CoQ10

Karysma Diego, Student Pharmacist Spring 2023

Scientific and Common Names

While CoQ10 is the name commonly used for the supplement, other names of the compound include: Coenzyme Q10,Q10,Ubidecarenone,Ubiquinone, andVitaminQ10¹ .

Purported and Common Uses

There are various purported uses of CoQ10, including as treatment for congestiveheartfailure,hypertension, and as an antioxidant¹³. Additionally, CoQ10 may play a role in migraine prevention and in liver damage reduction.

Dosage Forms and Dosing

CoQ10 can be administered orally via tabletorcapsule,topicallyviasolution, or intravenously¹ ⁵. Depending on the intended treatment, oral doses range from 50 mg to 1200 mg per day. There is one case of an experimental topical application of CoQ10, which was given asan85mg/mlsolutioninsoybeanoil. WhenadministeredthroughIV,patients are given50mgto100mgdailyforup to one month or 1.5 mg/kg/day for 7 days⁵ .

BackgroundandHistory

https://pubchem.ncbi.nlm.nih.gov/ compound/Coenzyme-Q10.

CoQ10 was first isolated in 1957 from beef heart by Professor Fred Crane at the University of WisconsinMadison. One year later, in 1958, Dr. Karl Folkers from Merk determined its chemical structure and theorized that CoQ10 could be used as a cardiovascular drug. However, the patent was sold to a company in Japan. nearly twenty years later, in 1976, Japan approved a version of CoQ10 intended to treat cardiovascular disease. This version of CoQ10 remained popular in Japanuntilthe1990s² ,

Pharmacology / Mechanism of Action

CoQ10 is involved in the electron transport chain (ETC) and consequently, adenosine triphosphate (ATP) production.BecauseofitsroleinATPproduction,itmay alsocontributetoanincreaseinBlymphocytesynthesis. CoQ10 is the body’s only naturally synthesized, lipidsoluble antioxidant. As an antioxidant, CoQ10 stabilizes cell membranes and prevents free radical damage to the rest of the cell. As a free-radical scavenger, it is theorized that CoQ10 aids in the body’s immune system by minimizing damage done to DNA and other molecules. CoQ10 is found in Complexes I and II of the ETCandbrieflyintheCitricAcidcycle.Becauseofthis, it is considered essential for maintaining tissue and organhealth.IntheETC,CoQ10acceptselectronsfrom Complex I and II. Without sufficient CoQ10, ATP productionwoulddecrease.Inthemitochondria,CoQ10 is able to inhibit LDL-cholesterol oxidation and protect cellularmembranesfromperoxidation

Effectiveness

CoQ10 takes between 2 weeks and 3 months to see results for patients with congestive heart failure. In these patients, CoQ10 levels in the blood increase with continued therapy. In patients with hypertension, it takes 3-4 weeks to produce results when consistently taking100mgperday⁵ .

Food and Drug Interactions

The effects of CoQ10 may decrease when taken concurrently with drugs meant to regulate or lower cholesterol, blood pressure, and blood sugar. Additionally, CoQ10 may alter the way drugs such as insulin and warfarin are used¹ . However, there are also studies showing that CoQ10 does not affect warfarin⁵ .

ArticleSummary

Safety, Toxicity, and Warnings

There are no reported adverse or toxic effect of CoQ10. Some side effects may occur, but none are consideredsevere⁴ . ,

Side Effects

Whiletheremaynotbemanyserioussideeffectsof CoQ10, some may experience gastrointestinal issues, such as nausea, headache, photosensitivity, and insomnia Other potential side effects might includelethargyandincreasedliverenzymes¹³

The article written by Garrido-Maraver, Cordero, Oropesa-Avila, et al is a comprehensive breakdown of the clinical application of coenzyme Q10. The article is an amalgamation of the various possible uses of CoQ10 and outlines different studies that aim to understand if, or how, CoQ10 is able to treat various conditions. Conditions in this article include, but are not limited to, CoQ10 deficiency, cardiovascular diseases, neurological diseases, and cancer. The article is overall an informative collection that summarizesstudies³ .

