CoQ10 is generally well tolerated, but it may interact with the blood thinner warfarin, with insulin and other glucose-lowering medicines, and with some chemotherapy and radiation treatments. Evidence on blood pressure medicines and on newer blood thinners such as apixaban (Eliquis) is limited. Statins and some other medicines lower the body's CoQ10 rather than interacting with it in a harmful way. If you take any prescription medicine, talk to your prescriber or pharmacist before starting CoQ10, and never stop or change a medicine on your own.
Key Takeaways
- NIH lists warfarin and insulin as medicines CoQ10 may interact with, and says it may not be compatible with some chemotherapy or radiation treatments.
- Warfarin evidence points in different directions: case reports describe a weaker effect, a small trial found no change in INR, and an observational study linked CoQ10 use with more self-reported bleeding.
- CoQ10 may lower insulin needs, so people using insulin or other glucose-lowering medicines should check with their doctor first.
- Reviews found CoQ10 has little or no meaningful effect on blood pressure, but tell your prescriber if you take blood pressure medicines.
- Statins lower blood CoQ10 levels, and beta-blockers can inhibit CoQ10-dependent enzymes; keep taking them exactly as prescribed.
- Bring a full list of your medicines and supplements to your pharmacist before adding CoQ10.
Evidence grade: Moderate. Interaction warnings come from NIH agency reviews, case reports and a few small human studies, while the drop in blood CoQ10 with statins is supported by a meta-analysis of placebo-controlled trials.
Coenzyme Q10 (CoQ10, also called ubiquinone) is a compound your body makes and uses to produce energy in cells; it also works as an antioxidant. Many people who consider CoQ10 already take blood-thinning, blood pressure, cholesterol or glucose-lowering medicines, so it is worth knowing what NIH agencies and studies say about each. The medicine names below are interaction notes, not comparisons or recommendations. This guide is general information and does not replace a conversation with your prescriber or pharmacist.
CoQ10 Interactions by Medication Type
| Medication type | Examples | What is known | What to do |
|---|---|---|---|
| Warfarin | Warfarin (Coumadin, Jantoven) | NCCIH and the National Cancer Institute say CoQ10 may interact with or reduce the body's response to warfarin. Small studies disagree on the direction and size of any effect. | Do not start or stop CoQ10 without the clinician who manages your warfarin. Ask whether you need extra INR checks. |
| Newer blood thinners (DOACs) | Apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa) | We found no studies, and NCCIH and NCI do not list an interaction. Absence of studies is not proof of safety. | Ask your prescriber or pharmacist before combining them. |
| Blood pressure medicines, including beta-blockers | Metoprolol, atenolol, lisinopril, amlodipine | Possible additive effect was a concern, but a Cochrane review and NCCIH found no meaningful effect of CoQ10 on blood pressure. Beta-blockers can inhibit CoQ10-dependent enzymes. | Tell your prescriber before starting and report any dizziness or light-headedness. |
| Insulin and glucose-lowering medicines | Insulin, glyburide, tolazamide | NCCIH lists insulin as a possible interaction; NCI says CoQ10 can decrease insulin requirements. Some oral glucose-lowering medicines lower blood CoQ10. | Talk to your doctor first and follow their advice on checking your blood sugar. |
| Chemotherapy and radiation | Doxorubicin and other treatments | NCCIH says CoQ10 may not be compatible with some cancer treatments. An observational study linked antioxidant supplements, including CoQ10, with a trend toward worse outcomes. | Take CoQ10 during treatment only if your oncology team approves. |
| Statins and other lipid-lowering medicines | Atorvastatin, simvastatin, rosuvastatin, pravastatin, gemfibrozil | These lower blood CoQ10 levels. This is not a harmful interaction, and whether it matters clinically is unclear. | Keep taking your medicine as prescribed. Ask your doctor before adding CoQ10. |
Always talk to your prescriber or pharmacist before combining any supplement with prescription medicines. Never change or stop a prescribed medicine on your own.
Warfarin and Other Blood Thinners
NCCIH states that CoQ10 may interact with warfarin, and the National Cancer Institute says CoQ10 can reduce the body's response to it. The underlying evidence is limited and points in different directions:
- Case reports described a weaker response to warfarin in a few people who took CoQ10.
- A small controlled trial in Denmark gave 24 outpatients on stable, long-term warfarin 100 mg of CoQ10 a day for four weeks in a placebo-controlled crossover design. INR stayed stable and the warfarin dose did not change.
- An observational study of 171 adults taking warfarin in Canada found CoQ10 use was associated with more self-reported bleeding events.
Because the results disagree and warfarin has a narrow safe range, the clinician who manages your warfarin should decide whether CoQ10 suits you and how closely to monitor your INR.
