Why Don’t Doctors Promote CoQ10 for Statin Muscle Problems?

Many doctors resist the idea that statin-type cholesterol-lowering medicines cause side effects. I know that seems odd. All medications have the potential to cause some adverse reactions in some people. But key articles in respectable medical journals maintain that statin muscle complaints are psychological in nature. That said, there is even a name for statin-associated muscle symptoms (SAMS). There is evidence that coenzyme Q10 (CoQ10) may help ease SAMS for many patients (Cureus, Aug. 31, 2024). Nevertheless, such a supplement is rarely recommended. Why not?

Many Doctors Deny SAMS Exist:

The United States Preventive Services Task Force (USPSTF) provides advice to health professionals. It recommends that doctors prescribe statins to anyone with elevated blood lipids, diabetes, hypertension or other risk factors (JAMA, Aug. 23/30, 2022).

When it comes to statin side effects, the USPSTF states:

“Although observational studies have reported an association between statin use and muscle pain, a pooled analysis of 9 trials (n = 46,388) found no increased risk of myalgia with statin therapy compared with placebo.”

The definition of myalgia, according to Johns Hopkins Medicine, is:

“muscle aches and pain”

So, according to the USPSTF and 9 clinical trials, statins do not contribute to statin-associated muscle symptoms!

But wait, there’s more. The Cholesterol Treatment Trialists’ Collaboration (CTTC) concluded that complaints of statin-associated muscle symptoms are “not due to the statin” (Lancet (Aug. 29, 2022).

Here is the full quote:

“In particular, for patients who report mild muscle symptoms when taking a statin, our findings suggest that it is most likely that the symptoms are not due to the statin, and statin therapy should continue until other potential causes have been explored.”

So, if people complain of muscle pain after taking statins, it must be psychosomatic or all in their heads. This idea is not new. And it’s not just statin-associated muscle symptoms. In April, 2014 an article was published in the European Journal of Preventive Cardiology titled:

“What proportion of symptomatic side effects in patients taking statins are genuinely caused by the drug?”

The authors concluded:

“Only a small minority of symptoms reported on statins are genuinely due to the statins: almost all would occur just as frequently on placebo.”

These researchers concluded that statins do not contribute to muscle symptoms and that the only real problem with statins was a modest increase in diabetes:

“Across both primary and secondary prevention trials, the rate of developing diabetes with statin was 3%, against 2.4% with placebo…”

So there you have it. According to these researchers, statins do not cause muscle aches, pain, weakness, fatigue or rhabdomyolysis (a potentially life-threatening destruction of muscle tissue), even though the FDA warns about such an adverse reaction in the official prescribing information for atorvastatin, lovastatin, simvastatin and rosuvastatin.

The bottom line on SAMS:

Remember, SAMS stands for statin-associated muscle symptoms. But even though there’s an official name for it, many doctors maintain that it does not exist. And if statin-associated muscle problems don’t exist, there’s no need to do anything about them.

There is a problem with this thinking, however. Dr. Steven Nissen is one of the country’s leading cardiologists.

Here is his bio from the Cleveland Clinic:

“Steven Nissen, MD, is Chief Academic Officer, Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute, and holds the Lewis and Patricia Dickey Chair in Cardiovascular Medicine.

“Dr. Nissen was Chairman of the Robert and Suzanne Tomsich Department of Cardiovascular Medicine from 2006 to 2019 after serving nine years as Vice Chairman of the Department of Cardiology and five years as Medical Director of the Cleveland Clinic Cardiovascular Coordinating Center (C5), an organization that directs multicenter clinical trials.”

In a paper published in the New England Journal of Medicine (April 13, 2023), Dr. Nissen and his colleagues wrote that:

“…7 to 29% of patients taking statins reports adverse musculoskeletal effects that prevent them from using statins or limit their ability to receive guideline-recommended doses.”

Dr. Rita Redberg is a cardiologist at the University of California, San Francisco School of Medicine. She was editor-in-chief of JAMA Internal Medicine for more than a decade.

She and her colleagues wrote this about SAMS in an editorial in JAMA Internal Medicine, Aug. 23, 2022:

“For example, in observational data, statin-associated muscle symptoms affect up to 1 in 10 individuals. Even if, as has been argued, statin-associated muscle symptoms are at least partly due to the nocebo effect, the extent to which muscle symptoms lead to either dose-reduction or discontinuation of statins (usually with subsequent cessation of these symptoms) should not be discounted.”

Statins Deplete the Body of CoEnzyme Q10:

Cardiologists have known for more than three decades that statin-type cholesterol-lowering drugs can lower levels of ubiquinone. Most people know ubiquinone by the name coenzyme Q10 or CoQ10.

Surprisingly, however, most doctors don’t recommend adding CoQ10 to a statin regimen.

The Mayo Clinic, for example, suggests that CoQ10 supplements are usually unnecessary because people can get enough from their diet:

“When the studies are double-blind — meaning neither the patient nor the doctor know if the medication they are getting is a statin or a sugar pill — then a coenzyme Q10 supplement has never been shown to be helpful in reducing muscle aches.”

