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Q10

Wat is q10?

Co-enzym Q10, kortweg CoQ10 of Q10, is een vetoplosbare verbinding met een chemische structuur die vergelijkbaar is met vitamine K (7000). De “Q10” verwijst naar 10 isoprenoïde eenheden bevestigd aan een chinonring. Het is een vetoplosbare, vitamine-achtige stof die in alle cellen in het lichaam voorkomt. Bij mensen komt co-enzym Q10 het meest voor; in andere soorten domineren co-enzymen Q6, Q7, Q8 en Q9 (7000, 11892, 11894). De hoogste concentraties co-enzym Q10 worden gevonden in het hart, de lever, de nieren en de alvleesklier van mensen (7000). Er zijn twee fysiologische vormen van co-enzym Q10 die ook beschikbaar zijn als supplementen: de geoxideerde vorm (ubiquinone) en de gereduceerde vorm (ubiquinol) (95707).

Wetenschappelijke naam

Ubiquinol, Ubiquinone, Ubidecarenone, Mitoquinone

Wat is q10?

Gebruik

Oraal wordt co-enzym Q10 gebruikt voor co-enzym Q10-tekort, hart- en vaatziekten, congestief hartfalen (CHF), angina, verwijde cardiomyopathie, hypertrofische cardiomyopathie, myocarditis, myocardinfarct (MI), diabetes, diabetische neuropathie, hypertensie, en hyperlipidemie. Het wordt ook oraal gebruikt voor bipolaire stoornis, ziekte van Huntington, ziekte van Parkinson, spierdystrofie, atletische prestaties, chronisch vermoeidheidssyndroom (CVS), ziekte van Lyme, pre-eclampsie, door warfarine veroorzaakt haarverlies, autismespectrumstoornis en aan chemotherapie gerelateerde vermoeidheid . Co-enzym Q10 wordt ook oraal gebruikt voor het stimuleren van het immuunsysteem bij mensen met HIV/AIDS, levensverlenging, mannelijke onvruchtbaarheid, migraine, mitochondriale myelopathieën, polycysteus ovarium syndroom (PCOS), niet-alcoholische leververvetting (NAFLD), gerimpelde huid en statine -geïnduceerde myopathie. Het wordt ook oraal gebruikt voor leeftijdsgebonden maculaire degeneratie (AMD), fibromyalgie, ischemie-reperfusieschade, multiple sclerose (MS), ziekte van Peyronie, ziekte van Alzheimer, amyotrofische laterale sclerose (ALS, ziekte van Lou Gehrig), cocaïneverslaving, post- poliosyndroom, astma, cerebellaire ataxie, chronische obstructieve longziekte (COPD), cyclisch braken syndroom (CVS), droge mond, staar, Friedreich ataxie, gehoorverlies, hepatitis C, door de moeder overgeërfde diabetes mellitus en doofheid (MIDD), Prader-Willi syndroom (PWS) en sepsis.

Plaatselijk wordt co-enzym Q10 gebruikt voor parodontitis. Als een oogdruppel wordt co-enzym Q10 gebruikt voor hoornvlieszweren en droge ogen.

Gebruik

Werking

Co-enzym Q10 is een vitamine-achtige verbinding die aanwezig is in vrijwel alle cellen en in bijzonder hoge concentraties in het hart, de lever, de nieren en de alvleesklier. In de cel wordt 25% tot 30% van het totale co-enzym Q10 in de kern gevonden, 40% tot 50% in de mitochondriën, 15% tot 20% in de microsomen en 5% tot 10% in de cytosol. Co-enzym Q10 is in vet oplosbaar en werkt vergelijkbaar met een vitamine (2134, 11892). Zijn primaire functies omvatten activiteit als een antioxidant, een membraanstabilisator en als een cofactor in veel metabole routes, met name bij de productie van adenosinetrifosfaat (ATP) bij oxidatieve ademhaling (2134, 6037, 6048, 6410, 11892).

Het lichaam produceert voldoende hoeveelheden co-enzym Q10, dus het wordt niet beschouwd als een vitamine (11893). Het wordt ook ingenomen in kleine hoeveelheden uit voedingsbronnen, waaronder vlees en zeevruchten. De hoeveelheden ingenomen in voedingsmiddelen benaderen echter niet de therapeutische doses. Co-enzym Q10 in sojaolie lijkt een superieure biologische beschikbaarheid te hebben in vergelijking met andere formuleringen (457).

