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Sublingual CoQ10 in Fibromyalgia Treatment

Reprinted with permission from The Townsend Letter for Doctors and Patients (www.tldp.com)

We report the successful use of sublingual CoQ10 troches in significantly decreasing Fibromyalgia pain and fatigue. Twenty-three consecutive patients were treated in an open study with the majority diagnosed by a minimum of two allopathic physicians, i.e., their family doctor and multiple consultants with special interest in fibromyalgia.

Fibromyalgia (FM) is recognized by the World Health Organization, affects an estimated 2% of the world population, and is characterized by chronic musculoskeletal pain (especially at characteristic soft-tissue sites), severe fatigue typically lasting >24 h with minimal activity, nonrestorative sleep and mood abnormalities.1-3

Recent research with CoQ10 has shown diffuse vascular benefit,4 but not necessarily fatigue improvement.5 Therefore, researcher expectations for benefit were low for these characteristically demoralized patients. Our control group of eighteen normal functioning healthy men and woman reported some increased energy on the first day of use and some insomnia with late day dosing. FM patients never reported day one beneficial effects, with decreased FM symptoms beginning at day 3-7. Optimal benefit was recorded on day 6 through 11.

Symptom improvement was not uniform. Some patients reported a decrease in muscle pain, others reported significantly reduced fatigue, and approximately 40% reported decreases in both pain and fatigue. All but one patient FM patient reported moderate to very significant improvement in pain or fatigue. Benefits were lost in 24-48 hours if the CoQ10 was not taken daily.

Treatment mean dosage was 200 mg per day with a range of 150 to 400 mg. Most patients divided a 200 mg sublingual troche (half after breakfast and half after lunch). One patient reported slight anxiety, which resolved with a dose reduction. A sublingual administration was used to maximize bioavailability, i.e., to avoid the liver's first pass effect. Our previous trials of 50-mg capsules PO q am did not offer measurable benefit.

Patients with comorbid Major Depression (MD) had identical improvements in pain and fatigue as patients without MD, but showed no significant improvement in MD rating scales.

FM causes marked morbidity and has no definitive single treatment. We offer these findings to add to treatment options. Individuals interested in finding a compounding pharmacist to create sublingual CoQ10 troche's can contact the International Society of Compounding Pharmacists (800 927 4227).

James L. Schaller, M.D.
Chester County Research Center
West Chester, PA

Ben Briggs, R.Ph.
Lionville, PA

Michael Briggs, Pharm.D.
Lionville, PA


  1. Matsumoto P. Fibromyalgia Syndrome. Nippon Rinsho, 1999;57:364-369.
  2. Cathebras P, Lauwers A, Rousset H. Fibromyalgia. A critical review. Ann Med Interne (Paris). 1998;149:406-414.
  3. White KP, Speechley M, Harth M, Ostbye T. The London fibromyalgia epidemiology study: the prevalence of fibromyalgia syndrome in London, Ontario. J Rheumatol, 1999;26:1570-1576.
  4. Langsjoen PH, Langsjoen AM. Overview of the use of CoQ10 in cardiovascular disease. Biofactors, 1999;9:273-284.
  5. Nielson AN, Mizuno M, Ratkevicius A, Mohr T, Rohde M, Mortensen SA, Quistorff B. No effect of antioxidant supplementation in triathletes on maximal oxygen uptake, 31P-NMRS detected muscle energy metabolism and muscle fatigue. Int J Sports Med, 1999;20:154-158.

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