Description
Coenzyme Q10 (CoQ10) is a naturally occurring antioxidant produced by the body. CoQ10 is utilised by cells for growth and maintenance. As CoQ10 is produced naturally in the body, CoQ10 deficiency is rare in the healthy population. Nevertheless, CoQ10 supplements are widely used and have been studied for various health indications. Research on CoQ10 has focused primarily on cardiovascular disease, although it has also been used in the context of cancer for chemotherapy-induced cardiotoxicity, cancer-related fatigue, inflammation and anti-tumour effects. The underlying mechanisms of action are thought to be antioxidant, immunomodulatory and possible anti-inflammatory.
Efficacy
Four systematic reviews (SRs) and three randomised controlled trials (RCTs) not included in these reviews are available.
Treatment-related cardiotoxicity: Three of five controlled clinical trials (CCTs) included in a SR reported positive effects on surrogate parameters of cardiac function, all studies were of high risk of bias.
Fatigue: In a SR of two RCTs in breast cancer patients, one RCT (n=236) of CoQ10 reported no improvements of fatigue while one RCT (n=59) of a combination product containing CoQ10 suggested some improvements
Inflammation: One SR (n=3 RCTs) reports anti-inflammatory effects of CoQ10 in liver and breast cancer patients (low-certainty evidence).
Tumour recurrence: One CCT (n=80) reported a significantly reduced risk of developing metastases in melanoma patients receiving CoQ10 + interferon vs interferon alone (CCT=80, low-certainty evidence).
PSA levels: there is conflicting evidence from two RCTs (n=79, n=49) of CoQ10 combination products (low-certainty evidence).
Safety
CoQ10 is generally safe and well tolerated when taken as a dietary supplement. In cancer care, there is some concern regarding its use before and during chemotherapy in breast cancer populations based on one observational study, which reported that the use of coenzyme Q10 (standalone or in combination with vitamins C, E) was associated with a non-significantly increased hazard of breast cancer recurrence.
Description
CoQ10 is a naturally produced molecule that is found in the membranes of nearly all of the body’s cells. Concentrations are particularly high in the inner mitochondrial membrane (da Silva 2013). CoQ10 is structurally related to vitamins K and E. Its structure is what gives CoQ10 its name: the "Q" refers to the molecule's quinone structure, while the "10" refers to the lipophilic isoprenoid chain of 10 subunits (NCI 2016). The term "ubiquinone" is frequently employed to describe CoQ10, furthermore it is referred to as Vitamin Q10, ubiquinol, ubidecarenon, mitoquinone, adelir, heartcin, neuquinone, and taidecanone. (Garrido-Maraver 2014)
CoQ10 is also available as a dietary supplement, made by microbial fermentation (Cluis 2012), and is mainly used in cardiovascular disease. Interest in CoQ10 as an agent in cancer care began in the 1960s when studies found lower serum concentrations of CoQ10 in a variety of cancers (NCI 2016).
Ingredients and quality issues
CoQ10 naturally occurs in meat, fatty fish such as sardines and mackerel, eggs, whole-grain cereals, rice, soya products, nuts, and vegetables especially broccoli and spinach (da Silva 2013). The quality and composition of CoQ10 products may differ between manufacturers (Overvad 1999, ConsumerLab.com 2023).
Alleged indications
CoQ10 has been mainly investigated for its use in cardiovascular disease (Al Saaidi 2021; Sue-Ling 2022). Other clinical applications include migraine, fatigue, neurogenerative diseases such as Parkinson’s, Alzheimer, multiple sclerosis as well as neuropathy and cancer. (Testai 2021)
In the context of cancer, CoQ10 has been purported to have anticancer effects, both as a preventative and treatment agent. (NCI 2016) It has also been reported to support treatment-related adverse effects such as fatigue and cardiotoxicity.
