The Physicians’ Desk Reference for Herbal Medicines has a discussion of how the statins may inhibit natural synthesis of coenzyme Q, placing a patient at risk for statin myopathy. Has a benefit been found in giving coenzyme Q to prevent or treat statin myopathy?
—Frank Seck, DO, Gladwin, Mich.
Despite many other claims for coenzyme Q (i.e., prevents cancer, prevents heart failure, etc.), I have not seen any evidence that its supposed benefit in reducing myopathy has actually been investigated, and it has certainly not been proven. Since the cellular mechanism behind statin myopathy is not clearly understood, the benefit of coenzyme Q is completely hypothetical. Therefore, I do not take it and do not recommend it to my patients. Furthermore, since most patients taking statins are usually taking other medications as well, I am quite clear in my advice not to take herbal treatments. The herbals are essentially unresearched, and I am very concerned about their potential for toxicity and particularly drug interaction.
Remember that statin myopathy (creatine kinase >10 times normal with muscle pain) is very rare, usually affecting in the range of 0.1%-0.3% of patients, possibly up to 0.5% with the 80-mg doses, so the chances of developing it are very low. The most severe reaction, fatal rhabdomyolysis from a statin alone, occurs in 1.5 patients for every 10 million prescriptions, making statins much safer than many OTC agents or recreational activities. Patients who need statin therapy should be made aware that heart disease has a high mortality, about 650,000 U.S. deaths each year, and is much more lethal than the medications used to treat it.
—Robert M. Guthrie, MD (100-20)