CoQ10 and L-carnitine for Statin Myalgia?

One of the main side effects of statins is myalgia or muscle pain. Statins are a standard of care in many clinical settings such as acute myocardial infarction and for patients having or at risk of cardiovascular (CV) disease. This is based on a plethora of data showing reductions in CV events and mortality. The CV benefit of statins can be partly explained by their ability to inhibit of HMG-CoA reductase, which subsequently lowers cholesterol and decreases the formation of mevalonate. However, the inhibition of the mevalonate pathway decreases the formation of coenzyme Q10 (CoQ10) within the body. It has been a long-standing theory that statin-associated muscle pain (myalgia) is caused, or at least partly contributed by, a reduction in CoQ10 levels in muscle mitochondria. One of the main side effects of statins is myalgia, which causes the patient to either stop their statin or significantly reduce the dose of their statin. The question of whether CoQ10 can help treat statin myopathy is a common one encountered by clinicians in current day practice. Clinical trials have shown that CoQ10 may decrease the incidence and/or severity of statin myalgia. CoQ10 is thought to work by replenishing the depleted CoQ10 levels in muscle mitochondria and/or through an antioxidant mechanism.Furthermore, CoQ10 supplementation has been shown to decrease LDL oxidation and improve flow-mediated dilation in several human and in vitro trials. LDL oxidation can initiate atherosclerosis and subsequent stroke or myocardial infarction. Thus, supplementing with CoQ10 may help treat statin myalgia and perhaps decrease the risk of cardiovascular (CV) disease. It has been found that, CoQ10 seems to be a reasonable approach for treating statin-induced muscle pains. Conclusion: In summary, it has been proposed that CoQ10 can help to treat statin myalgia. While this is not conclusive, there are two randomized controlled trials showing significant improvements in the severity of muscle pain with the use of CoQ10 in patients treated with statins. Thus, it is not unreasonable to supplement a patient who is experiencing muscle pains on a statin with CoQ10. While there are no clinical trials showing improvements in muscle pain with the use of l-carnitine, patients who experience statin myalgia frequently have carnitine abnormalities. It is too soon to recommend l-carnitine for statin myalgia, but future trials should test this supplement to see if it has any place for this adverse effect. Other common alternatives for treating statin myalgias are supplementation with vitamin D or vitamin B12, especially in the setting of suboptimal serum levels. SOURCE: MEDSCAPE