Personal / Professional Opinion

https://www walgreens com/store/c/nature% 27s-bounty-coq10-softgels,-100mg/ID=prod3430767-product

CoQ10 can be a useful supplement but it is not one that should be taken without consulting a physician first. Not only is CoQ10 a naturally occurring compound, its drug interactions are not fully known. In doing research for this monograph, there were various conflicting statements about CoQ10's effect on medications, primarily warfarin and other blood thinners. However, the generallyagreeduponbenefitsofCoQ10couldbesomethingthat benefits consumers. While its link to cancer and chronic diseases are not fully known, taking this supplement under physician guidancewouldnotbeparticularlyharmfultothepatient ~KDiego

References

1 PDQ® Integrative, Alternative, and Complementary Therapies Editorial Board PDQ Coenzyme Q10 Bethesda, MD: National Cancer Institute Updated Apr 06, 2022 Accessed Feb 16, 2023 https://www cancer gov/aboutcancer/treatment/cam/patient/coenzyme-q10-pdq

2 Pelton R Coenzyme Q10: A Miracle Nutrient Advances in Understanding Integr Med (Encinitas) 2020;19(2):1620. Published 2020 Apr. Accessed Apr. 2, 2023. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7482328/.

3. Garrido-Maraver J, Cordero MD, Oropesa-Avila M, et al. Clinical applications of coenzyme Q10. Front Biosci (Landmark Ed). 2014;19(4):619-633. Published 2014 Jan 1. doi:10.2741/4231

4 National Center for Biotechnology Information PubChem Compound Summary for CID 5281915, Coenzyme Q10

Accessed Feb 16, 2023 https://pubchem ncbi nlm nih gov/compound/Coenzyme-Q10

5. Coenzyme Q10. IBM Micromedex Solutions. Truven Health Analytics, Inc. Ann Arbor, MI.

Accessed Feb 16, 2023 http://www micromedexsolutions com

Madison Detzer

Student Pharmacist

Spring 2023

Background: Cranberry (Vaccinimmacrocarpon) is a type of plant, an evergreen shrub, that grows in wet regions and originates in the northeastern and north central parts of the United States. Historically, the fruit and leaves of the cranberry bush have been used for bladder, stomach, and liver problems as well as for wounds1 .

Common Uses:

The most common uses of cranberry are for the prevention of urinary tract infections (UTIs) Other alleged uses for cranberry are for benign prostatic hyperplasia, overactive bladder, cancer, cognitive decline, diabetes, and cardiovascular disease2

Mechanism of Action:

Cranberry contains about 90% water, and the other contents are rich with anthocyanidins, phenols, flavonoids, catechins, and organic acids. The many antioxidants in cranberries help neutralize the free radicals in the body. Free radicals cause oxidative stress to cells and can be an aggravating factor in various disease states. In vitrostudies have also shown cranberries have some antibiotic properties against3

Dosage Forms:

There are a few types of ways to take cranberry. There is the natural fruit, cranberry juice, dried powder supplement pills.

Dried powder pills are typically dosed as 250-1500mg daily for up to 6 months. Cranberry juice is typically used as 250-750mL daily for up to 90 days2 .

Effectiveness:

Some research suggests that for those who have recurrent UTIs, the use of cranberry can reduce the risk of developing a UTI by about one-third. Although, some of these studies have been reported on not being the highest of quality. It is not known how long it takes to show results. Cranberry should not be used for the treatment of UTIs since there is no evidence shown of effectiveness1

Safety:

The consumption of cranberry is general considered as safe. If taken in too large of amounts, like 3-4 L of cranberry juice a day, some adverse effects could be diarrhea and other gastrointestinal disturbances, but cranberry is generally well tolerated. Information on toxic doses is insufficient, but there have been rat studies that suggest more than 5g/kg in rats can be lethal3

Interactions:

There is evidence that there could be moderate interactions with the drugs Atorvastatin, Nifedipine, and Warfarin by potentially increasing blood levels and adverse effects. If one takes any of these drugs, be cautious with supplementing of cranberry. There are no evidence of any interactions with other supplements2

Article Summary:

Cranberries are a naturally occurring fruit and have been used for various ailments throughout history, and there has been research over prevention of UTIs that point to some efficacy and is generally safe. Not many other studies have been done about other ailments, toxicity levels, adverse effects, and interactions1 .

