CoQ10 Energizer Formula by NSI - Nutraceutical Sciences Institute

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Two capsules contain: Coenzyme Q10 200 mg • Alpha Lipoic Acid 600 mg • ActiVin brand Grape seed extract (standardized to >85% proanthocyanidins) 100 mg • Red Wine extract (standardized to 30% polyphenols) 100 mg. Other Ingredients: Gelatin (capsule shell).

Brand name products often contain multiple ingredients. To read detailed information about each ingredient, click on the link for the individual ingredient shown above.

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Below is general information about the effectiveness of the known ingredients contained in the product CoQ10 Energizer Formula. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ALPHA-LIPOIC ACID (Alpha Lipoic Acid)

POSSIBLY EFFECTIVE

Diabetic neuropathy. Oral or intravenous alpha-lipoic acid 600-1800 mg daily seems to improve symptoms of peripheral neuropathy in patients with diabetes. Its benefits in patients with cardiac autonomic neuropathy are unclear. Details: Several clinical studies show that taking alpha-lipoic acid, either alone or in combination with gamma-lipoic acid, superoxide dismutase, or vitamin B12, seems to improve neuropathic sensory symptoms such as burning, pain, numbness, and prickling of the feet and legs, as well as objective measures such as ratings of neurological deficit and disability. Symptom improvement seems to occur within 3 to 5 weeks of oral or intravenous dosing (3540,3541,3557,3868,10148,12106,20473,20475,20478,20480)(20481,20484,20488,90447,103333,111429,111703). A meta-analysis of 10 clinical studies in adults with diabetic polyneuropathy shows that taking alpha-lipoic acid 600-1800 mg daily for 3 weeks to 2 years reduces the incidence, severity, and frequency of sensory symptoms and improves measures of impairment and neurological disability but does not improve vibration perception threshold or measures of nerve conduction when compared with placebo (111703). However, another meta-analysis of 6 studies in patients with type 1 or 2 diabetes, that includes some of the same studies, shows that giving alpha-lipoic acid 600-1800 mg daily orally or intravenously for 3-8 weeks does not improve neuropathic pain when compared with placebo (112937). Orally, alpha-lipoic acid 600-1800 mg daily in one to three divided doses has been used (3540,3541,3868,20475,20478,103333,111429). A specific combination product containing alpha-lipoic acid 600 mg and superoxide dismutase 140 IU (ALA600 SOD, Alfa Wassermann) has also been used (20488). Intravenously, alpha-lipoic acid 600 mg and 1200 mg daily have been used (3540,3541,3557,10148,20480,20481,20484). In one study, a specific product (Thiotacid, Eva Pharma) was used (103333). However, some preliminary clinical research shows that lower doses of alpha-lipoic acid are ineffective for improving nerve conduction velocity or subjective complaints of neuropathy (3869,20479,20482,20486,20487). Also, although there is some preliminary evidence that taking alpha-lipoic acid improves nerve function indices, such as Valsalva maneuver, Ewing's tests, or electrocardiogram measurements in patients with a specific type of diabetic neuropathy called cardiac autonomic neuropathy, taking alpha-lipoic acid orally does not improve clinical symptoms (3542,20483,20485,96223,107892).
Hyperlipidemia. Oral alpha-lipoic acid seems to reduce levels of total and low-density lipoprotein (LDL) cholesterol in certain populations. However, it is unclear whether alpha-lipoic acid is clinically beneficial in patients with hyperlipidemia. Details: A meta-analysis of 11 clinical trials shows that taking alpha-lipoic acid 300-1200 mg daily for up to 16 weeks decreases total cholesterol by 10 mg/dL and LDL cholesterol by 9 mg/dL, but does not seem to improve high-density lipoprotein (HDL) cholesterol or triglycerides, when compared with placebo (100709). In addition, in a large group of generally healthy adults, taking alpha-lipoic acid 800-1200 mg for 4 years reduces levels of total and LDL cholesterol, as well as triglycerides, when compared with baseline. The 1200 mg daily dose was more effective than the 400 mg daily dose (104650). A meta-analysis of clinical research in various patient populations shows that taking oral alpha-lipoic acid 300-1200 mg daily for 2-16 weeks decreases levels of total cholesterol by 11 mg/dL, LDL cholesterol by 11 mg/dL, and triglycerides by 31 md/dL when compared with placebo. It is unclear whether dose or treatment duration affect these outcomes (107885). These findings are limited by the high heterogeneity of the included studies and patient populations. One clinical study in adults with gestational diabetes, most of whom had elevated cholesterol levels at baseline, shows that taking oral alpha-lipoic acid (Puritan's Pride) 100 mg daily for 8 weeks reduces triglycerides, but does not improve levels of total, HDL, or LDL cholesterol, when compared with placebo (107890). The validity of this study is limited due to short duration of treatment. While many patients in these studies had elevated lipid levels at baseline, none of the studies specifically evaluated patients with hyperlipidemia. Thus, the benefits of alpha-lipoic acid in these patients is unclear.
Obesity. Most research shows that oral alpha-lipoic acid seems to improve weight loss by a small amount. Details: While individual clinical studies show mixed results (21674,97630,100710,103327,103334), meta-analyses of clinical research show that taking alpha-lipoic acid 300-1800 mg daily for 2-48 weeks can modestly reduce body weight by 0.7-2.3 kg and body mass index (BMI) by up to 0.5 kg/m2 when compared with placebo in overweight individuals or patients with obesity. The magnitude of these improvements are not dependent on the dose or duration of treatment (96231,96232,103332,111294). While these improvements are statistically significant, they may not be clinically meaningful. In addition, a network meta-analysis of randomized controlled trials in adults with obesity shows that taking alpha-lipoic acid 300-600 mg orally daily for 8-10 weeks improves some markers of insulin resistance, but not blood pressure or cholesterol levels (111294). Taking alpha-lipoic acid might also reduce body weight in overweight children or children with obesity. In adolescents aged 10-17 years, clinical research shows that taking alpha-lipoic acid 300 mg twice daily for 3 months reduces body weight by 3.2 kg when compared with placebo. However, there was no effect on blood lipids or fasting blood glucose (103330). Also, a small clinical study in children 8-16 years of age shows that taking alpha-lipoic acid (Tiobec 800, Laborest) 800 mg daily for 12 weeks does not improve body weight, BMI, blood pressure, blood lipids, glycemic control, insulin resistance, or endothelial function when compared with placebo (100708). However, this study may have been inadequately powered to detect a difference in many of these outcomes.

