Coenzyme Q10 for statin-related myopathy (short)

Banach M, et al. Effects of coenzyme Q10 on statin-induced myopathy: A meta-analysis of randomized controlled trials. Mayo Clinic Proc 2015;90:24-34.

Bottom line: Coenzyme Q10 has no effect on statin-related myopathy. Clinicians should investigate and manage other causes and risk factors for myalgias. In those with likely statin-related myalgias, strategies include alternate-day statin dosing, decreasing the dose, or switching to a different statin.



  • ~5-10% of patients report myalgias while taking statins
    • Described as a heaviness/stiffness/cramping or weakness/loss of strength, more often in the lower limbs, that's worse with exertion, with a median onset 4 weeks after starting the statin
    • Risk factors for statin-related myalgia:
      • Higher statin dose
      • Demographics: Older age, female sex, asian
      • Other conditions: CKD, electrolyte disorders, hypothyroidism, existing myalgias
  • One of the hypothesized mechanisms of statin-related myopathy is the interference of Coenzyme Q10 (CoQ10) production


  • Systematic review of MEDLINE, Embase, the Cochrane Library, and Scopus up to May 2014
    • No attempts to uncover unpublished or gray literature
  • Included 6 RCTs of CoQ10 versus placebo in 302 patients with statin-induced myopathy that reported on outcomes of changes in creatine kinase (CK) or myalgia
  • Evaluated study quality using the flawed Jadad score
    • Although reviewers rated all trials as "high quality", trials often had questionable allocation concealment and blinding, biasing results in favor of the CoQ10 group
  • Meta-analyzed using a random-effects model to account for heterogeneity in study design


  • I: CoQ10 100-400 mg/day x30 days (1 trial) to 12 weeks (5 trials)
  • C: Placebo (in at least 1 trial, "placebo" not inert (vitamin E) and looked different from CoQ10 capsule)


  • No statistically significant difference in muscle pain in 5 trials with high heterogeneity (I^2 = 89%)
    • 2/5 trials reported statistically significant differences (at least 1 of which wasn't truly placebo-controlled or properly blinded), whereas 3/5 reported no difference or trend towards increased myalgia
    • Standard mean difference -0.53 (95% confidence interval -1.33 to 0.28,)
      • No single validated statin myalgia scale, so various scales used in different studies
  • No statistically or clinically significant difference in CK in 5 trials
    • Mean difference +11.69 units (95% confidence interval -14.25 to +37.63, p=0.38)
  • Sensitivity analysis suggested no greater chance of benefit with higher doses
  • Did not report other important outcomes, such as % of patients able to tolerate statins, or able to increase dose

Additional evidence