De biosynthese van co-enzym Q10 is een 17-stappenproces dat riboflavine, niacinamide, pantotheenzuur (B5), pyridoxine, cobalamine (B12), foliumzuur, vitamine C en andere sporenelementen vereist (89413). Tekorten aan serumco-enzym Q10 kunnen worden veroorzaakt door onvoldoende inname van deze voedingsstoffen.

Werking

Veiligheid

Waarschijnlijk veilig

Indien oraal en op de juiste manier gebruikt. Co-enzym Q10 is veilig gebruikt in onderzoeken die maximaal 5 jaar duren, bij lokaal gebruik op het tandvlees (2107, 2108, 2134, 6037, 6038, 6407, 8163, 8916, 8917, 8918, 8938, 8939, 8940, 15395, 17413, 17716, 96538).

Kinderen

Waarschijnlijk veilig

Wanneer oraal en op de juiste manier gebruikt. Co-enzym Q10 in doses van 1-10 mg/kg/dag is tot 9 maanden veilig gebruikt onder medisch toezicht (12199, 13223, 15256, 44005).

Zwangerschap

Mogelijk veilig

Wanneer oraal en op de juiste manier gebruikt. Co-enzym Q10 100 mg tweemaal daags is met schijnbare veiligheid gebruikt tijdens de zwangerschap, beginnend bij een zwangerschapsduur van 20 weken tot het einde van de zwangerschap (17201).

Lactatie

Onvoldoende betrouwbare informatie beschikbaar; vermijd te gebruiken.

Effectiviteit

Waarschijnlijk effectief

Co-enzym Q10-tekort
Zeldzame gevallen van gedocumenteerde co-enzym Q10-tekort met symptomen van zwakte, vermoeidheid en epileptische aanvallen zijn gemeld. Co-enzym Q10 oraal innemen lijkt de symptomen van een tekort te verbeteren (8160, 8161). Oraal co-enzym Q10 800 mg dagelijks driemaal, is aanbevolen voor de behandeling van co-enzym Q10-tekort bij volwassenen. Bij kinderen is 30 mg/kg per dag in drie verdeelde doses aanbevolen (89417).

Mitochondriale myopathieën
Co-enzym Q10 oraal innemen lijkt de symptomen te verminderen bij sommige patiënten met genetische en verworven aandoeningen van mitochondriale dysfunctie (8159, 8162, 8163, 8912, 11050, 44240, 97905). Het effect begint langzaam, met een maximaal effect na 6 maanden (8163). Een specifieke co-enzym Q10-formulering (UbiQGel, Tishcon Corporation) heeft de Amerikaanse Food and Drug Administration (FDA) weesgeneesmiddelstatus bereikt voor mitochondriale myopathieën, waaronder MELAS (myoclonische epilepsie met lactaatacidose en beroerte-achtige afleveringen) syndroom, Kearns-Sayre-syndroom en MERRF (myoclonus epilepsie met rafelige rode vezels).

Mogelijk effectief

Congestief hartfalen (CHF)
Populatieonderzoek heeft aangetoond dat hartfalen geassocieerd is met lage co-enzym Q10-waarden (44220). Bovendien kunnen co-enzym Q10-waarden een voorspeller zijn van mortaliteit bij patiënten met hartfalen (44059). Sommige klinische onderzoeken tonen aan dat suppletie met co-enzym Q10 gunstig kan zijn voor patiënten met hartfalen. Een analyse van beschikbaar klinisch onderzoek uit 2017 bij patiënten met hartfalen toont aan dat dagelijks gebruik van co-enzym Q10 30-300 mg de inspanningscapaciteit verbetert en de mortaliteit met 31% vermindert in vergelijking met placebo. Co-enzym Q10 is echter niet geassocieerd met een verandering in de ejectiefractie of de classificatie van de New York Heart Association (NYHA) (97902). De grootste studie in deze analyse laat zien dat het dagelijks innemen van co-enzym Q10 300 mg gedurende maximaal 2 jaar de dood of ziekenhuisopname vermindert bij patiënten met NYHA klasse III-IV hartfalen die conventionele therapie krijgen. In deze specifieke populatie is het aantal patiënten dat moet worden behandeld om één groot cardiovasculair voorval te voorkomen 9 (96542). Ander klinisch onderzoek toont aan dat toevoeging van oraal co-enzym Q10 aan conventionele behandelingen de kwaliteit van leven lijkt te verbeteren en symptomen van hartfalen zoals dyspneu, perifeer oedeem, vergrote lever en slapeloosheid bij patiënten met milde tot ernstige (NYHA klasse II-IV) CHF lijkt te verminderen (6407, 6408, 6409, 8909, 12170, 44042, 44288, 44289, 44304, 44334, 44352). Aanvullend klinisch onderzoek toont aan dat het dagelijks innemen van co-enzym Q10 30 mg als adjuvans bij standaardzorg de incidentie van atriumfibrilleren met ongeveer 73% vermindert in vergelijking met standaardzorg (alleen bij patiënten met NYHA klasse II-IV CHF) (95609).