POSSIBLY INEFFECTIVE

Alcohol-related liver disease. Oral alpha-lipoic acid does not seem to improve liver function in patients with alcohol-related liver disease. Details: Taking alpha-lipoic acid orally 300 mg daily for up to 6 months does not appear to improve liver function or reduce liver damage when compared with placebo in patients with alcohol-related liver disease (3880,21678).
Altitude sickness. Oral alpha-lipoic acid, in combination with vitamins C and E, does not seem to be beneficial for altitude sickness prevention or treatment. Details: Clinical research in healthy volunteers ascending to 5200 meters shows that taking alpha-lipoic acid 600 mg in combination with vitamin C 1 gram and vitamin E (alpha-tocopherol) 400 IU in four divided doses daily, beginning on the day of travel to high altitude and continuing for 2 weeks thereafter, does not prevent the occurrence nor decrease the severity of altitude sickness when compared with placebo (20499).
Contrast induced nephropathy. Oral alpha-lipoic acid does not seem to prevent nephropathy after undergoing coronary angiography. Details: In diabetic patients at low risk for contrast induced nephropathy, alpha-lipoic acid (Thioactacid 600 mg RH, MEDA Manufacturing GmbH) 600 mg taken 30 minutes prior to and 24 and 48 hours after undergoing coronary angiography, with or without standard hydration therapy, does not reduce the risk of contrast induced nephropathy when compared with standard hydration therapy (90442). In addition, treatment with alpha-lipoic acid 600 mg orally every 8 hours beginning the afternoon prior to angiography and continuing for 2 days does not attenuate the maximum increase in serum creatinine or reduce the incidence of contrast induced nephropathy in most patients when compared with standard hydration therapy alone (90446).
Diabetes. Oral or intravenous alpha-lipoic acid does not seem to be beneficial for glycemic control in patients with type 2 diabetes. Details: Although some conflicting findings from individual studies exist, the overall evidence does not support the use of oral or intravenous alpha-lipoic acid for improving glycemic control or insulin sensitivity in patients with type 2 diabetes (3545,3874,3875,3876,20490,20493,20494,20495,20496,90443)(90445,110118,111305). A meta-analysis of 16 small clinical studies in patients with type 2 diabetes shows that taking alpha-lipoic acid 200-1200 mg daily for up to 52 weeks leads to slight improvements in glycemic control and body weight, but these improvements are not clinically significant. When compared with placebo, alpha-lipoic acid reduced fasting blood glucose by 6 mg/dL, glycated hemoglobin (HbA1c) by 0.17%, body weight by 0.7 kg, and body mass index (BMI) by 1.1 kg/m2. While triglyceride levels were reduced by 19 mg/dL, improvements in other lipids levels and blood pressure were lacking (110118). A specific alpha-lipoic acid product administered orally or intravenously in some of these studies was Thioctacid (Asta Medica) (3874,3875,3876). Alpha-lipoic acid has also been evaluated in patients with gestational diabetes or type 1 diabetes. A small clinical study in adults with gestational diabetes shows the taking alpha-lipoic acid (Puritan's Pride) 100 mg daily for 8 weeks improves fasting blood glucose levels and insulin sensitivity but does not affect HbA1C when compared with placebo (107890). The validity of this study is limited due to its short duration, which was likely inadequate to detect a change in HbA1c. Also, one small clinical study in adolescent patients with type 1 diabetes who show signs of early stage diabetic cardiomyopathy shows that taking alpha-lipoic acid 300 mg twice daily for 4 months, in combination with insulin therapy, improves left ventricular systolic and diastolic function (90443).
Diabetic retinopathy. Oral alpha-lipoic acid does not seem to prevent macular edema in patients with diabetic retinopathy. Details: Some research shows that taking oral alpha-lipoic acid 600 mg daily for 24 months does not improve the incidence of clinically significant macular edema when compared with placebo in patients with mild to moderate nonproliferative diabetic retinopathy (20491).
HIV/AIDS-related dementia. Oral alpha-lipoic acid does not seem to improve cognitive impairment related to this condition. Details: Clinical research shows that taking alpha-lipoic acid 600 mg daily, alone or along with selegiline (Deprenyl), for 10 weeks may worsen HIV-associated cognitive impairment and does not affect mood or functional status when compared with placebo in patients with confirmed HIV infection and evidence of cognitive impairment (1556).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Age-related cognitive decline. It is unclear if oral alpha-lipoic acid is beneficial for age-related cognitive decline. Details: Preliminary clinical research in elderly adults shows that taking alpha-lipoic acid 600 mg orally daily for 12 weeks does not improve cognitive function scores when compared with baseline (111303). The validity of this study is limited by the lack of a comparator group.
Age-related macular degeneration (AMD). It is unclear if oral alpha-lipoic acid is beneficial for AMD. Details: A small clinical trial shows that taking alpha-lipoic acid (Pure Encapsulations) 1200 mg daily for 18 months does not improve visual acuity or reduce the rate of atrophy when compared with placebo in patients with advanced AMD (103335). It is unclear if alpha-lipoic acid would be beneficial in patients with less severe symptoms of AMD.
Age-related testosterone deficiency. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A very small clinical study in males with overweight or obesity, mild erectile dysfunction, and normal to low androgen levels shows that taking a combination product containing alpha-lipoic acid 800 mg, myo-inositol, folic acid, and apple (Sinopol Forte, Laborest) increases testosterone, luteinizing hormone, and measures of erectile dysfunction but not follicle-stimulating hormone or sperm parameters when compared to baseline (111674). The validity of these findings is limited by the small sample size and lack of a comparator group, and it is unclear if these effects are due to alpha-lipoic acid, other ingredients, or the combination.
Aging skin. Topical alpha-lipoic acid may be beneficial for aging skin. Details: A small clinical study shows that applying a cream containing alpha-lipoic acid 5% to the face twice daily for 12 weeks reduces the fine lines and roughness associated with aging of facial skin when compared with a control cream (12021).
Alzheimer disease. It is unclear if oral alpha-lipoic acid is beneficial for this condition. Details: Some preliminary clinical research shows that taking alpha-lipoic acid 600 mg once daily in combination with standard cholinesterase inhibitors may slow cognitive decline when compared with cholinesterase inhibitors alone in some patients with Alzheimer disease (20500,90437). However, higher-quality clinical research shows that taking alpha-lipoic acid 600-900 mg daily for up to 2 years, in combination with vitamin C and vitamin E, does not affect cognitive function when compared with placebo in patients with mild to moderate Alzheimer disease (19206,20501).
Amanita mushroom poisoning. Evidence on the use of intravenous alpha-lipoic acid for amanita mushroom poisoning is limited to anecdotal reports. Details: Intravenous alpha-lipoic acid has been used in combination with other treatments for poisoning from amanita mushroom ingestion. Its use is controversial. Reports are anecdotal, and experimental evidence does not support its effectiveness. Some researchers recommend against its use (105,1548,1549,3871,3879).
Anthracycline cardiotoxicity. It is unclear if oral alpha-lipoic acid is effective for the prevention of anthracycline cardiotoxicity. Details: A small clinical study in patients with breast cancer receiving doxorubicin shows that taking alpha-lipoic acid 600 mg daily for 6 months does not improve ejection fraction but does decrease levels of brain natriuretic peptide (BNP), a marker of ventricular hypertrophy, when compared with placebo (110112).
Antipsychotic-induced hyperprolactinemia. It is unclear if oral alpha-lipoic acid is effective for the prevention or treatment of antipsychotic-induced hyperprolactinemia. Details: A very small, open-label study in patients with schizophrenia shows that taking alpha-lipoic acid 600 mg daily along with conventional antipsychotic therapy for 12 weeks reduces prolactin levels by 51% when compared to baseline (110116). The validity of this finding is limited by the lack of a control group.
Antipsychotic-induced metabolic side effects. Small clinical studies suggest that oral alpha-lipoic acid does not seem to improve antipsychotic-induced metabolic side effects in patients with schizophrenia. Details: A very small, open-label study in patients with schizophrenia shows that taking alpha-lipoic acid 600 mg daily along with conventional antipsychotic therapy for 12 weeks reduces fasting blood glucose levels by around 17 mg/dL but actually increases glycated hemoglobin (HbA1c) by 0.14% when compared to baseline. No improvements in body weight or lipid levels were reported (110116). Another small clinical study in patients with schizophrenia stabilized on antipsychotic therapy for at least 1 year shows that taking alpha-lipoic acid 100 mg daily for 16 weeks does not improve body mass index (BMI) when compared with placebo (110115).
Aromatase inhibitor-induced arthralgia. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with estrogen receptor positive (ER+) breast cancer and aromatase inhibitor-induced arthralgia shows that taking a specific combination product (Opera, Gamfarma Srl) containing alpha-lipoic acid 240 mg, Boswellia serrata 40 mg, methylsulfonylmethane 200 mg, and bromelain 20 mg once daily for 6 months reduces arthralgia intensity when compared to baseline, with around 22% of patients having complete symptom resolution at the end of the study (109570). The validity of these findings is limited by the lack of a control group.
