Coenzyme Q10 Supplementation for the Treatment of Statin Induced Myalgia

Background: A significant number of the population is on 3-hydroxy-3methylglutaryl coenzyme A (HMGCoA) reductase inhibitors (statins) because statins are the main pharmacologic drug prescribed for the treatment of hypercholesteremia. Statins also have been shown to reduce the relative risks of coronary events. Statins work by inhibiting the mevalonate pathway. This is the same pathway from which Coenzyme Q10 is synthesized. Coenzyme Q10 is essential for muscle respiration. One of the theories is that statin therapy reduces coenzyme Q10 levels in muscle mitochondria, which leads to myalgia. One of the primary side effects of statin drugs is myalgia which often causes patients to decrease the dosage of the statin or discontinue it. The clinical question of whether coenzyme Q10 can be used in the treatment of myopathic pain caused by statin drug use is a common one encountered by health care providers in primary care. This article is a review of the literature to further address this question. Methods: A systematic review of the English-language published literature was conducted using MEDLINE, CINAHL and ISI Web of Science using keywords myalgia, muscle pain, myopathy, statin, HMG-CoA, reductase inhibitors, Coenzyme Q10, CoQ10, and ubiquinone. There is very limited research examining the outcome of Coenzyme Q10 for the treatment of myopathy in statin users. Two randomized control studies researching this outcome and one prospective cohort study were retrieved and analyzed for quality and results. Results: One randomized control study found a significant relationship between the use of Coenzyme Q10 and a decrease in myopathic symptoms, as did the prospective cohort study. However, the other randomized control study found no clinical significance in decreased myopathic symptoms with the addition of Coenzyme Q10. Fewer results were of statistical or clinical significance after the adjustments for known confounders were completed. Limited results showed Coenzyme Q10 supplementation decreased myopathic symptoms in patients on statin medications. Conclusion: Current guidelines suggest placing patients on the lowest dose of statin medication to control the cholesterol and to decrease side effects like myopathy. Additional randomized trials of larger populations are needed to quantify and qualify possible risks of Coenzyme Q10 supplementation using myopathy as an independent risk factor. Degree Type Capstone Project Rights Terms of use for work posted in CommonKnowledge. This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/221 Copyright and terms of use If you have downloaded this document directly from the web or from CommonKnowledge, see the “Rights” section on the previous page for the terms of use. 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Email inquiries may be directed to:. copyright@pacificu.edu This capstone project is available at CommonKnowledge: http://commons.pacificu.edu/pa/221 NOTICE TO READERS This work is not a peer-reviewed publication. The Master’s Candidate author of this work has made every effort to provide accurate information and to rely on authoritative sources in the completion of this work. However, neither the author nor the faculty advisor(s) warrants the completeness, accuracy or usefulness of the information provided in this work. This work should not be considered authoritative or comprehensive in and of itself and the author and advisor(s) disclaim all responsibility for the results obtained from use of the information contained in this work. Knowledge and practice change constantly, and readers are advised to confirm the information found in this work with other more current and/or comprehensive sources. The student author attests that this work is completely his/her original authorship and that no material in this work has been plagiarized, fabricated or incorrectly attributed. Coenzyme Q10 Supplementation for the Treatment of Statin Induced Myalgia Jessica Pomaikai Asherin A Clinical Graduate Project Submitted to the Faculty of the School of Physician Assistant Studies Pacific University Hillsboro, OR For the Masters of Science Degree, August 14, 2010 Faculty Advisor: Rob Rosenow, PharmD, OD Clinical Graduate Project Coordinators: Annjanette Sommers MS, PAC & Rob Rosenow PharmD, OD