The Cleveland Clinic put this on its website (January 17, 2025):

“Taking a Statin? Here’s Why You Don’t Need CoQ10 Supplements”

“There’s not enough evidence to show that this supplement has any effect on muscle aches from cholesterol-lowering meds.”

A Different Point of View About Statin-Associated Muscle Problems and CoQ10:

Despite the fact that mainstream medicine insists that 1) statins do not cause muscle symptoms and 2) Coenzyme Q10 doesn’t help the imaginary muscle problems, here is the latest research (Cureus, Aug. 31, 2024):

This systematic review is titled:

“Effectiveness of Coenzyme Q10 Supplementation in Statin-Induced Myopathy”

The investigators analyzed one meta-analysis and four randomized controlled trials that included 800 patients altogether. All of the randomized controlled trials compared CoQ10 to placebo for people with muscle pain while taking statins. There were no notable side effects of CoQ10. The authors concluded:

“Therefore, it can be deduced that CoQ10 supplementation significantly ameliorates statin-induced musculoskeletal symptoms.”

A Reader Weighs in:

We wish more cardiologists would be open to this idea.

One reader described the desperation that statin-induced muscle pain can cause:

“My husband cannot tolerate statins. He has tried several different ones, and even at the lowest dose, he had intolerable side-effects such as muscle pain and wasting. He didn’t have the symptoms before he took them, he got them while taking them, and then the symptoms resolved when he stopped taking them.

“The only reasonable deduction is that the statins were the source of the symptoms. Unfortunately, his former cardiologist would not listen to him and kept insisting he try another and another.

“A large meta-analysis found that the longevity benefit for statins averaged about two weeks. Given the long list of potential side effects, this benefit is unimpressive to say the least.

“I speak from experience when I say that a person can be suffering a great deal from muscle damage before the markers show up in a blood test. By that time, the damage could be severe and potentially irreversible.

“Statins work by suppressing an enzyme in the liver that interferes with cholesterol production, HMG Coenzyme-A reductase. It is also needed for other fundamental biological processes, including Coenzyme Q10. That’s essential for cell energy and heart health. The cholesterol pathway dependent on HMG Coenzyme-A reductase is also linked to the production of vitamin D, adrenal hormones, and sex hormones. In addition, it makes many gene-signaling molecules required for healthy cell function and preventing cellular mutation (cancer).

“It seems to me that you don’t need a degree in molecular biology (which I do, in fact, have) to realize that this is a dangerous metabolic tack to be taking. If my husband can’t walk and is in constant pain, it doesn’t matter what his cholesterol numbers are. Some people obviously benefit from this drug and clearly, some people can tolerate them. Many cannot, though. Just dismissing their very real concerns is not good medicine.”

CoQ10 may not reverse muscle pain for everyone on a statin. And it should not be taken by people on the anticoagulant warfarin. But this dietary supplement is considered safe and might help some people struggling with statin-related muscle pain.

When Statin-Associated Muscle Symptoms Are REALLY Bad!

Many patients have reported to us that statins not only cause muscle pain and weakness; they can sometimes trigger myositis or irreversible muscle damage. Trust us when we tell you that myositis is very different from myalgia. That’s muscle pain. Myositis is debilitating, dangerous and potentially deadly.

An analysis published in Expert Review of Clinical Immunology (March, 2018) admits that:

“Currently there is no consensus regarding the terminology physicians should use for the muscle involvement occurring in patients receiving statins. Hence, myalgia, myositis, and myopathy are used interchangeably, and this adds some confusion to the topic.”

Here is a link to learn more about myositis and other serious muscle complications associated with statins.

Another Reader Reports CoQ10 Helped:

One reader got very good results by using CoQ10 to prevent statin-associated muscle symptoms:

Q. I started taking statins 30 years ago. After several years, I developed terrible muscle pain. Eventually we figured out why and I switched to another medication to control high cholesterol. It was very expensive compared to statins, which are usually free with insurance.

At various times over the years, I tried different statins. Each time, I had severe muscle pain almost immediately.

A few years ago, my doctor wanted me to start taking statins again. When I objected, she said that if I took CoQ10 in addition to rosuvastatin, I would not get the muscle pain. She was right!

It’s been at least three years since I started this routine, and the muscle pain did not return. I haven’t seen this written up anywhere. Hopefully it will help other people with the same problem.

We want to emphasize that not everyone gets a good result from CoQ10. It’s a trial and error kind of situation. However, because CoQ10 is low risk, it is worth a try.

Which CoQ10 Should You Get?

Q. I have been prescribed several different statins to lower my cholesterol. They all caused me leg cramps and muscle pains. I was told to add Coenzyme Q10 to my regimen. It seems to have helped a little bit, but I never know which brand to buy. I have read that some forms of CoQ10 are not well absorbed. Any suggestions?

A. Doctors have a name for your situation: SAMS. It stands for statin-associated muscle symptoms. We have heard from hundreds of readers who report much the same problem you have experienced.