Atrial fibrillation. It is unclear if oral alpha-lipoic acid is beneficial for atrial fibrillation. Details: Clinical research shows that taking alpha-lipoic acid 600 mg daily for 12 months does not reduce the recurrence of atrial fibrillation when compared with placebo in patients who underwent a catheter ablation procedure. However, there was a decrease in the need for antiarrhythmic drugs in patients receiving alpha-lipoic acid (97628).
Back pain. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: An observational study in adults with chronic lower back pain and sciatica suggests that taking a combination of alpha-lipoic acid 800 mg, palmitoylethanolamide 600 mg, and myrrh 200 mg daily for 30 days, along with periradicular infiltrations of oxygen-ozone, is associated with resolution of pain in 17% more patients when compared with periradicular steroid infiltrations at 60 days (111308). However, it is unclear if this effect is due to alpha-lipoic acid, other ingredients, or the combination.
Beta-thalassemia. It is unclear if oral alpha-lipoic acid is beneficial for reducing iron accumulation in beta-thalassemia major. Details: A small, crossover study in patients with beta-thalassemia major who are receiving iron chelation therapy shows that adding oral alpha-lipoic acid 600 mg before breakfast or dinner for 8 weeks reduces levels of serum ferritin when compared with placebo (107888). Serum ferritin was reduced by 104 ng/mL and 38 ng/mL in the treatment and placebo groups, respectively. The validity of this finding is limited due to the small, exploratory nature of the study.
Bipolar disorder. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research shows that taking acetyl-L-carnitine 1000 mg plus alpha-lipoic acid 600 mg up to three times daily for 12 weeks does not improve depression when compared with placebo in patients with type I or type II bipolar disorder (90441).
Burning mouth syndrome. It is unclear if oral alpha-lipoic acid is beneficial for burning mouth syndrome. Details: A meta-analysis of nine small, low-quality clinical trials in patients with burning mouth syndrome shows that taking alpha-lipoic acid 400-800 mg daily for up to 2 months does not reduce pain intensity when compared with placebo or active controls such as multivitamins, Biotene mouth rinse, capsaicin, laser therapy, clonazepam, or pregabalin. However, in an analysis of three placebo-controlled studies, alpha-lipoic acid increased the likelihood of any burning mouth syndrome-related symptom improvement by 92% when compared with placebo (110111). Individual studies, most of which were included in the analysis, show conflicting results overall (20474,21661,21662,21663,21664,21665,21666,111427). One small clinical trial shows that taking alpha-lipoic acid 600 mg daily improves symptoms of burning mouth syndrome in patients who had never previously been treated with anxiolytics or antidepressants, but not in those who had received these prior treatments (21668). This suggests that alpha-lipoic acid may improve symptoms of burning mouth syndrome resulting from stress, but not from depression or drug-induced hyposalivation.
Cancer. Although there is interest in using oral alpha-lipoic acid for preventing or treating cancer, there is insufficient reliable information about the clinical effects of alpha-lipoic acid for this condition.
Cardiovascular disease (CVD). Although there is interest in using oral alpha-lipoic acid for preventing or treating CVD, there is insufficient reliable information about the clinical effects of alpha-lipoic acid for this condition.
Carpal tunnel syndrome. It is unclear if oral alpha-lipoic acid is beneficial for carpal tunnel syndrome, either before or after surgery. Details: In patients with mild to moderate carpal tunnel syndrome, preliminary clinical research shows that taking alpha-lipoic acid 600 mg daily for 60 days reduces pain by a moderate amount when compared with not taking alpha-lipoic acid, but with no effect on functionality (103328). In patients with neuropathic pain due to carpal tunnel syndrome, giving alpha-lipoic acid 600 mg intravenously daily for 30 days, then 600 mg orally daily for 60 days, decreases pain on a visual analog scale, and improves functionality when compared with oral alpha-lipoic acid alone, or no treatment (112938). Alpha-lipoic acid has also been studied in combination with other ingredients. One study shows that taking a combination of alpha-lipoic acid 600 mg and gamma-linolenic acid 360 mg for 90 days improves functional scores and subjective symptom scores when compared to baseline (21653). The validity of this finding is limited by the lack of a comparator group. Another clinical study in adults with mild to moderate carpal tunnel syndrome shows that taking a combination product containing alpha-lipoic acid, acetyl-L-carnitine, phosphatidylserine, turmeric, and vitamins C, E, B1, B2, B6, and B12 twice daily for 60 days reduces symptom severity and pain but does not improve measures of hand and wrist function when compared with control (111702). The validity of these effects is limited by a lack of blinding. The study may also be inadequately powered to detect a difference between groups. Additionally, it is unclear if the effects are due to alpha-lipoic acid, other ingredients, or the combination. Alpha-lipoic acid has also been evaluated in patients who have undergone carpal tunnel release surgery. Taking alpha-lipoic acid 600 mg daily for 40 days starting immediately after surgery does not improve the rate of nerve recovery when compared with placebo, although it seems to reduce the occurrence of post-operative pillar pain, which is a common complication of carpal tunnel release surgery (96233).
Cataracts. Although there is interest in using oral alpha-lipoic acid for cataracts, there is insufficient reliable information about the clinical effects of alpha-lipoic acid for this condition.
Cervical dysplasia. It is unclear if oral alpha-lipoic acid is beneficial in patients with cervical dysplasia. Details: A small clinical study in patients with low-grade cervical intraepithelial neoplasia shows that taking alpha-lipoic acid 600 mg daily for 3 months reduces the proportion of patients with intraepithelial neoplasia by 95% when compared with placebo (110113).
Chemotherapy-induced peripheral neuropathy. There is conflicting evidence regarding the effectiveness of oral alpha-lipoic acid for the prevention of chemotherapy-induced peripheral neuropathy. Details: One clinical study shows that taking alpha-lipoic acid 600 mg three times daily for 24 weeks during treatment with cisplatin or oxaliplatin does not affect the symptoms or severity of chemotherapy-induced peripheral neuropathy when compared with placebo (90439). However, another small clinical study in patients with breast cancer receiving paclitaxel shows that taking alpha-lipoic acid 600 mg daily for 6 months reduces the severity of peripheral neuropathy when compared with placebo (110112). The reason for this disparate finding is unclear, but it may be due to differences in chemotherapy regimens. Alpha-lipoic acid has also been evaluated in combination with other ingredients. A small clinical study shows that taking a specific product (Opera, Gamfarma s.r.l.) containing alpha-lipoic acid 240 mg, methylsulfonylmethane (MSM) 200 mg, Boswellia serrata 40 mg, and bromelain 20 mg daily for 12 weeks reduces overall pain when compared to baseline in adults with chemotherapy-induced peripheral neuropathy (96449). The validity of these findings is limited by the lack of a control group. Other preliminary clinical research shows that taking alpha-lipoic acid 600 mg orally once daily and ipidacrine 20 mg orally three times daily throughout 6 paclitaxel-based chemotherapy cycles improves sensory nerve action potential parameters when compared with control (111292). It is unclear if these effects are due to alpha-lipoic acid, the other ingredients, or the combination.
Chronic fatigue syndrome (CFS). Although there is interest in using oral alpha-lipoic acid for CFS, there is insufficient reliable information about the clinical effects of alpha-lipoic acid for this condition.
Chronic kidney disease (CKD). It is unclear if oral alpha-lipoic acid is beneficial for CKD. Details: Preliminary clinical research in patients with stage 2 or 3 CKD related to autosomal dominant polycystic kidney disease shows that taking alpha-lipoic acid 1.6 grams daily for 6 months has modest benefits on biochemical markers and cognitive tests when compared to control. Taking alpha-lipoic acid reduces serum glucose, insulin, C-reactive protein (CRP), and uric acid levels, and improves insulin resistance and flow-mediated dilation and cognitive test results. However, there was no effect on intima media thickness or the ankle brachial index (101867).
Coronary artery bypass graft (CABG) surgery. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients undergoing elective CABG surgery shows that taking a combination of alpha-lipoic acid 100 mg, coenzyme Q10 100 mg, magnesium orotate 400 mg, and omega-3 fatty acids 300 mg three times daily, with selenium 200 mcg once daily, for up to 2 months prior and 1 month after surgery, decreases plasma troponin levels and reduces the average postoperative hospital stay by 1.2 days when compared with placebo (21651). It is unclear if this effect is due to alpha-lipoic acid, the other ingredients, or the combination.
Coronavirus disease 2019 (COVID-19). It is unclear if oral alpha-lipoic acid is beneficial in patients with persistent loss of the sense of smell after COVID-19 infection. Details: In adults with sense of smell loss persisting for more than 3 months after COVID-19 infection, adding alpha-lipoic acid 300 mg twice daily orally for 12 weeks to olfactory training reduces the incidence of anosmia, and improves the olfactory threshold, the sense of smell measured on a visual analog scale, and the smell identification score by a similar amount to placebo (112935).