Diabetische neuropathie
Klinisch onderzoek toont aan dat het dagelijks gebruiken van co-enzym Q10 400 mg gedurende 12 weken de parameters van zenuwgeleiding en symptomen van neuropathische pijn en stoornissen aanzienlijk verbetert in vergelijking met placebo bij diabetespatiënten met polyneuropathie (44217).

Fibromyalgie
Klinisch onderzoek toont aan dat het dagelijks innemen van co-enzym Q10 400 mg gedurende 3 maanden de pijn verbetert met 24% tot 37%, vermoeidheid met 22% en slaapstoornissen met 33% in vergelijking met placebo bij vrouwen met fibromyalgie (97913). Voorlopig klinisch onderzoek toont ook aan dat het dagelijks gebruik van co-enzym Q10 300 mg gedurende 40 dagen de pijn met 52% tot 56% vermindert, vermoeidheid met 47%, ochtendmoeheid met 56% en gevoelige punten met 44% in vergelijking met placebo (89416). Deze patiënten ervoeren ook een verbetering van psychische symptomen, waaronder een vermindering van interpersoonlijke gevoeligheid, depressie, angst en vijandigheid (97912).

Co-enzym Q10 is ook geëvalueerd in combinatie met ginkgo (Bio-Biloba, Pharma Nord) voor de behandeling van fibromyalgie. Het dagelijks gebruiken van deze combinatie gedurende 12 weken verbetert de kwaliteit van leven, zoals fysieke fitheid, emotionele gevoelens, sociale activiteiten, algehele gezondheid en pijn in vergelijking met baseline (17716).

HIV/AIDS
Co-enzym Q10 oraal innemen lijkt de immuunfunctie bij patiënten met HIV/AIDS te verbeteren (2123, 2124).

Ischemie-reperfusieletsel
Klinisch onderzoek toont aan dat co-enzym Q10 oraal of intraveneus gedurende een week vóór cardiale bypass of vaatchirurgie hypoxische schade tijdens chirurgie vermindert (11902, 11903, 44031, 44294). Eén klinische studie toont aan dat het dagelijks innemen van co-enzym Q10 300 mg gedurende 2 weken voorafgaand aan cardiale bypass-chirurgie de subjectieve kwaliteit van leven verbetert in vergelijking met placebo na een follow-up van 37 maanden (43937). Sommige klinische onderzoeken wijzen er echter op dat co-enzym Q10 oraal, binnen 24 uur vóór de operatie, of in kleine doses van 100 mg per dag geen effect heeft op de hartfunctie of troponinespiegels in vergelijking met placebo na reperfusiechirurgie (11904, 44292). Co-enzym Q10 in combinatie met magnesium, selenium en omega-3-vetzuren gedurende 2 maanden voorafgaand aan en een maand na hartchirurgie lijkt de troponinespiegels en de duur van ziekenhuisopname aanzienlijk te verminderen (21651).