Application and dosage
Dietary intake of CoQ10 is only 3-10mg/d; the body meets additional need for CoQ10 by means of endogenous synthesis from precursors of cholesterol biosynthesis. As a result, in healthy individuals there is generally no CoQ10 deficiency (Lesser 2013, Potgieter 2013, Kaikkonen 1999, Overvad 1999). The reference range of the CoQ10 concentration in serum/whole blood lies between 433-1,532 mcg/L for adults (HealthMatters 2023).
CoQ10 is sold as a dietary supplement and usually taken orally as a capsule or tablet. It can also be administered intravenously. There are challenges in absorbing Co10 from dietary supplements and different products have yielded different results (López-Lluch 2019). Due to its lipophilic nature, CoQ10 is absorbed more effectively when taken with high-fat foods. Consequently, intravenous CoQ10 is available as lipid preparations (NCI 2016). Typical doses range from 60-1000mg per day for up to 12 weeks. (NatMed 2023) Dosages of 50-3000 mg/day have been used in clinical studies.
Mechanism of action
CoQ10 possesses antioxidant and anti-inflammatory properties, which have been identified as the primary mechanisms of action underlying its activity.
In vitro and animal studies have reported CoQ10's protective effects against doxorubicin-induced testicular toxicity by reversing apoptosis (El-Sheikh 2014). When administered with UBIAD1, its biosynthetic enzyme, CoQ10 altered the mechanical properties of cell membranes, counteracting cancer progression (Tosi 2024).
In retinoblastoma cells, co-therapy with trolox reduced tumour invasion and growth (Upreti 2024). CoQ10 mitigated carboplatin-induced nephrotoxicity (Kabel 2017) and, when combined with alpha-lipoic acid, protected against cisplatin-induced kidney damage (Khalifa 2020).
Reduced CoQ10 demonstrated radioprotective effects and ameliorated radiation enteropathy in mice (Shimizu 2019). It reduced cardiac damage (Pei 2022) as well as gastric mucosal damage and gut microbiota dysregulation in various doxorubicin-treated animal models (Zhao 2021).
In glioblastoma cells, it inhibited angiogenesis and decreased tumour volume (Frontiñán-Rubio 2022).
In humans, a systematic review (SR, see below under “Does it work”) reported reduced tumour angiogenesis (Alimohammadi 2021). CoQ10 exerted protective effects against trastuzumab-induced cardiotoxicity in a single study involving 100 HER2-positive breast cancer patients (Al-Hammadi 2023). A reduction in tumour burden was observed in another trial involving 84 breast cancer patients treated with tamoxifen, riboflavin, and niacin, potentially leading to a better prognosis due to increased DNA repair activity (Premkumar 2017). Furthermore, a randomised controlled trial involving 59 breast cancer patients undergoing tamoxifen treatment reported reductions in inflammatory mediators (IL-8, IL-6) (Zahrooni 2019).
Legal issues
CoQ10 is a nutritional supplement and can be purchased over the counter.
Four systematic reviews (SRs) evaluating the effects of CoQ10 on a range of outcomes such as health-related quality of life, antitumour treatment and treatment-related adverse effects are available. (Alimohammadi 2021; Arring 2019; Tafazoli 2017; Roffe 2004). The most recent three SRs were published between 2017 and 2021.
The Tafazoli 2017 narrative review aimed to evaluate the effects of CoQ10 on a range of outcomes and included all studies from in vitro to clinical. It included the same RCTs as the more recent SRs mentioned above but the authors did not report quantitative findings hence its findings cannot be meaningfully interpreted.
The SRs are summarized below and described in table 1. The SRs all suffered methodological shortcomings including considerable heterogeneity, high risk of bias of the primary studies, which adds to the considerable uncertainty about any therapeutic effects. Further RCTs investigated PSA levels (n=2) and tumour recurrence (n=1) (included in SRs by Grammatikopoulou 2020 and Hackshaw 2015).