Diabetic nephropathy. When used in combination with certain conventional medications, intravenous or oral alpha-lipoic acid may improve some measures of albuminuria in patients with diabetic nephropathy. Details: Preliminary clinical research shows that intravenous alpha-lipoic acid (YantaiZhichu Pharmaceutical Co., Ltd.) 450 mg plus intravenous alprostadil 20 mcg once daily for 14 days reduces urinary albumin excretion rate by 23% and cystatin C levels by 19% when compared with alprostadil alone (96221). Patients treated with alpha-lipoic acid 600 mg intravenously plus valsartan 80 mg orally once daily for 14 days showed a 25% lower urinary albumin excretion rate and a 27% and 31% lower serum level of beta2-microglobulin and cystatin C, respectively, when compared with patients treated with valsartan alone (101866). A meta-analysis of clinical research in adults with diabetic nephropathy shows that taking oral alpha-lipoic acid 300 mg, 450 mg, or 600 mg daily in combination with oral valsartan 80 mg daily for 14 days reduces urinary albumin excretion rate, as well as levels of urinary albumin and serum beta 2-microglobulin, when compared with either valsartan or alpha-lipoic acid alone (107891). These findings are limited by the high heterogeneity of the included studies and the presence of potential publication bias. Additionally, the long-term benefits of alpha-lipoic acid are unclear. Another meta-analysis of clinical research in patients with diabetes shows that taking oral alpha-lipoic acid 600 mg daily in conjunction with other medications (e.g. antihypertensives, vitamin B6) for 3-18 months reduces levels of urine albumin, but does not improve urinary albumin excretion rate, when compared with placebo. Notably, alpha-lipoic acid alone did not affect outcomes (107886). The validity of these findings is limited by the high heterogeneity of the included studies; additionally, the quality of evidence was considered low to moderate.
Dry eye. It is unclear if topical alpha-lipoic acid is beneficial in patients with dry eye. Details: A small clinical study in patients with diabetes and dry eye symptoms shows that application of an eye drop containing alpha-lipoic acid 0.1% and hydroxy-propyl-methylcellulose (HPMC) 0.3% three times daily for 2 months does not improve subjective or objective measures of dry eye symptoms when compared with HPMC alone (110119).
Dysmenorrhea. It is unclear if oral alpha-lipoic acid is beneficial for dysmenorrhea. Details: Preliminary clinical research shows that taking alpha-lipoic acid 600 mg orally daily, with or without mefenamic acid 250 mg daily, for 5 days starting before menstruation reduces pain associated with moderate to severe primary dysmenorrhea by approximately 24% and 44%, respectively, when compared to baseline (101871). The validity of this finding is limited by the lack of a comparator group.
Erectile dysfunction (ED). It is unclear if oral or intravenous alpha-lipoic acid is beneficial for ED. Details: Preliminary clinical research in males with diabetes and ED shows that intravenous alpha-lipoic acid 600 mg with alprostadil 10 mcg once daily for 14 days improves the quality and frequency of erection in 95% of patients, compared with only 81% of those taking tadalafil 5 mg orally daily (96224). It is not clear if this improvement is due to alpha-lipoic acid, alprostadil, or the combination. Another very small study in males with mild ED, overweight or obesity, and normal to low androgen levels shows that taking a combination product containing alpha-lipoic acid 800 mg, myo-inositol, folic acid, and apple (Sinopol Forte, Laborest) improves measures of erectile dysfunction when compared to baseline (111674). The validity of these finding is limited by the small sample size and the lack of a comparator group, and it is unclear if these effects are due to alpha-lipoic acid, other ingredients, or the combination.
Fibromyalgia. It is unclear if intravenous alpha-lipoic acid is beneficial for fibromyalgia. Details: Preliminary clinical research shows that taking alpha-lipoic acid (SiSU Vita Health) 600-1800 mg daily for 4 weeks does not reduce pain intensity when compared with placebo in patients with fibromyalgia (104655). Alpha lipoic acid has also been studied as a combination therapy for fibromyalgia. Preliminary clinical research in adults with fibromyalgia shows that taking a combination of alpha-lipoic acid and pregabalin for 6 weeks does not improve pain or depression scores when compared with either product alone (111428). However, the study may have been inadequately powered to detect a difference between groups.
Glaucoma. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with open-angle glaucoma shows that taking a combination product containing alpha-lipoic acid 100 mg, omega-3 fatty acids 2240 mg, vitamin C 180 mg, vitamin E 27.9 mg, lutein 10 mg, zeaxanthin 2 mg, zinc 15 mg, copper 1 mg, and taurine 150 mg (NuaDHA Vision, Nua Biological) orally daily for 6 months does not improve intraocular pressure when compared with baseline (111310).
Heart failure. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with heart failure participating in a handgrip exercise shows that taking alpha-lipoic acid, vitamin E, and vitamin C reduces mean arterial pressure by about 6 mmHg and reduces vascular resistance by about 12% when compared with placebo (19219). The first dose consisted of vitamin E 200 IU, vitamin C 500 mg, and alpha-lipoic acid 300 mg. The subsequent dose consisted of vitamin E 400 IU, vitamin C 500 mg, and alpha-lipoic acid 300 mg (19219). It is unclear if these effects are due to alpha-lipoic acid, other ingredients, or the combination.
Hemorrhoids. It is unclear if oral alpha-lipoic acid is beneficial for hemorrhoids. Details: A preliminary open-label clinical trial shows that taking alpha-lipoic acid 200 mg daily for 12 weeks decreases anal pain while sitting, pain at defecation, itching, and bleeding when compared with no treatment in patients with second- and third-degree hemorrhoids (100707). The validity of these results is limited by a lack of blinding and placebo control.
Herniated disc. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small observational study in adults with acute lumbosacral radiculopathy secondary to lumbar disc herniation shows that taking a combination supplement containing alpha-lipoic acid 404 mg, myrrh, and palmitoylethanolamide (PEA) (Tiobec Dol, Uriach Italy Srl) twice daily for 4 weeks, along with steroids and as needed opioids, reduces pain and disability and improves physical but not mental health as it pertains to quality of life when compared with steroids and as needed opioids alone (111711). However, it is unclear if these effects are due to alpha-lipoic acid, other ingredients, or the combination.
HIV/AIDS. It is unclear if oral alpha-lipoic acid is beneficial for patients with HIV/AIDS who are unresponsive to highly active antiretroviral therapy (HAART). Details: A small clinical study in patients who were unresponsive to HAART shows that taking alpha-lipoic acid (Alpha Lipoic Sustain 300, Jarrow Formulas) 300 mg three times daily for 6 months improves lymphocyte proliferation and whole blood glutathione levels when compared with placebo. However, there was no change in HIV RNA levels or CD4 count (21655).
Hypertension. It is unclear if oral alpha-lipoic acid is beneficial for hypertension. Details: Clinical research in a small number of patients with mild (stage I) hypertension shows that adding alpha-lipoic acid 600 mg daily to quinapril 40 mg daily for 8 weeks does not significantly decrease blood pressure when compared with quinapril alone (21656). A meta-analysis of 11 clinical trials shows that alpha-lipoic acid lowers systolic blood pressure by a mean of about 5 mmHg, and diastolic blood pressure by a mean of about 3 mmHg, but there is significant heterogeneity between the studies. The small decrease in blood pressure is also only seen with doses of alpha-lipoic acid below 800 mg daily when given for 12 weeks or less (112934).
Hypertriglyceridemia. Clinical studies suggest that oral alpha-lipoic acid does not reduce triglyceride levels in patients with hypertriglyceridemia, however it might be beneficial in certain populations. Details: In overweight adults with elevated triglycerides, taking alpha-lipoic acid 600 mg daily for 24 weeks does not reduce triglyceride levels when compared with placebo (103327). In addition, a meta-analysis of 11 clinical trials in patients with or without hypertriglyceridemia at baseline shows that taking alpha-lipoic acid 300-1200 mg daily for up to 16 weeks does not improve triglyceride levels when compared with placebo (100709). However, one clinical study in adults with gestational diabetes, most of whom had elevated triglyceride levels at baseline, shows that taking alpha-lipoic acid (Puritan's Pride) 100 mg daily for 8 weeks reduces triglyceride levels by 30 mg/dL, compared with an increase of 5 mg/dL in those taking placebo, a difference that was statistically significant (107890). The validity of this study is limited due to short duration of treatment.
Impaired glucose tolerance (prediabetes). It is unclear if oral or intravenous alpha-lipoic acid is beneficial for prediabetes. Details: A small clinical study in patients with prediabetes shows that intravenous alpha-lipoic acid 600 mg daily for 2 weeks decreases postprandial plasma glucose, steady state plasma insulin, cholesterol, and fatty acid levels and increases insulin sensitivity when compared with placebo (21657). In a large group of generally healthy adults, taking alpha-lipoic acid 800-1200 mg for 4 years reduces levels of fasting plasma glucose when compared with baseline. The 1200 mg daily dose was more effective than the 400 mg daily dose (104650). While some patients in this study had prediabetes or impaired fasting glucose at baseline, the study did not specifically evaluate patients with prediabetes.