Migraine
Sommige klinische onderzoeken tonen aan dat orale inname van co-enzym Q10 de frequentie van hoofdpijn met ongeveer 30% en het aantal dagen met hoofdpijngerelateerde misselijkheid met ongeveer 45% verlaagt bij volwassenen (8135, 11872). Een andere studie toont aan dat het dagelijks innemen van co-enzym Q10 (WN Pharmaceuticals, Ltd.) gedurende 3 maanden 100 mg de ernst van migraine, het aantal gemiste werkdagen als gevolg van migraine vermindert en de frequentie met de helft bij 60% van de patiënten (95608). Om de frequentie van migraine bij volwassenen met 50% te verminderen, is het aantal dat nodig is om (NNT) te behandelen met co-enzym Q10 100 mg TID gedurende 3 maanden (11872). Het kan tot 3 maanden duren voor een aanzienlijk voordeel (11872, 95608). In een meta-analyse van 5 onderzoeken verminderde co-enzym Q10 het aantal migraine-aanvallen per maand niet, maar verminderde het de duur van migraine en het aantal dagen met migraine in een maand (99430). Richtlijnen van de American Academy of Neurology beschouwen co-enzym Q10 mogelijk effectief voor de preventie van migraine (99430).

In één observationeel onderzoek is aangetoond dat het nemen van een specifiek combinatieproduct (Antemig, PiLeJe) met co-enzym Q10 100 mg, moederkruid 100 mg, magnesium 112,5 mg en vitamine B6 1,4 mg per dag gedurende 12 weken het aantal hoofdpijndagen per maand vermindert met 3,5 dagen en tegelijkertijd de kwaliteit van leven verbeteren in vergelijking met baseline (96531).

Bij kinderen en adolescenten suggereert klinisch onderzoek dat het gebruik van co-enzym Q10 100 mg gedurende 16 weken de frequentie, ernst of duur van de hoofdpijn niet significant verbetert in vergelijking met placebo (44197). Het gebruik van co-enzym Q10 lijkt echter de migraine-frequentie te verminderen bij kinderen met een laag co-enzym Q10 (15256).

Multiple sclerose (MS)
Klinisch onderzoek toont aan dat het dagelijks innemen van co-enzym Q10 500 mg gedurende 3 maanden vermoeidheid en depressie vermindert bij MS-patiënten (96539).

Spierdystrofie
Co-enzym Q10 oraal innemen lijkt de fysieke prestaties te verbeteren bij sommige patiënten met spierdystrofieën (2127).

Myocardinfarct (MI)
Klinisch onderzoek suggereert dat oraal innemen van co-enzym Q10 het risico op cardiale gebeurtenissen lijkt te verminderen bij patiënten met recent MI die risico lopen op atherotrombose. Wanneer gestart bij patiënten binnen 72 uur na MI, lijkt co-enzym Q10 het risico op cardiale gebeurtenissen, waaronder niet-fatale MI en hartdood, aanzienlijk te verminderen met 52% bij toediening gedurende 28 dagen en met 45% bij toediening gedurende maximaal een jaar (10152, 44330). In één klinisch onderzoek verbeterde het toedienen van een enkele oplaaddosis van 250 mg co-enzym Q10 gevolgd door drie dagelijkse doses van 150 mg via een nasogastrische buis gedurende 5 dagen de overlevingskans van 3 maanden aanzienlijk met 134% vergeleken met placebo bij patiënten met recente MI die reanimatie kreeg (43935).

Sommige klinische onderzoeken tonen aan dat het dagelijks gebruiken van een combinatie van 100 mg co-enzym Q10 en 100 mcg selenium gedurende een jaar, het risico op verlenging van het QT-interval met 60% verlaagt in vergelijking met placebo bij post-MI-patiënten (44275).

Peyronie-ziekte
Klinisch onderzoek toont aan dat bij patiënten met vroege chronische Peyronie-ziekte, het gebruik van co-enzym Q10 (Kaneka Nutrients, Osaka) gedurende 24 weken 300 mg per dag gedurende 24 weken nieuwe plaquevormingen aanzienlijk vermindert en de erectiele functie en plaquegrootte verbetert in vergelijking met placebo. Bovendien hebben patiënten die deze dosis co-enzym Q10 gebruiken een kans van 75,6% om de ziekteprogressie te vertragen in vergelijking met placebo (44180).

