There is no good evidence that CoQ10 ameliorates statin myalgia. This is based upon three small trials:
Bookstaver studied 76 patients in a robust double-blind placebo-controlled trial. Both groups improved equally underscoring the huge placebo effect.
Young studied 44 patients also in a robust randomised double-blind placebo-controlled trial. Again both groups improved without significant difference.
Caso studied 32 patients, randomised double-blind with Vitamin E control. Puzzling that Vitamin E group pain scores didn’t change at all, expect some placebo effect. Statistical issues include use of a only a single outcome measure, which was the mean (not median) of an ordinal pain scale, giving undue influence to outliers. Especially with small patient numbers, as in this study.
One issue with all three trials is that enrolment with myalgia was allowed without robust proof that it was statin induced. It is possible that inclusion of non-statin myalgia diluted a beneficial effect of CoQ10. Nevertheless, and as frustrating as it is to have such a poor evidence base, the best synthesis is that CoQ10 does not improve statin-induced myalgia and that the placebo effect explains most anecdotal reports of benefit.
In addition, there is a lingering concern that that CoQ10 may reduce the effectiveness of statin therapy. The many randomised trials showing that statins reduce cardiovascular events were all conducted without CoQ10 supplementation. This protection afforded by statins is not explained by LDL-lowering alone, other mechanisms await elucidation. It is possible that some of the benefit derives from reduction of endogenous CoQ10 levels, via undiscovered mechanisms.
We suggest that CoQ10 supplementation is deployed only as a last resort for statin myalgia, when all available statins and dosing regimens have been tried and not tolerated, and after discussing with the patient the possibility that it may reduce effectiveness of the statin.
Bookstaver DA, Burkhalter NA, Hatzigeorgiou C.
Effect of coenzyme Q10 supplementation on statin-induced myalgias.
Am J of Cardiol. 2012;110(4):526?529
Young JM, Florkowski CM, Molyneux SL, et al.
Effect of coenzyme Q(10) supplementation on simvastatin-induced myalgias.
Am J Cardiol. 2007;100(9):1400-1403
Caso G, Kelly P, McNurlan MA, Lawson WE.
Effect of coenzyme Q10 on myopathic symptoms in patients treated with statins.
Am J Cardiol. 2007;99(10):1409-1412
What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug? Systematic review of randomized placebo-controlled trials to aid individual patient choice
Finegold, Manisty, Goldacre, Barron, Francis
European Journal of Preventive Cardiology 2014 21: 464