Is CoQ10 a blood thinner?
No. CoQ10 is not a blood thinner and must never be used in place of one. The concern is that it may change how warfarin works in some people.
CoQ10 and apixaban (Eliquis) or other newer anticoagulants
We found no clinical studies of CoQ10 with apixaban, rivaroxaban or dabigatran, and the NIH sources we checked do not list an interaction. These medicines are prescribed to prevent clots, so check with your prescriber or pharmacist before adding any supplement.
Other supplements to review if you take warfarin
- Vitamin K: the NIH Office of Dietary Supplements advises people taking warfarin to keep their vitamin K intake about the same every day.
- Vitamin E: large doses can increase bleeding risk with anticoagulant or antiplatelet medicines.
- Fish oil: most research found 3 to 6 g a day did not significantly change anticoagulation, but INR monitoring is still advised.
For how CoQ10 pairs with common vitamins, see what vitamins to take with CoQ10.
Blood Pressure Medicines, Including Beta-Blockers
Earlier clinical trials suggested CoQ10 might lower blood pressure, which led to warnings about an additive effect with blood pressure medicines. More rigorous reviews are less convinced. A 2016 Cochrane review pooled two placebo-controlled trials (50 participants) in adults with raised blood pressure and found no significant change in systolic or diastolic pressure; the authors rated this as moderate-quality evidence of no clinically significant effect. NCCIH likewise says CoQ10 probably does not have a meaningful effect on blood pressure.
The National Cancer Institute notes that beta-blockers can inhibit CoQ10-dependent enzyme reactions, and its patient summary says medicines used to lower blood pressure may decrease the effects of CoQ10. If you take a beta-blocker, ACE inhibitor, calcium channel blocker or diuretic, tell your prescriber before you start CoQ10 and report any dizziness or light-headedness.
Insulin and Glucose-Lowering Medicines
NCCIH lists insulin among the medicines CoQ10 may interact with, and the National Cancer Institute says CoQ10 can decrease insulin requirements in people with diabetes. NCI also notes that some oral glucose-lowering medicines, such as glyburide and tolazamide, lower blood CoQ10 levels. If you use insulin or another glucose-lowering medicine, talk to your doctor before starting CoQ10 and follow their advice on how often to check your blood sugar.
Chemotherapy and Radiation
CoQ10 is an antioxidant, and some cancer treatments work partly through oxidative stress. NCCIH cautions that CoQ10 may not be compatible with some types of cancer treatment. The National Cancer Institute adds that clinical trials of CoQ10 during treatment have not followed patients long enough to show whether it reduces the effectiveness of chemotherapy or radiation, and in one mouse study CoQ10 given with radiation reduced the radiation's effectiveness.
In a 2020 observational study of 1,134 patients with breast cancer enrolled in a treatment trial, use of any antioxidant supplement (vitamins A, C and E, carotenoids or CoQ10) both before and during chemotherapy was associated with a trend toward a higher risk of recurrence (hazard ratio 1.41, 95% CI 0.98 to 2.04). Take CoQ10 during treatment only if your oncology team has approved it.
Statins and Other Medicines That Lower CoQ10
Statins lower cholesterol by blocking an enzyme the body also needs to make CoQ10. A 2015 meta-analysis of placebo-controlled trials found that statins lowered blood CoQ10 by an average of 0.44 micromol/L, with the effect seen for atorvastatin, simvastatin, rosuvastatin and pravastatin; the authors said its clinical relevance still needs to be clarified. The National Cancer Institute notes that gemfibrozil and some oral glucose-lowering medicines also lower blood CoQ10.
Whether CoQ10 helps the muscle aches some people report on statins is debated. A 2018 meta-analysis of 12 trials (575 patients) found lower muscle-symptom scores with CoQ10, while NCCIH says the overall evidence does not support a benefit. Some people take both, but only your doctor can tell you whether that makes sense for you. Keep taking your statin exactly as prescribed.
If You Decide to Take CoQ10
- Bring a list of every medicine and supplement you take to your prescriber or pharmacist before you start.
- Take CoQ10 with a meal that contains some fat, since it is fat-soluble. See the best time to take CoQ10.
- Follow the label dose, and never use CoQ10 in place of a prescribed medicine.
- Contact your healthcare provider if you notice unusual bruising or bleeding, changes in your blood sugar readings, dizziness or other new symptoms.
Check with your pharmacist first. If you take any of the medicines above, ask before using OPA CoQ10 Ubiquinone or any CoQ10 product. It provides 200 mg of CoQ10 as ubiquinone in one capsule, within the 90 to 390 mg a day range used in human studies, with a cellulose vegetable capsule and rice flour as the other ingredients; a bottle holds 30 capsules. The label suggests one capsule once daily, 20 to 30 minutes before a meal with water. For the two forms of CoQ10, see our ubiquinone vs ubiquinol guide, and for groups who should get advice first, see who should not take ubiquinol.