Veiligheid

Bijwerkingen

Oraal, co-enzym Q10 wordt over het algemeen goed verdragen. In klinische onderzoeken zijn geen significante bijwerkingen gemeld waaronder één onderzoek met een hoge dosis co-enzym Q10 (dagelijks 2,4 gram) gedurende maximaal 5 jaar  (2134 ,6037, 6038, 6047, 8135, 8938, 8939, 8940, 17201, 17413, 43955, 44131, 44233, 44334, 95606, 95607, 95608, 95610, 96538). Co-enzym Q10 kan echter gastro-intestinale bijwerkingen veroorzaken zoals misselijkheid, braken, diarree, onderdrukking van de eetlust, brandend maagzuur en epigastrisch ongemak, hoewel dit voorkomt bij minder dan 1% van de patiënten (2134, 3370, 6409, 8135, 8938, 8939, 8940, 10152). Sommige van deze bijwerkingen kunnen worden geminimaliseerd als de totale dagelijkse doses van meer dan 100 mg worden verdeeld en twee tot drie keer per dag worden toegediend (3370).

Bijwerkingen

Interacties

Medicijnen

Alkylerende agenten
Theoretisch kunnen antioxidanten zoals co-enzym Q10 tumorcellen beschermen tegen chemotherapeutische middelen die werken door oxidatieve stress te induceren, zoals de alkylerende middelen (bijv. Cyclofosfamide, Cytoxan) en radiotherapie (5158, 5159). Het klinische belang van deze interactie is onbekend en vereist verder onderzoek.

Antihypertensieve drugs
Co-enzym Q10 kan de bloeddruk verlagen en kan additieve bloeddrukverlagende effecten hebben bij gebruik met antihypertensiva; voorzichtig gebruiken. Sommige antihypertensiva omvatten captopril (Capoten), enalapril (Vasotec), losartan (Cozaar), valsartan (Diovan), diltiazem (Cardizem), amlodipine (Norvasc), hydrochloorthiazide (HydroDiuril), furosemide (Lasix) en vele anderen (2122, 9890, 17702, 43932, 43982).

Doxorubicin (Adriamycin, anderen)
Voorlopig bewijs suggereert dat de niveaus van co-enzym Q10 zijn verhoogd bij kinderen en adolescenten van 2,5-19 jaar oud met kanker die doxorubicine (Adriamycin) krijgen in vergelijking met andere chemotherapeutica (14412). Dit kan een gevolg zijn van de afgifte van co-enzym Q10 uit apoptotisch hartweefsel. Co-enzym Q10 lijkt de farmacokinetiek van doxorubicine niet significant te veranderen (14413). De invloed van co-enzym Q10 op de effectiviteit van doxorubicine is onbekend.

Warfarin (Coumadin)
Gelijktijdig gebruik kan de antistollingseffecten van warfarine verminderen (2128, 6048, 6199). Co-enzym Q10 is chemisch vergelijkbaar met menaquinon en kan vitamine K-achtige procoagulerende effecten hebben. Vier gevallen van verminderde werkzaamheid van warfarine waarvan wordt gedacht dat deze te wijten zijn aan co-enzym Q10 zijn gemeld (2128, 6048, 11048). Er is echter voorlopig klinisch onderzoek dat suggereert dat co-enzym Q10 de effecten van warfarine mogelijk niet significant vermindert bij patiënten met een stabiele INR (11905). Houd patiënten die warfarine en co-enzym Q10 gebruiken nauwlettend in de gaten. Een dosisaanpassing kan nodig zijn.

Kruiden en supplementen

Acacia
Het combineren van co-enzym Q10 met acaciagom lijkt de absorptie van co-enzym Q10 te beïnvloeden. In farmacokinetisch onderzoek bij dieren en mensen verhoogt emulgerend co-enzym Q10 in acaciagom de absorptie van co-enzym Q10 vergeleken met alleen co-enzym Q10 poeder (44168). Theoretisch kan dit het risico op bijwerkingen verhogen.

Beta-carotene
Co-enzym Q10 kan de serumspiegels van beta-caroteen beïnvloeden. In klinisch onderzoek verhoogde suppletie met co-enzym Q10 de bètacaroteenwaarden (44330). Theoretisch kan dit het risico op bijwerkingen verhogen

Kruiden en supplementen met hypotensieve effecten
Co-enzym Q10 kan de bloeddruk verlagen (2122, 9890, 17702, 43932, 43982). Theoretisch kan het combineren van co-enzym Q10 met andere kruiden of supplementen met hypotensieve effecten het risico op hypotensie verhogen. Sommige van deze kruiden en supplementen zijn andrographis, caseïnepeptiden, kattenklauw, co-enzym Q10, visolie, L-arginine, lycium, brandnetel, theanine en anderen.