Infertility. Although there is interest in using oral alpha-lipoic acid to increase the chance of pregnancy, there is insufficient reliable information about the clinical effects of alpha-lipoic acid for infertility.
Interstitial cystitis. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: In individuals with vulval pain associated with painful bladder syndrome, clinical research shows that taking a specific product containing alpha-lipoic acid 600 mg, docosahexaenoic acid 250 mg, eicosapentaenoic acid 16.67 mg, vitamin E 12 mg, vitamin D 5 mg, and magnesium 56.25 mg (ALAnerv Age; Alfa Wassermann) daily in combination with amitriptyline up to 30 mg daily for 12 weeks reduces pelvic pain between 15% to 49% more than amitriptyline alone. Also, use of the combination supplement more than doubled the number of patients with an improvement in pain during intercourse (97629). It is unclear if the benefit is associated with alpha-lipoic acid, other ingredients, or the combination.
Lyme disease. Although there is interest in using oral alpha-lipoic acid for Lyme disease, there is insufficient reliable information about the clinical effects of alpha-lipoic acid for this condition.
Male infertility. Most small clinical studies suggest that oral alpha-lipoic acid might improve sperm characteristics in males with infertility. However, it is unclear whether alpha-lipoic acid improves pregnancy or live birth rates in these individuals. Details: A meta-analysis of three small clinical studies in males with infertility shows that taking alpha-lipoic acid 600 mg daily for 80-90 days improves sperm motility and increases sperm concentration and semen volume when compared with placebo (110108). More recent clinical trials in males with idiopathic asthenozoospermia or history of recurrent pregnancy loss shows that taking alpha-lipoic acid 600 mg orally daily for 80-90 days improves sperm motility, sperm concentration, and semen volume and reduces sperm DNA damage when compared with placebo (110110,111425). However, a small clinical study in males with infertility due to high levels of sperm DNA damage shows that taking alpha-lipoic acid 600 mg daily for 80 days does not improve pregnancy rate, sperm motility, sperm concentration, semen volume, or other measures of sperm health when compared with placebo (110109). Alpha-lipoic acid has also been evaluated in combination with other ingredients. A small clinical study in males with oligoasthenoteratozoospermia (OAT) shows that taking one tablet daily of a specific product (Fertiplus SOD, Idi-Pharma) containing alpha-lipoic acid, superoxide dismutase, glutathione, and other nutrients 30 days prior to IVF procedures improves the pregnancy rate from 9% of all embryo transfers pre-treatment to 45% and reduces the rate of miscarriage when compared to baseline (97627). It is unclear if the benefit is associated with alpha-lipoic acid, the other ingredients, or the combination.
Metabolic syndrome. It is unclear if oral alpha-lipoic acid is beneficial in patients with metabolic syndrome. Details: Preliminary clinical research in adults with metabolic syndrome shows that taking alpha-lipoic acid 600 mg orally daily for 12 weeks modestly improved serum triglyceride levels, but not serum low-density lipoprotein (LDL), or high-density lipoprotein (HDL) cholesterol levels, when compared with placebo (111307). However, the study may have been inadequately powered to detect a difference between groups.
Migraine headache. It is unclear if oral alpha-lipoic acid is beneficial in patients with migraine headaches. Details: A small clinical study in females with episodic migraines shows that taking alpha-lipoic acid 300 mg twice daily for 12 weeks reduces migraine frequency by around 2 attacks per month and improves migraine severity, but not the duration of migraine pain, when compared with placebo (110117). Another small clinical study in adults with migraines shows that taking alpha-lipoic acid 400 mg twice daily for 6 months reduces migraine frequency by at least 50% in 69% of patients and reduces the need for migraine treatment by 56% when compared to baseline, although the validity of these findings is limited by the lack of a control group (96229). In contrast, one small clinical study in adults with migraine headaches shows that taking alpha-lipoic acid 600 mg daily for 3 months does not improve monthly migraine attack frequency when compared with placebo (21660). The reasons for these disparate findings are unclear. Alpha-lipoic acid has also been evaluated in adolescents for migraine prophylaxis. A small open-label study in adolescents aged 10-19 years with a history of migraine shows that taking alpha-lipoic acid 300 mg with flunarizine 5 mg as prophylaxis daily for 12 weeks reduces the frequency of migraine attacks and reduces monthly migraine headache days by 9 days, but does not reduce migraine severity or measures of disability when compared with flunarizine alone. For every 3 patients treated with alpha-lipoic acid and flunarizine over flunarizine alone, 1 additional patient had a 50% or greater reduction in migraine frequency (111706). The validity of these effects is limited by a lack of blinding.
Muscle strength. It is unclear if oral alpha-lipoic acid prevents a loss of muscle strength after exercise. Details: In athletes, a small clinical trial shows that taking a single dose of alpha-lipoic acid 150 mg (Athenion GmbH) after an intensive load protocol does not prevent loss of leg strength approximately 24 hours later when compared with placebo. However, taking the same dose for 2 days, followed by 300 mg daily during a 6-day training protocol, results in the maintenance of leg strength, compared with a loss in those taking placebo (104652).
Neck pain. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a combination of alpha-lipoic acid 600 mg plus superoxide dismutase 140 IU once daily for 2 months, along with physiotherapy, reduces chronic neck pain in approximately 50% more patients when compared with physiotherapy alone (90440).
Neuropathic pain. It is unclear if oral alpha-lipoic acid is beneficial in patients with neuropathic pain. Details: In patients with peripheral neuropathies, taking alpha-lipoic acid orally, up to 1800 mg daily for 6 weeks, is less effective for reducing pain intensity scores and improving quality of life than pregabalin, taken orally in doses up to 450 mg daily (112940). A nonblinded clinical study in patients with refractory chronic lumbosacral radicular pain shows that taking alpha lipoic acid orally, 600 mg three times daily for 3 weeks followed by 600 mg daily for 2 weeks, in addition to a single, pulsed radiofrequency treatment to the dorsal ganglion, improves pain severity and disability scores at 6 months when compared with pulsed radiofrequency treatment alone. A pain score of less than 4 is achieved at 12 weeks in about 80% of patients taking alpha lipoic acid, compared with about 65% of patients without alpha-lipoic acid. (107895).
Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral alpha-lipoic acid is beneficial for NAFLD. Details: Small clinical studies in adults with NAFLD and obesity show that taking alpha-lipoic acid 600 mg orally twice daily for 8-12 weeks does not improve liver health markers, such as liver function test levels or liver steatosis, cholesterol levels, body weight, or visceral fat when compared with placebo or control (104660,100710,111304). However, these clinical trials show that taking alpha-lipoic acid 600 mg orally twice daily for 8-12 weeks may provide small improvements in interleukin-6 levels, adiponectin levels, and insulin resistance (104660,100710). However, these studies may have been inadequately powered to detect differences in some of these outcomes.
Orthostatic hypotension. It is unclear if oral alpha-lipoic acid is beneficial for orthostatic hypotension. Details: Preliminary clinical research shows that taking alpha-lipoic acid 430-788 mg orally daily for a mean of 2.3 years attenuates changes in blood pressure upon standing when compared with baseline in some patients with chronic neurogenic orthostatic hypotension or orthostatic intolerance (101868).
Pain (chronic). It is unclear if oral alpha-lipoic acid is beneficial for various chronic pain conditions. Details: A clinical study in patients with untreated, mild to moderate idiopathic pain (i.e. neuropathic pain, joint pain, and muscle pain with unknown etiology) shows that taking oral alpha-lipoic acid 400 mg once or twice daily for 2 months may improve pain severity when compared with baseline, with greater effects observed with daily doses of 800 mg (107887). Although the study enrolled a control group, a statistical comparison between groups was not conducted, limiting the validity of this finding. Additionally, sub-analyses evaluating outcomes based on type of chronic pain were not conducted.
Periodontitis. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with moderate or advanced periodontitis shows that taking a supplement containing alpha-lipoic acid 25 mg, coenzyme Q10, cranberry extract, grapeseed extract, selenium, vitamin C, vitamin E, and zinc twice daily for 8 weeks in addition to standard nonsurgical therapy does not reduce periodontal indices including bleeding on probing, gingival recession, plaque index, or inflammation, among others, when compared with placebo (111708).
Peripheral arterial disease (PAD). It is unclear if oral alpha-lipoic acid is beneficial for PAD. Details: Preliminary clinical research shows that taking alpha-lipoic acid 300 mg twice daily reduces pain associated with exercise in people with PAD and claudication when compared with placebo. However, exercise tolerance does not seem to improve (16391).