Description of included studies
Treatment-related cardiotoxicity
A SR analysed the issue of whether oral administration of CoQ10 improved the tolerability of chemotherapy and reduced adverse events and toxicity (Roffe 2004). The review examined five controlled interventional studies in which patients with different malignant haematological systemic diseases or solid tumours were given CoQ10 at doses of 90-240mg/d concomitantly with anthracycline chemotherapy. Three of the five studies reported positive effects on surrogate parameters of cardiac function. The authors of the review regarded this as potential evidence of CoQ10 reducing the cardiotoxicity of anthracycline chemotherapeutic agents. However, they also determined the risk of bias in the studies to be very high, thus greatly limiting the strength of the findings.
Fatigue
The SR by Arring 2019 evaluated the effects of integrative therapies for cancer-related fatigue and included two RCTs of CoQ10 (one thereof a combination product with amino acids and L-carnitine) in breast cancer patients.
The first RCT assessed 236 women with newly diagnosed breast cancer and planned adjuvant chemotherapy who were randomized to oral supplementation of 300-mg CoQ10 or placebo, each combined with 300-IU vitamin E, divided into 3 daily doses. There were no significant differences between the CoQ10 and placebo arms at 24 weeks for fatigue scores. (Lesser 2013)
The second RCT aimed to investigate the efficacy of Inner Power®, containing branched-chain amino acids (2500mg) coenzyme Q10 (30mg) and L-carnitine (50mg) in controlling cancer-related fatigue in 59 breast cancer patients (Iwase 2016). The authors reported that compared with usual care (recommendations for exercise and relaxation), the supplement reduced the worst level of fatigue but had no effect on average feeling of fatigue.
Inflammation
The SR by Alimohammadi 2021 evaluated the effects of CoQ10 on serum levels of various inflammatory markers in the large and relatively homogenous sample of breast cancer participants undergoing tamoxifen therapy. The SR included results from 2 RCTs (1 RCT thereof is reported in 4 papers; total number of participants is unclear due to double counting). The SR found some evidence for altered immune function/biomarkers of inflammation such as reductions in vascular endothelial growth factor, interleukin-8, matrix metalloproteinase-2 or matrix metalloproteinase-9; and no effect on tumour necrosis factor-α, interleukin-6, interleukin-1β, catalase, superoxide dismutase, glutathione peroxidase, glutathione, or thiobarbituric acid reactive substances.
One RCT not included in the above SRs (Liu 2016) evaluated effectiveness of various doses of CoQ10 compared with placebo in reducing markers of inflammation in 41 participants with hepatocellular cancer. It reported significantly decreased levels of oxidative stress and inflammatory markers as well as increased antioxidant enzymes activity after 12 weeks of supplementation with 300mg/day of coenzyme Q10.
Tumour recurrence
A two-arm, non-randomised trial compared the effects of CoQ10 (400mg/d, oral) on the recurrence rate in melanoma patients (n=81) who received three years of adjuvant therapy with recombinant IFNα-2b and CoQ10 versus no adjuvant therapy (Rusciani 2007). In the CoQ10 treatment group, the recurrence rate was significantly lower after 5 years of follow-up. The risk of developing metastases was about 10 times lower in IFN+CoQ10 group compared with the IFN group (95% CI: 0.0020–0.6732). Odds ratios computed for stage II vs. stage I and for IFN+CoQ10 vs. IFN therapy were 14.32 (95% CI: 1.7090–120.0029) and 0.078 (95% CI: 0.0093–0.6569), respectively, indicating that the risk of metastasis increased with rising disease stage, and that therapy with IFN+CoQ10 reduced this risk. However, the results are at high risk of bias due to the lack of randomisation and the small patient sample.
PSA levels
Hoenjet 2005 evaluated the effects of CoQ10 (200mg) in combination with vitamin E (350 mg), Selenium (200 μg), vitamin C (750 mg) over a period of 21 weeks in a sample of 70 prostate cancer patients (N=70) after radical prostatectomy or curative radiotherapy, or without curative treatment. The authors reported that compared with placebo the intervention had no effect on serum PSA concentrations.