Author’s Opinion:

I think that cranberry, whether a daily glass (ex. 8 fl oz) or a dried powder supplement, can be beneficial to someone with reoccurring UTIs. I know many women who struggle with UTIs, and they say cranberry juice helps them. -M. Detzer

References:

1. Cranberry. National Center for Complimentary and Integrative Health, National Institute of Health. U.S. Department of Health and Human Services. Bethesda, MD. Accessed February 21, 20223. https://www.nccih.nih .gov/health/cranberry

2. Cranberry. Natural Medicines. Therapeutic Research Center. Somerville, MA. Accessed February 21, 2023. https://naturalmedi cines.therapeuticresearch.com

3. Cranberry. Natural Products Database. Facts & Comparisons eAnswers Wolters Kluwer Health, Inc. Riverwoods, IL. Accessed February 21, 2023. http://online.factsandcomparisons.com

4. RuslamOmega. iStock by Getty Images https://www.istockphoto.com/ photo/forest -cranberries-bush-of-ripe-berries-a-few-red-berries-gm 178121032-24998138 Published June 12, 2013. Accessed February 21, 2023.

Creatine

Smith Student Pharmacist Spring 2023

Creatine is stored in the muscle as phosphocreatine Phosphocreatine is a precursor for energy molecule ATP in skeletal tissues. Phosphocreatine paired with creatine kinase utilize ADP to resynthesize ATP. This ATP can then be used as energy when exercising for short 10-20second-high intensity energy bursts.

D O S A G E F O R M S

Creatine is available orally in a solid dosage form or a solution. Creatine is also available in the topical form but there is limited research on this form.

D O S I N G

Creatine Monohydrate, Creatine Phosphate, CrP, Phosphocreatine

In 1832, French Chemist Michel Chevruel discovered creatine as an organic meat component. Observation of wild foxes in 1847 proved that the flesh of those killed in the chase had about 10 times more creatine than those living in captivity. This observation later led to researchers from Harvard Medical School determining a connection between the ingestion of creatine and amplified creatine in muscle tissues in 1912. In the 1990s, creatine was finally studied for its effect on exercise performance in people. Reports found a 20% increase in muscle mass following creatine supplementation.

Adult dosing starts with a loading dose of 20 grams daily for up to 7 days. This is followed by a maintenance dose of 3-5 grams per day. This regimen can be maintained for several weeks to months without having serious side effects. Dosing in children has limited research.

Although the trials are ongoing, creatine is most used as a supplement to enhance performance in high-intensity, shortduration exercises.

E F F E C T I

E N E S S

Short term, high-energy work has been proven to improve slightly using creatine. For example, in a blind study with 18 male sprinters, creatine was found to aid in decreasing their times for the 60-meter sprint and 100-meter sprint. So, creatine has been proven to enhance anaerobic, highintensity work, though not substantially.

Creatine should not be used in patients with impaired kidney function If an inadequate amount of water is consumed while using creatine, excessive dehydration can occur. For this reason, creatine should not be used with diuretics as well. The French Agency for Food, Environmental and Occupational Health and Safety has warned against the use of creatine at high doses due to cytotoxic compounds potentially being produced.

Orally taken creatine can cause adverse effects such as: diarrhea, dehydration, muscle cramps, GI upset, and water retention. Rare adverse effects of creatine can include renal dysfunction, interstitial nephritis, rhabdomyolysis, and venous thrombosis.