Polycystic ovary syndrome (PCOS). It is unclear if oral alpha-lipoic acid is beneficial for PCOS. Details: Alpha-lipoic acid has been studied alone and in combination with inositol for the treatment of PCOS. Observational research shows that taking alpha-lipoic acid 2000 mg, alone or in combination with myo-inositol (Sinopol, Laborest s.r.l.) 800-1000 mg, daily for 3-24 months is associated with reduced insulin levels and reduced menstrual cycle length, but not weight loss or improvements in hirsutism or insulin resistance, when compared with baseline (101869,101870). Another observational study shows that taking alpha lipoic acid 800 mg with a higher dose of myo-inositol 2000 mg is associated with slightly greater weight loss when compared with a lower dose of myo-inositol 1000 mg daily (103751). Also, taking alpha-lipoic acid 400 mg orally daily for 12 weeks does not affect levels of hormones, although improvements occur when alpha-lipoic acid is taken in combination with inositol 1000 mg daily (101870). The validity of this research is limited by its observational nature. A meta-analysis of 7 controlled trials in young, overweight adults with PCOS, shows that taking alpha-lipoic acid 600-1800 mg daily orally for 6-25 weeks, alone or in combination with inositol, reduces fasting blood sugar, and homeostatic model assessment of insulin resistance (HOMA-IR), when compared with control. However, there is no effect on insulin levels, body mass index, lipid profile, or hormone levels (112939).
Preterm labor. It is unclear if vaginal alpha-lipoic acid is beneficial for preventing preterm birth. Details: Preliminary clinical research shows that administering alpha-lipoic acid 400 mg vaginally once nightly for 30 days after an episode of preterm labor prevents cervical shortening when compared with placebo (96226). It is unclear if these findings are associated with a reduction in the rate of preterm birth.
Radiation exposure. Oral alpha-lipoic acid might reduce radiation levels in children living in areas contaminated with radiation. Details: Preliminary clinical research shows that taking alpha-lipoic acid 400 mg, alone or in combination with vitamin E (RRR-alpha-tocopherol) 200 mg, daily for 28 days reduces chemiluminescence in leukocytes and urinary radioactivity when compared to baseline in children living in areas contaminated with radiation (21669).
Schizophrenia. There is mixed evidence regarding the effectiveness of oral alpha-lipoic acid in patients with schizophrenia. Details: A small clinical study in patients with treatment-resistant schizophrenia receiving conventional antipsychotic therapy shows that taking alpha-lipoic acid 300 mg daily for 8 weeks improves scores related to negative symptoms of schizophrenia, but not positive symptoms, when compared with placebo (110114). A very small, open-label study in patients with stable, chronic schizophrenia shows that taking alpha-lipoic acid 100 mg daily along with ongoing antipsychotic medication for 4 months improves symptoms by 64% when compared to baseline. Specific symptom domains, including negative and positive symptoms, excitement, depressive symptoms, and extrapyramidal symptoms all show improvement, although the validity of these findings is limited by the lack of a control group (96228). In contrast, another small clinical study in patients with schizophrenia stabilized on antipsychotic therapy for at least 1 year shows that taking alpha-lipoic acid 100 mg daily for 16 weeks does not improve symptoms of schizophrenia or cognitive function when compared with placebo (110115). Also, a very small, open-label study in patients with schizophrenia shows that taking alpha-lipoic acid 600 mg daily along with conventional antipsychotic therapy for 12 weeks does not improve positive or negative symptoms of schizophrenia when compared to baseline (110116). A meta-analysis of 4 studies in patients with clinically stable schizophrenia does not show any benefit of oral alpha-lipoic acid when compared with placebo, although details of the analysis are limited (112936). Overall, the reasons for the disparate research findings are unclear, but they may be due to differences in the alpha-lipoic acid dose, treatment duration, and severity of schizophrenia across studies. Alpha-lipoic acid has also been evaluated in combination with other ingredients. A small clinical study in patients who responded well to antipsychotic therapy after a single episode of psychosis shows that taking alpha-lipoic acid 150 mg, eicosapentaenoic acid (EPA) 1000 mg, and docosahexaenoic acid (DHA) 500 mg twice daily does not prevent 2-year cumulative relapse or delay relapse time when compared with placebo (90675).
Sciatica. It is unclear if oral alpha-lipoic acid is beneficial for sciatica. Details: Preliminary clinical research in patients with sciatica secondary to a herniated disc shows that taking alpha-lipoic acid (Byodiniral 300 QR, MDM SpA) 600 mg daily for 60 days improves signs and symptoms of sciatica and decreases the use of analgesics when compared with taking acetyl-L-carnitine (Nicetile, SigmaTau Ind. Farm. Riunite SpA) 1180 mg daily (21671). However, taking alpha-lipoic acid does not affect sleep quality in these patients. Alpha-lipoic acid has also been studied in combination with other ingredients for sciatica. Research in patients with sciatica secondary to a herniated disk shows that taking a combination of alpha-lipoic acid 600 mg with acetyl-L-carnitine, resveratrol, and cholecalciferol orally once daily for 30 days, concurrently with a physiotherapy protocol, reduces pain and disability, and improves quality of life when compared with the physiotherapy protocol alone (112933). Additionally, observational research in patients with sciatic pain due to herniated discs suggests that taking a combination of alpha-lipoic acid 800 mg, myrrh extract 200 mg, and palmitoylethanolamide 600 mg daily for 20 days along with 3 sessions of oxygen-ozone therapy over 30 days is associated with slight improvements in pain when compared with oxygen-ozone therapy alone (111113). It is unclear if the effects are due to alpha-lipoic acid, other ingredients, or the combination.
Tinnitus. It is unclear if oral alpha-lipoic acid is beneficial for tinnitus. Details: A small observational study in patients with tinnitus associated with cochlear dysfunction and metabolic syndrome suggests that taking alpha-lipoic acid 600 mg for 60 days is associated with improvements in several audiometric parameters and overall tinnitus handicap inventory scores, with a larger effect on functional and emotional scores, when compared to baseline. However, patients with tinnitus secondary to acoustic nerve lesions do not appear to benefit from alpha-lipoic acid supplementation (111705). The validity of these effects is limited by a lack of a comparator group.
Toxin-induced liver damage. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients being treated with anti-tuberculosis drugs shows that taking alpha-lipoic acid 250 mg, coenzyme Q10 200 mg, and acetyl-L-carnitine 250 mg twice daily for 2 weeks reduces the risk of drug-induced liver injury by 73% when compared with placebo (107445). It is unclear if these findings are due to alpha-lipoic acid, other ingredients, or the combination.
Vertigo. Oral alpha-lipoic acid has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in adults with benign paroxysmal positional vertigo with serum 25-hydroxyvitamin D levels less than 20 ng/mL shows that taking a specific combination product containing alpha-lipoic acid 600 mg, zinc 7.5 mg, L-carnosine 165 mg, curcumin 100 mg, piperine 1 mg, cholecalciferol 800 units, vitamin B2 0.8 mg, and vitamin B6 1 mg (Vertistop D, Difass) orally daily for 6 months moderately reduces the number of vertigo relapse episodes when compared with control. However, in patients with serum 25-hydroxyvitamin D levels greater than 20 ng/mL that took a specific combination product containing alpha-lipoic acid 600 mg, zinc 7.5 mg, L-carnosine 165 mg, curcumin 100 mg and piperine 1 mg (Vertistop L, Difass) orally daily for 6 months there was no difference in relapse episodes when compared with control (111294). It is unclear if this effect is due to alpha-lipoic acid, other ingredients, or the combination.
Vitiligo. It is unclear if oral alpha-lipoic acid is beneficial for vitiligo when used in conjunction with phototherapy. Details: When used in combination with phototherapy, clinical research shows that taking alpha-lipoic acid (Shandong Qidu Pharmaceutical Co., Ltd.) 300 mg daily for 6 months does not improve repigmentation when compared with placebo (104654). In contrast, a small clinical study shows that taking two tablets of a specific combination product (Lipoacid Combi, General Topics) containing alpha-lipoic acid 50 mg, vitamin C 50 mg, vitamin E 20 mg, and polyunsaturated fatty acids 12%, starting 8 weeks prior to ultraviolet B phototherapy and continuing for 6 months during phototherapy treatment, seems to increase the likelihood of repigmentation by 29% when compared with placebo (19210). It is not clear if this effect is due to alpha-lipoic acid, other ingredients, or the combination.
Wilson disease. Although there is interest in using oral alpha-lipoic acid for Wilson disease, there is insufficient reliable information about the clinical effects of alpha-lipoic acid for this condition.
Wound healing. It is unclear if oral alpha-lipoic acid is beneficial for wound healing. Details: A small clinical study shows that taking a specific alpha-lipoic acid product (Byodinoral 300, M.D.M. Spa) 300 mg one hour before and one hour after hyperbaric oxygen therapy administered daily for 14-30 days reduces wound area in 30% more patients with ischemic ulcers when compared with hyperbaric oxygen therapy alone (21677).
Wrinkled skin. Although there is interest in using topical alpha-lipoic acid for wrinkled skin, there is insufficient reliable information about the clinical effects of alpha-lipoic acid for this condition. More evidence is needed to rate alpha-lipoic acid for these uses.

