Chem Pathol Pharmacol, 12, 3, 533-540.

Kishi, T., Watanabe, T. & Folkers, K.  (1977).  Bioenergetics in clinical medicine XV. Inhibition of coenzyme Q10-enzymes by clinically used adrenergic blockers of beta-receptors. Res Commun Chem Pathol Pharmacol, 17:157–164.

Littarru, G. P., Tiano, L., Belardinelli, R., & Watts, G. F. (2011). Coenzyme Q(10) , endothelial function, and cardiovascular disease. Biofactors (Oxford, England), 37(5), 366-373.

Mortensen, S. A., Rosenfeldt, F., Kumar, A., Dolliner, P., Filipiak, K. J., Pella, D., & Littarru, G. P. (2014). The effect of coenzyme Q10 on morbidity and mortality in chronic heart failureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... Read more about this term: results from Q-SYMBIO: a randomized double-blind trial. JACC. Heart FailureThe Mayo Clinic defines heart failure, also known as congestive heart failure and/or chronic heart failure, as the failure of the heart muscle to pump blood to the body adequately.  In other words, heart failure is not a heart attack, and it is not death from heart disease, which its name might seem to imply. Heart failure is a condition... Read more about this term, 2(6), 641-649.

Okuyama, H., Langsjoen, P. H., Hamazaki, T., Ogushi, Y., Hama, R., Kobayashi, T., & Uchino, H. (2015). Statins stimulate atherosclerosisAtherosclerosis is the thickening of the artery walls brought about by the build-up of plaque (plaque is made up of cholesterol and other fatty substances and waste products and calcium and fibrin) and the subsequent slowing of the flow of blood through the clogged arteries. More research is needed into the role of Coenzyme Q10 in the prevention and adjunct... Read more about this term and heart failure: pharmacological mechanisms. Expert Review of Clinical Pharmacology, 8(2), 189-199.

Palan, P. R., Connell, K., Ramirez, E., Inegbenijie, C., Gavara, R. Y., Ouseph, J. A., & Mikhail, M. S. (2005). Effects of menopause and hormone replacement therapy on serum levels of coenzyme Q10 and other lipid-soluble antioxidants. Biofactors (Oxford, England), 25(1-4), 61-66.

Palan, P. R., Magneson, A. T., Castillo, M., Dunne, J., & Mikhail, M. S. (2006). Effects of menstrual cycle and oral contraceptive use on serum levels of lipid-soluble antioxidants. American Journal of Obstetrics And Gynecology, 194(5), e35-e38.

Pelton, R. (19990. Drug-induced Nutrient Depletion Handbook.  Hudson, OH: Lexi-Comp.

Sinatra, Stephen.  (2017).  Medications That Deplete CoQ10 & the CoQ10 Dosage You Need.  Retrieved from: https://www.drsinatra.com/medications-that-deplete-coq10-and-the-coq10-dosage-you-need

Disclaimer: The information presented in this review article is not intended as medical advice and should not be construed as such.