Oxi-Q

• Approved Indications:

  • Primary mitochondrial diseases: Adjunctive therapy to improve mitochondrial bioenergetics in patients with mitochondrial cytopathies.
  • Chronic heart failure (NYHA Class II–IV): Used as adjunctive therapy to improve symptoms, reduce hospitalization, and enhance quality of life.
  • Ischemic heart disease: Supportive treatment post-myocardial infarction and in chronic stable angina to improve cardiac function.
  • Statin-induced myopathy: To alleviate muscle pain, weakness, and fatigue associated with statin therapy by replenishing reduced endogenous CoQ10 levels.

  Clinically Important Off-Label Uses:

  • Neurodegenerative disorders: Adjunctive use in Parkinson’s disease, Huntington’s disease, and Alzheimer’s disease to improve mitochondrial function and reduce oxidative damage.
  • Migraine prophylaxis: To reduce frequency and severity of migraine attacks by enhancing mitochondrial energy metabolism.
  • Male and female infertility: To improve sperm motility and oocyte quality in infertility related to oxidative stress.
  • Chronic fatigue syndrome and fibromyalgia: To reduce fatigue and muscle pain by enhancing cellular energy production.

• Adults:
• Typical oral doses range from 100 mg to 300 mg daily, divided into 2–3 doses.
• For chronic heart failure: 100 mg twice daily (200 mg total daily) is common.
• For migraine prevention: 100 mg three times daily.
• Statin myopathy: 100–200 mg daily.
• Pediatrics:
• Limited data; doses generally weight-based, around 2–10 mg/kg/day, with careful clinical monitoring.
• Elderly:
• No specific dose adjustment required; standard adult dosing is appropriate, monitor tolerability.
• Renal or Hepatic Impairment:
• No formal dose adjustment recommended, but caution is advised due to limited studies.
• Route: Oral administration as capsules, softgels, or tablets.
• Administration Notes: Best absorbed with meals containing fat because of its lipophilic nature.
• Duration: Typically used long-term; treatment duration varies depending on indication and clinical response.

Coenzyme Q10 (ubidecarenone) is a lipophilic molecule structurally similar to vitamin K, integral to the mitochondrial electron transport chain. It acts as an electron carrier shuttling electrons from complexes I and II to complex III, facilitating the generation of adenosine triphosphate (ATP) via oxidative phosphorylation. This supports cellular energy production, especially in high-energy-demand tissues such as the heart and skeletal muscle. Additionally, CoQ10 functions as a potent antioxidant in its reduced form (ubiquinol), neutralizing reactive oxygen species, preventing lipid peroxidation, and protecting mitochondrial and cellular membranes from oxidative damage. These combined actions enhance cellular energy metabolism and reduce oxidative stress, underlying its therapeutic effects in cardiovascular and neurodegenerative conditions.

• Absorption: Oral bioavailability is variable and generally low (approx. 3–5%), improved significantly when taken with fatty meals.
• Distribution: Widely distributed in tissues with high mitochondrial activity including heart, liver, kidneys, pancreas, and skeletal muscle. CoQ10 is highly lipophilic, incorporated into mitochondrial membranes.
• Metabolism: Metabolized in the liver primarily by reduction to ubiquinol (active antioxidant form). Undergoes enterohepatic recycling.
• Elimination: Mainly eliminated via bile into feces; minor renal elimination occurs.
• Half-life: Approximately 33 hours, allowing for twice-daily dosing in most cases.

• Pregnancy: Classified as FDA Pregnancy Category C. There are no well-controlled clinical studies in pregnant women. Animal studies have not demonstrated teratogenic effects. Use only if clearly needed and benefits outweigh potential risks.
• Lactation: Limited data available on excretion into breast milk. Given its endogenous presence and low toxicity, likely safe, but caution advised during breastfeeding until more data are available.

• Nutritional supplement / mitochondrial coenzyme.
• Antioxidant and electron transport chain enhancer.

• Known hypersensitivity to Coenzyme Q10 or any excipients in the formulation.
• Caution advised in patients taking anticoagulants due to potential interaction.

• Anticoagulation: CoQ10 may reduce the effectiveness of warfarin and other vitamin K antagonists; close INR monitoring is essential during concurrent use.
• Blood Pressure: May lower blood pressure; use caution in hypotensive patients or those on antihypertensive therapy.
• Surgery: Discontinue 1–2 weeks before elective surgery due to potential bleeding risk.
• Hypersensitivity: Rare allergic reactions reported; discontinue if symptoms develop.
• Use in Pediatrics and Pregnant Women: Safety has not been established; use only when benefits justify potential risks.

• Common: Gastrointestinal disturbances such as nausea, diarrhea, abdominal discomfort; headache; dizziness.
• Uncommon/Rare: Allergic reactions including rash and itching; insomnia; irritability.
• Generally well tolerated with mild and transient adverse effects.

• Warfarin and other anticoagulants: May decrease anticoagulant effect, increasing risk of clotting. Requires frequent coagulation monitoring.
• Statins: May mitigate statin-induced muscle symptoms by replenishing endogenous CoQ10.
• Chemotherapy agents: The antioxidant effects may theoretically interfere with oxidative mechanisms of some chemotherapeutic drugs, though clinical significance remains uncertain.
• Minimal interaction with cytochrome P450 enzymes; low potential for CYP-mediated drug interactions.

• The Q-SYMBIO study (2014) and subsequent meta-analyses have strengthened evidence supporting CoQ10 as adjunct therapy in chronic heart failure, showing reduced morbidity and mortality.
• Guidelines increasingly recognize CoQ10’s benefit in migraine prophylaxis and statin-associated myopathy.
• Regulatory bodies recognize CoQ10 primarily as a dietary supplement, not a drug, though supportive clinical data continue to accumulate.

• Store at 20°C to 25°C (68°F to 77°F) in a tightly closed container, protected from moisture and light.
• Avoid excessive heat and freezing conditions.
• No refrigeration necessary.
• Keep out of reach of children.