Omega-3 vetzuren
Co-enzym Q10-niveaus en omega-3-vetzuren kunnen elkaars positieve werking op lipide en non-lipide parameters bij plaquevorming in de slagaders bevorderen. In klinisch onderzoek verbeterde de combinatie van omega-3-vetzuren met co-enzym Q10 de leverenzym-activiteit, bloeddruk en ontstekingsmarkers (44128).

Rode gist rijst
Theoretisch, aangezien rode gist HMG-CoA-reductaseremmer (“statine”) bestanddelen bevat, kan het de co-enzym Q10-waarden verlagen (512).

Vitamine A
Co-enzym Q10 kan de serumspiegels van vitamine A beïnvloeden. In klinisch onderzoek verhoogde suppletie met co-enzym Q10 de vitamine A-waarden (44330). Theoretisch kan dit het risico op bijwerkingen verhogen die verband houden met vitamine A.

Vitamine C
Co-enzym Q10 kan de serumspiegels van vitamine C beïnvloeden. In klinisch onderzoek verhoogde suppletie met co-enzym Q10 de vitamine C-waarden (44330). Theoretisch kan dit het risico op bijwerkingen verhogen die verband houden met vitamine C.

Vitamine E
Co-enzym Q10 kan de serumspiegels van vitamine E beïnvloeden. In klinisch onderzoek verhoogde suppletie met co-enzym Q10 de vitamine E-waarden (44330). Theoretisch kan dit het risico op bijwerkingen geassocieerd met vitamine E verhogen.

Vitamine K
Co-enzym Q10 is chemisch vergelijkbaar met vitamine K2 (menaquinon) en kan vitamine K-achtige effecten hebben, waaronder antagonisme van warfarine (2128, 6048). Gelijktijdig gebruik van co-enzym Q10 en vitamine K kan additieve effecten veroorzaken en het risico op stolling verhogen bij mensen die anticoagulantia gebruiken.

Voedsel

Geen bijwerkingen bekend.

Lab testen

Prostaatspecifiek antigeen (PSA)
Klinisch bewijs toont aan dat het dagelijks innemen van co-enzym Q10 100 mg gedurende 12 weken PSA-waarden tot 33% verlaagt bij gezonde mannen (89423). Theoretisch kan co-enzym Q10 PSA-niveaus en testresultaten beïnvloeden bij mannen die worden gescreend op prostaatkanker.

Ziektes

Hypotensie, Hypertensie
Co-enzym Q10 kan de bloeddruk verlagen. Het kan additieve effecten hebben met medicijnen die worden gebruikt voor hypertensie; voorzichtig gebruiken (2122, 3365, 9890).

Roken
Het roken van sigaretten put het lichaam van co-enzym Q10 uit (7722).

Chirurgie
Co-enzym Q10 kan de bloeddruk beïnvloeden. Theoretisch kan co-enzym Q10 de bloeddrukcontrole tijdens en na chirurgische ingrepen verstoren. Vertel patiënten om co-enzym Q10 ten minste 2 weken voor electieve chirurgische procedures te stoppen.

Interacties

Dosering

Volwassenen

Oraal

Typische doseringen van co-enzym Q10 variëren van 60-1000 mg per dag gedurende 12 weken. Er zijn ook doseringen tot 2400 mg gebruikt tot maximaal 5 jaar. Om bijwerkingen te minimaliseren, moeten doseringen van boven de 100 mg per dag verdeeld worden over de dag.

Crème

Co-enzym Q10 is tot 5 maanden gebruikt als een 1% crème.

Oogheelkundig

Co-enzym Q10 is in verschillende oogdruppels, in combinatie met andere ingrediënten, tot 9 maanden gebruikt.

Kinderen

Oraal

Co-enzym Q10 is bij kinderen gebruikt in doseringen van 50-250 mg per dag verdeeld over meerdere innamemomenten tot 1 jaar. Dit komt ook overeen met 1-20 mg per kilogram lichaamsgewicht.

Dosering
Referenties
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