Safety and Interactions
No serious side effects of CoQ10 have been reported. Mild insomnia or digestive upset can occur; the National Cancer Institute notes mild insomnia in some people at 100 mg a day or more. Other reported effects include nausea, upper abdominal pain, heartburn, headache, dizziness, rash, irritability, sensitivity to light and fatigue. Long-term use of 300 mg a day has been linked to raised liver enzymes, without reported liver damage.
Talk to your prescriber or pharmacist first if you take warfarin or another blood thinner, insulin or other glucose-lowering medicines, blood pressure medicines including beta-blockers, statins or other lipid-lowering medicines, or if you are having chemotherapy or radiation. If you are pregnant or breastfeeding, talk to your healthcare provider before taking CoQ10. Never stop or change a prescribed medicine to make room for a supplement.
Frequently Asked Questions
Does CoQ10 interact with any medicines?
Possibly. NIH agencies list warfarin and insulin as possible interactions and say CoQ10 may not be compatible with some chemotherapy or radiation treatments. Evidence on blood pressure medicines and newer blood thinners is limited. Talk to your prescriber or pharmacist before combining CoQ10 with prescription medicines.
Is CoQ10 a blood thinner?
No. CoQ10 is not a blood thinner. It may change how warfarin works, so if you take a blood thinner, talk to your prescriber before using CoQ10.
Can I take CoQ10 with Eliquis?
There are no good studies of CoQ10 with apixaban (Eliquis), and NIH sources do not list an interaction. Ask your prescriber or pharmacist before combining them.
Can I take CoQ10 with beta-blockers?
Beta-blockers can inhibit CoQ10-dependent enzymes, and no harmful interaction is well established. Check with your prescriber first and report any dizziness, especially if you take more than one blood pressure medicine.
Should a statin and CoQ10 be taken together?
Only with your doctor's approval. Statins lower blood CoQ10 levels, but this is not harmful on its own, and evidence that CoQ10 eases statin-related muscle aches is mixed. Keep taking your statin as prescribed.
Does CoQ10 affect blood sugar?
It may. The National Cancer Institute notes that CoQ10 can decrease insulin requirements, so anyone using insulin or other glucose-lowering medicines should check with their doctor first.
Sources
- National Center for Complementary and Integrative Health (NIH). Coenzyme Q10. Updated 2019.
- National Cancer Institute (NIH). Coenzyme Q10 (PDQ), Health Professional Version. Updated 2024.
- National Cancer Institute (NIH). Coenzyme Q10 (PDQ), Patient Version.
- Engelsen J, Nielsen JD, Hansen KF. Effect of coenzyme Q10 and Ginkgo biloba on warfarin dosage in patients on long-term warfarin treatment: a randomized, double-blind, placebo-controlled cross-over trial. Ugeskr Laeger. 2003.
- Shalansky S, Lynd L, Richardson K, et al. Risk of warfarin-related bleeding events and supratherapeutic international normalized ratios associated with complementary and alternative medicine: a longitudinal analysis. Pharmacotherapy. 2007.
- Ho MJ, Li EC, Wright JM. Blood pressure lowering efficacy of coenzyme Q10 for primary hypertension. Cochrane Database Syst Rev. 2016.
- Ambrosone CB, Zirpoli GR, Hutson AD, et al. Dietary supplement use during chemotherapy and survival outcomes of patients with breast cancer enrolled in a cooperative group clinical trial (SWOG S0221). J Clin Oncol. 2020.
- Banach M, Serban C, Ursoniu S, et al. Statin therapy and plasma coenzyme Q10 concentrations: a systematic review and meta-analysis of placebo-controlled trials. Pharmacol Res. 2015.
- Qu H, Guo M, Chai H, et al. Effects of coenzyme Q10 on statin-induced myopathy: an updated meta-analysis of randomized controlled trials. J Am Heart Assoc. 2018.
- NIH Office of Dietary Supplements. Vitamin K: Fact Sheet for Consumers.
- NIH Office of Dietary Supplements. Vitamin E: Fact Sheet for Health Professionals.
- NIH Office of Dietary Supplements. Omega-3 Fatty Acids: Fact Sheet for Health Professionals.
Disclosure: OPA Nutrition sells supplements, including products mentioned in this article. This content is for education only and is not medical advice. Statements about dietary supplements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. Talk to your healthcare provider before using any supplement, especially if you take medication or have a medical condition.
Written and reviewed by Michael Gonzales, Founder, OPA Nutrition · Last reviewed: · How OPA researches and writes