(Read more about ALPHA-LIPOIC ACID)

COENZYME Q10

LIKELY EFFECTIVE

Coenzyme Q10 deficiency. Taking coenzyme Q10 orally improves symptomatic deficiency. Details: Rare cases of acquired coenzyme Q10 deficiency with symptoms of weakness, fatigue, and seizures have been reported (8160,8161). In adults, deficiency can be treated with coenzyme Q10 orally, 150-2400 mg daily in up to three divided doses. In children, 30 mg/kg, or 60-250 mg daily in up to three divided doses has been used (8160,8161,89417). Data from several multinational disease registries has also evaluated the use of coenzyme Q10 in patients with primary coenzyme Q10 deficiency, a rare genetic disorder. This data indicates that patients who take coenzyme Q10 supplements have a mean reduction of 88% in proteinuria at 12 months when compared with patients who do not take coenzyme Q10. In patients under 18 years of age with primary deficiency and chronic kidney disease at baseline, taking coenzyme Q10 supplements is associated with a 5-year survival without kidney failure of 62%, compared with 19% for those not taking coenzyme Q10 (108956).
Mitochondrial myopathies. Taking coenzyme Q10 orally seems to reduce symptoms in some patients with genetic and acquired mitochondrial dysfunction. Details: A specific coenzyme Q10 formulation (UbiQGel, Tishcon Corporation) has been evaluated for mitochondrial myopathies, including MELAS (myoclonic epilepsy with lactic acidosis and stroke-like episodes) syndrome, Kearns-Sayre syndrome, and MERRF (myoclonus epilepsy with ragged red fibers). Typical doses are 150-160 mg, or 2 mg/kg, daily, gradually increasing to 3000 mg daily in some cases. The onset of action is slow, with maximal effects around 6 months (8159,8162,8163,8912,11050,44240,97905).