Schroder 2005 evaluated the effects of CoQ10 (4mg) in combination with soy (62.5 mg), lycopene (15 mg), and selenium (128 mg) in an RCT of 49 patients with a history of prostate cancer and rising prostate-specific antigen (PSA) levels. The authors reported that compared with placebo the intervention delayed PSA progression.
Adverse effects
CoQ10 is considered a safe supplement (Hidaka 2008). Infrequent adverse effects have been reported which are generally mild and transient, often affecting the gastrointestinal tract (Drovandi 2022).
Mild events included headaches, dizziness, insomnia, fatigue, skin itching, irritability (Mayo Clinic 2023). Less than or equal to 1% of users may experience heartburn and epigastric discomfort (NatMed 2023). In a single RCT, 57 breast cancer patients receiving chemotherapy, CoQ10, and L-carnitine reported non-severe fatigue, anaemia, fever, myalgia, leukopenia, anorexia, and palpitations (Iwase 2016).
Severe events included one case of venous thrombosis and one case of cerebral stroke among 202 moderate heart failure patients (Mortensen, 2014), as well as two cases of diverticulitis and bleeding ulcers in a study involving 65 patients with progressive supranuclear palsy (Apetauerova, 2016). The adverse events were attributed to CoQ10 supplementation.
Several RCTs have indicated that a dosage of up to 300 mg/day administered for up to five years is safe. However, patients involved in these studies showed high heterogeneity in their conditions (Mantle 2024).
In children, a maximum daily dose of 10mg/kg body weight is considered safe; in pregnant women, a maximum daily dose of 200mg/day is considered safe (NatMed 2023).
Contraindications
To date, no confirmed contraindications have been reported at the recommended supplement dosage (NatMed 2023).
Interactions
CoQ10 supplementation in rats affected cytochrome P450 theophylline metabolism (Baskaran 2008). Limited human studies suggest CoQ10 may enhance nivolumab outcomes (Akagi 2020). However, data is insufficient to confirm whether CoQ10 affects other drugs metabolized by cytochrome/P-glycoprotein or checkpoint inhibitors.
Potential interaction between antioxidants such as CoQ10 and radiotherapy or alkylating chemotherapy is plausible but no conclusive clinical data currently support this effect (Mantle 2024).
In a single RCT involving 1,134 breast cancer patients undergoing treatment with cyclophosphamide, doxorubicin, or paclitaxel, and supplements including CoQ10, an association with an increased hazard of recurrence and reduced survival was observed. (Ambrosone 2020).
A single case report noted a reduced response to warfarin, which resolved after supplementation was discontinued (Landbo 1998). Conversely, a small RCT found no change in INR levels among patients who received coumarins and CoQ10 at doses of up to 100 mg/day for four weeks (Engelsen 2003).
Interactions with antihypertensives have been suggested based on studies in rats (Chen 2019), while those with vitamin K remain theoretical (NatMed 2023).
Alleged interactions observed in in vivo studies include an enhanced effect of phenytoin (Tawfik, 2011). Other theoretical interactions include those with antidiabetics, beta-blockers, statins, diuretics, tricyclic antidepressants, beta-carotene, hypotensive herbs, and insulin (NCI 2016).
Warning
CoQ10 accumulates in the liver and undergoes biliary elimination, necessitating caution in related disorders (Drovandi 2022). Variations in formulation impact bioavailability, influencing therapeutic outcomes, with effervescent or fast-melting tablets offering rapid absorption (Joshi 2003).
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Citation
CAM Cancer Collaboration. Coenzyme Q10, April 2025.
Document history
Revision of “Mechanisms of action” and “Is it safe” sections in January 2025 by Lisa dal Pozzo. Update of “What is it” and “Does it work” sections in 2023 by Pawel Posadzki and the CAM Cancer Collaboration. Updated literature search in March 2025.
Updated in June 2016 by Mario Rottorf. Assessed as up to date in April 2014 by Barbara Wider. Updated in December 2012, September 2011 and August 2009 by Helen Cooke. First published in 2005, authored by Helen Seers and Helen Cooke.
