Coenzyme Q10 and statins: does CoQ10 help statin muscle aches?

The British Heart Foundation explains that CoQ10 plays a part in helping cells produce energy and may also act as an antioxidant. Small amounts are found in foods such as meat, fish and nuts, and the body can also make it. It is widely available as an over-the-counter nutritional supplement.

The link with statins comes from how statins work. The BHF says statins reduce the amount of cholesterol the liver makes by blocking a chain of chemical reactions in the body's cells, and that the same chain is used to produce CoQ10. Taking statins may therefore lead to lower CoQ10 levels, and one theory is that lower levels might be linked to the muscle cramps and aches that some people experience. That theory is why CoQ10 supplements are marketed to people on statins.

The NHS lists common side effects of statins as headaches, dizziness, feeling sick, feeling more tired or weaker than usual, wind, constipation or diarrhoea, muscle pain and sleep problems, and says not everyone gets them. It advises that if you think your medicine is causing side effects you should talk to a doctor, who may prescribe another statin or change your dose. It also says some side effects are rare but serious and you may need to contact 111 for advice.

The BHF notes that muscle pain and cramps are difficult to diagnose and may be affected by the dose and type of statin, as well as a person's age, gender, genetics and overall health. That is one reason muscle aches should be reviewed by a clinician rather than assumed to be caused by the statin or fixed by a supplement.

The BHF says studies looking at the effect of CoQ10 supplements on statin-related muscle pain are mixed and inconclusive. Its dietitian's verdict is that current evidence does not support taking CoQ10 supplements for statin-attributed muscle pain or cramps, and that UK clinical guidance from NICE also advises not to use them for this purpose.

A separate BHF page on vitamins and supplements that can interact with heart medicines repeats the point: CoQ10 is sold for energy production and for people who experience muscle aches while taking statins, but the evidence is mixed and CoQ10 has not been shown to reliably help people continue with statin treatment or reduce muscle symptoms. It says UK Government guidance is clear that people should not take CoQ10 to help them continue taking statin treatment.

The same page lists CoQ10 in its interaction guide as something that may ease muscle pain but for which evidence is lacking. For comparison, it makes similar points about vitamin D, which studies have not shown to help statin-related muscle aches, and about niacin (vitamin B3), which does not add benefit and may increase side effects.

The BHF says CoQ10 is generally considered safe to take with few side effects, though some studies report minor stomach effects such as nausea, indigestion and diarrhoea. It says supplements are not regulated in the same way as medicines in the UK, so it is hard to know how much CoQ10 you are actually getting in each tablet, and that there is no agreed effective dose.

CoQ10 supplements may interact with blood pressure medicine and with warfarin. Always talk to your GP or cardiologist before taking any supplements, which the BHF repeats in several places. The BHF also says most people do not need supplements unless they have a diagnosed deficiency, and that the only routine recommendation is vitamin D during the colder months.

The BHF says that if you are taking statins and experiencing muscle pains you should speak to your doctor, because a change in dose or type of statin may help, and that you should not stop taking statins without first talking to your GP. The NHS gives the same advice, saying that if you stop taking statins your cholesterol levels may be affected and that you should talk to a doctor or pharmacist before stopping.

The NHS lists alternatives for people who cannot take statins, including tablets such as ezetimibe, fibrates and bempedoic acid and injections such as inclisiran, alirocumab and evolocumab. Your doctor can explain which, if any, suits you. The NHS also says you can report any suspected side effect through the Yellow Card scheme.

The BHF also covers CoQ10 for heart failure. It describes one long-term trial, Q-SYMBIO, published in 2014, in which 420 heart failure patients took 3 x 100 mg CoQ10 a day or a placebo for 2 years alongside usual medicines, with the CoQ10 group having fewer heart problems and fewer hospital admissions. It stresses that the benefits remain unclear and more research is needed, and says that CoQ10 is not recommended in UK and international heart failure treatment guidelines and is not prescribed by UK doctors.

Statin side effects can be reviewed with a GP, practice pharmacist or pharmacist on the NHS, and a review often involves checking the dose, the type of statin and other medicines you take. CoQ10 supplements are sold privately as supplements rather than prescribed, and the BHF notes they are not regulated like medicines. If you choose to try one, tell your GP or pharmacist so it is recorded alongside your other medicines.