Although no food or drug interactions with creatine are well enough researched to be confirmed, there are a couple products that could potentially interact with creatine. There is one case in which Ma Huang, used in Chinese medicine, combined with creatine could have possibly caused an ischemic stroke in an individual. In another study, there is some evidence that consuming caffeine-containing foods or drinks while using creatine will decrease the ergogenic effects of creatine. However, there is not enough research to support either of these claims

In July of 2015, a study was conducted on 60- to 80-year-old women to see how creatine supplements affected their muscle mass and function while subject to resistance training. The resistance training consisted of 3 one-hour sessions per week for 12 weeks using elastic bands and weights. Half of the 50 participants received 5 grams of creatine per day while the other half received 5 grams of maltodextrin per day as a placebo. After the 12 weeks, the test group was found to be able to exert a significant amount of force more than the placebo group when testing the quadriceps isometric force on the quadriceps table. However, when measuring the number of meters a participant could walk in 12 minutes, creatine showed no significant results. One can conclude from this study that creatine has a substantial effect on anaerobic performance, but not aerobic performance in older women https://www.britannica.com/science/isoleucine#/me dia/1/142124/217200

Bunout D, Hirsch S. Effects of creatine supplementation on muscle mass and function among older women subjected to resistance training. National Library of Medicine. 2014. NCT02188849. Creatine. Encyclopedia Britannica. Accessed February 25, 2023.

Creatine IBM Micromedex Solutions Truven Health Analytics, Inc Ann Arbor, MI Accessed February 25, 2023 http://www micromedexsolutions com

I believe that creatine is effective as a muscle enhance for anaerobic exercise when used correctly. Users of creatine should be exercising regularly and be adequately hydrated to see an effect. In the future I was searching for a performance enhancer, I would consider using a creatine supplement. ~E Smith

Creatine Lexi-Drugs Lexicomp Wolters Kluwer Health, Inc Riverwoods, IL Accessed February 25, 2023 http://online lexi com

Creatine Natural Medicines TRC Healthcare Stockton, CA Accessed February 25, 2023 https://trchealthcare com

Devil’s Claw

(Harpagophytum procumbens)

Mina Lin

Student Pharmacist

Spring 2023

Pharmacology

No known mechanism

Dosage Form

Can be found in concentrated extract, capsules, tablets, or powder. As well as an ingredient in herbal tea(s).

Most typical dosing for Devil’s Claw is between 600 to 2,610 mg.

Article

Two randomized placebo trials were placed in use of Devil’s Claw effectiveness towards osteoarthritis. One trial had no statistic calculation and the other trial composed of a hypothesis. One set of patients was given freeze dried Devil’s Claw and the other was given weak non-steroid anti-inflammatory drug (NSAID) for both trials. After 4 months, there was significant difference between the two treatments In the end, it did show that Devil’s Claw did have fewer side effects.

Professional Opinion

I think the Devil’s Claw is a good supplement for relieving pain like arthritis and inflammation. A good advice would be talking to your physician first on taking the supplements and if it would benefit your health to do so.

M Lin

History

Devil’s Claw was native to Southern Aftrica as it is then introduced in early 1900s in Europe. It gets its name from the tiny hooks that covers its fruits.

Common Use

It has many uses throughout history, but today is it commonly used for inflammation, relieving arthritis pain, headache, and lower back pain.

Effectiveness

Overall, it may relieve inflammation like arthritis, but it is mostly best to speak to your doctor about it before taking it.

Safety Concerns

Devil’s Claw put these health concerns at a higher risk like heart disorder, diabetes, gallstones, and stomach ulcers.

Side Effects

Most common side effects could be mild diarrhea. Other side effects can include allergic reaction, headaches, and coughing.

Interactions

Devil’s Claw may slow the absorption of NSAID, enhance blood tinners, and may decrease effects of stomach acid reducers.

References

Devil’s claw Information | Mount Sinai - New York. Mount Sinai Health System. Published 2009.

https://www.mountsinai.org/health-library/herb/devils-claw https://www.healthline.com/nutrition/devils-claw#side-effects doi:https://doi.org/10.1093/rheumatology/41.11.1332

Devil’s Claw: Benefits, Side Effects and Dosage. Healthline. Published August 27, 2018. Accessed February 26, 2023.

Chrubasik S. Effectiveness of devil’s claw for osteoarthritis. Rheumatology. 2002;41(11):1332-1333.