The research on CoQ10 as an antidote to SAMS is contradictory. Some studies report benefit while other research suggests this dietary supplement is not helpful.

Coenzyme Q10 will be absorbed better if you take it after a fatty meal. Black pepper contains piperine, which can also enhance absorption. To learn about the best brands of dietary supplements, including CoQ10, you might want to subscribe to ConsumerLab.com. It tests a wide variety of products to determine the best quality for the price. One of our favorites comes from Nature Made because the 100 mg softgels contain black pepper extract.

Side effects of CoQ10 may include digestive upset, headache, insomnia or skin rash. People taking anticoagulants such as warfarin should probably avoid this dietary supplement, as it might counteract the effectiveness of the medicine.

Some Readers Quit Statins Because of Side Effects:

This reader is hoping that Coenzyme Q10 can help reverse his statin-associated muscle symptoms. Is he right?

Q. I stopped taking my statin about six months ago because it was causing a lot of muscle pain. I started by cutting my pill in half, but that didn’t work. I had begun taking CoQ10 before I quit the statin and have continued it since then.

I am feeling better, but my progress has been slow. Some days, I still suffer from bouts of pain that feel like the worst case of the flu you can imagine. However, at least I have good and bad days. That is much better than the constant pain I suffered for many years.

I take a multi-vitamin along with the CoQ10 every day. It is my hope that the pain will diminish further with time. I started taking a supplement that has turmeric in it and that seems to help as well. My memory and cognitive abilities are much improved over what they were when I was taking the statin.

More Stories About Statin-Associated Muscle Symptoms:

Here are some poignant accounts from readers:

Antonio’s mother experienced serious muscle weakness:

“My mother took statins for almost 20 years, lost muscle strength and fell frequently without being able to get up. All neurologists and orthopedists she consulted denied that this was caused by statins. However, she stopped taking statins on one doctor’s recommendation and stopped falling.”

Falls in an older person can lead to fractures. This can be a life-altering event.

Carole learned about statin-associated muscle symptoms first hand:

“After less than six months of taking them, my quality of life had degraded significantly because of the intense muscle pain caused by the statin. Eliminating them brought almost immediate relief. After 3 months, I was back to my normal self.”

Dedicated athletes like Buzz are able to report some interesting observations about their experience with statins:

“I was prescribed Lipitor when I was 44 years old. My cholesterol is inherited and is about 220 or so. The statin lowered my cholesterol. However, after a couple of years of taking Lipitor, depression started hitting me hard. My mind wasn’t as sharp as it used to be either.

“Of course, the doctor prescribed me an anti-depressant and after another 2 years of taking Lipitor, I was diagnosed with Type 2 Diabetes. There is no history of this in my family whatsoever.

“Well, I continued taking Lipitor for ten years. Suddenly, after lifting weights for 35 years, I had terrible pain in my left clavicle that had been broken 20 years earlier in a skiing accident. My shoulder blades were quite painful after lifting too. They seem to be weaker now.

“I started doing research online, trying to avoid the conspiracy nuts, and found out that statins could be a cause of depression, muscle pain and high blood sugar. So, I decided to stop taking them to see what would happen.

Stopping the Statin Got Rid of the Pain:

“Within 2 weeks my muscle pain went away, and I am now lifting the weights I lifted when I was in my 30s. I have ZERO muscle pain now. My depression took about 6 months to start fading away and has now gone away too, and I feel normal again. Guess what? I am no longer a Type 2 diabetic either. My doctor didn’t even request an A1C measurement at my last blood test.

“I was switched between statins in an attempt to find one that worked — they ALL caused the same issues in me. I feel great and I am getting so much done now. On a statin, I just sat around thinking getting older was no fun.”

Jessica also experienced serious statin-associated muscle symptoms:

“I also take statins due to family history of heart disease. Statins caused severe arthritic pain, muscle weakness, and put me in a wheelchair. Now I believe they may also have caused my subsequent diabetes. Instead of taking me off the sacrosanct statins, doctors prescribed a myriad of additional pills to treat the side effects. At one point I was taking over 16 different pills, including massive doses of NSAIDS.

“All that ‘therapy’ permanently damaged my kidneys, caused massive weight gain, etc. I was finally able to get  get off statins, NSAIDS, etc. with help from a new doctor who agreed that the meds were the culprits. It took over a year to recover my mobility, and it has never been the same as before statins.”

No one should ever stop taking a statin without medical supervision. Some people have to take statins because of diagnosed heart disease.

Learn More:

You can learn more about the pros and cons of statins as well as other approaches to improving cardiac health in our eGuide to Cholesterol Control and Heart Health. This online resource may be found in the Health eGuides section of this website.

Please share your own statin story in the comment section below. If you think this article is helpful, please share it with friends and family. We would also be grateful if you posted it on your social media account. And if you were to encourage your acquaintances to sign up for our free newsletter at this link, we would be really delighted. Newsletter subscribers like you help keep The People’s Pharmacy going strong. Thanks for your support.