POSSIBLY EFFECTIVE

Congestive heart failure (CHF). Oral coenzyme Q10 may provide benefit to patients with CHF by improving some, but not all, measures of disease severity when given in combination with conventional therapy. Details: Population research has found that CHF is associated with low coenzyme Q10 levels that correlate with severity of disease, and may be a predictor of mortality risk (44059,44220). A 2017 meta-analysis of clinical research shows that taking coenzyme Q10 30-300 mg, or 2 mg/kg, orally daily in two or three divided doses for up to 2 years, in addition to conventional therapy, improves exercise capacity, reduces hospitalizations, and reduces mortality by about 30% when compared with placebo. Other clinical research shows that adding oral coenzyme Q10 seems to improve quality of life and decrease symptoms of CHF such as dyspnea, peripheral edema, enlarged liver, and insomnia in patients with mild to severe (New York Heart Association (NYHA) class II-IV) CHF (6037,6038,6407,6408,6409,8909,12170,43967,43971,44042)(44277,44288,44289,44304,44334,44352,95610,96542). Additional clinical research shows that taking coenzyme Q10 30 mg daily for 1 year in addition to standard care reduces the incidence of atrial fibrillation by about 73% when compared with standard care alone in patients with NYHA class II-IV CHF (95609). However, not all evidence is positive. Some research suggests that coenzyme Q10 does not improve objective measures of CHF, including left ventricular ejection fraction (LVEF), cardiac output, or NYHA classification (5090,5248,6037,6038,43904,43932,96542,43932,97902). It is possible that the benefit of coenzyme Q10 depends on the dose and duration, the severity of CHF, and the specific conventional therapies taken concurrently (43973). A meta-analysis of 11 small, low-quality studies concludes that coenzyme Q10 probably reduces risk of all-cause and cardiovascular mortality, and of hospital admission for CHF, but data on improvement in LVEF or exercise capacity and the risk for myocardial infarction and stroke are inconclusive. However, the included studies used a range of coenzyme Q10 doses, varying concurrent therapy, short follow-up periods, and variable measures of treatment effect (108954). In patients with CHF with preserved ejection fraction (HFpEF) and a LVEF of 50% or greater, taking coenzyme Q10 600 mg daily for 12 weeks reduces B-type natriuretic peptide levels and improves Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, level of vigor, and LVEF when compared with placebo (108959).
Diabetic neuropathy. When taken alone or as add-on treatment with pregabalin, most research suggests that oral coenzyme Q10 reduces symptoms in patients with diabetes and neuropathy. Details: Clinical research shows that taking coenzyme Q10 400 mg orally daily for 12 weeks significantly improves nerve conduction and symptoms of neuropathic pain when compared with placebo in diabetic patients with polyneuropathy (44217). The beneficial effects of coenzyme Q10 have also been investigated as an add-on treatment in patients taking pregabalin 150 mg daily. Clinical research shows that taking coenzyme Q10 100 mg three times daily for 8 weeks reduces pain severity and sleep interference due to pain when compared with placebo. The proportion of patients taking coenzyme Q10 with a decline in pain of at least 50% was 47%, compared with 27% of those taking placebo. Despite these findings, there was no difference in patient global improvement (109391). However, some research disagrees. One clinical trial shows that taking coenzyme Q10 (Health Burst) 200 mg daily for 12 weeks does not affect neuropathic symptoms, including pain, sensations, and strength, when compared with placebo (109386).
Fibromyalgia. Oral coenzyme Q10 seems to improve both physical and psychological symptoms of this condition. Details: Clinical research in women with fibromyalgia shows that taking coenzyme Q10 300-400 mg orally daily for 40 days to 3 months improves pain by 24% to 56%, fatigue by 22% to 47%, sleep disturbances by 33%, morning tiredness by 56%, and tender points by 44% when compared with placebo. Patients also experience an improvement in psychological symptoms, including depression and anxiety (89416,97912,97913).
Ischemia-reperfusion injury. Oral or intravenous coenzyme Q10 may help reduce hypoxic damage during cardiac bypass or vascular surgery. Details: Clinical research shows that taking coenzyme Q10, 150-300 mg orally daily in up to 3 divided doses for 1-2 weeks before cardiac bypass or vascular surgery, or 5 mg/kg IV two hours prior to surgery, reduces hypoxic damage during the surgery (11902,11903,44031,44294). However, coenzyme Q10 has no effect on cardiac function or troponin levels (11904,44292).
Migraine headache. The American Academy of Neurology considers oral coenzyme Q10 to be possibly effective for migraine prevention in adults. Its benefit in children is unclear. Details: Two small open-label, non-randomized clinical trials in adults show that taking coenzyme Q10 100-150 mg daily decreases the frequency of headaches by up to 50% when compared with baseline or control, although it can take up to 3 months to see benefit (8135,95608). Higher quality research suggests a smaller benefit. A meta-analysis of small randomized controlled trials in adults shows that taking coenzyme Q10 alone or with other supplements reduces migraine attacks by 1.5 times per month and reduces duration of migraines by about 12 minutes when compared with control (105070). In children and adolescents, some clinical research shows that taking coenzyme Q10 orally, as 100 mg daily or 1-3 mg/kg daily, for 12-16 weeks does not improve headache frequency, severity, or duration when compared with placebo. However, it may reduce migraine frequency in children with low coenzyme Q10 levels (15256,44197). However, another clinical study shows that taking coenzyme Q10 daily is less effective than amitriptyline after one month, but as effective after 3 months, for improving headache frequency, severity, or duration, as well as quality of life. In this study, the dose of coenzyme Q10 was based on weight; 30 mg daily for children weighing less than 30 kg and 60 mg daily for children weighing at least 30 kg (109388).
Multiple sclerosis (MS). Oral coenzyme Q10 seems to reduce fatigue and depression associated with MS. Details: Clinical research shows that taking coenzyme Q10 500 mg orally daily for 3 months reduces fatigue and depression in patients with MS when compared with placebo (96539).
Muscular dystrophy. Oral coenzyme Q10 seems to improve physical performance in patients with muscular dystrophy of various forms. Details: Two small clinical studies show that taking coenzyme Q10 orally 100 mg daily for 3 months seems to improve physical performance when compared with placebo in some patients with various muscular dystrophies (2127).
Myocardial infarction (MI). Oral coenzyme Q10 seems to reduce cardiac events and improve survival in patients who have had an MI. It is unclear if coenzyme Q10 improves survival in patients after cardiac arrest. Details: One small clinical study in patients with acute MI shows that starting coenzyme Q10 60 mg twice daily within 72 hours of the MI appears to significantly reduce the risk of cardiac events, including non-fatal MI and cardiac death, by 52% when administered for 28 days and by 45% when administered for up to one year (10152,44330). Also, a small clinical study in patients with recent MI who received cardiopulmonary resuscitation, shows that administering a 250 mg loading dose of coenzyme Q10 solution followed by 150 mg three times daily through a nasogastric tube for 5 days improves the 3-month survival rate by 134% when compared with placebo (43935). However, another clinical study in a similar patient population conducted to replicate these results shows that administering coenzyme Q10 300 mg in 50 mL of Ensure every 12 hours for 7 days does not improve in-hospital mortality or neurological outcomes when compared with placebo (105068).
Peyronie disease. Coenzyme Q10 taken orally may reduce Peyronie disease severity. Details: Clinical research shows that, in patients with early chronic Peyronie disease, taking coenzyme Q10 (Kaneka Nutrients, Osaka) 300 mg orally daily for 24 weeks reduces new plaque formation and plaque size and improves erectile function when compared with placebo. Additionally, disease progression is slowed in about 76% of patients (44180).

POSSIBLY INEFFECTIVE

Alzheimer disease. Coenzyme Q10 appears to be ineffective for improving cognition. Details: One clinical study shows that taking coenzyme Q10 1200 mg orally daily for 16 weeks does not improve cognition scores when compared with placebo in patients with Alzheimer disease (19206).
Amyotrophic lateral sclerosis (ALS, Lou Gehrig's disease). Oral coenzyme Q10 does not attenuate functional decline in ALS patients. Details: Clinical research shows that taking coenzyme Q10 2700 mg orally daily for 9 months does not significantly attenuate a decline in ALS functioning scores when compared with placebo (44131). Higher doses, up to 3000 mg daily, have been tolerated by patients with ALS for 5 months, although the effect on ALS functioning at this dose is not known (43955).
Chemotherapy-related fatigue. Oral coenzyme Q10 does not seem to help with fatigue due to chemotherapy. Details: Clinical research shows that taking coenzyme Q10 100 mg orally three times daily for 24 weeks does not reduce chemotherapy-related fatigue or improve quality of life when compared with placebo in breast cancer patients undergoing chemotherapy with or without radiation (89420).
Diabetes. Most clinical research does not show any benefit with oral coenzyme Q10 in patients with type 1 or type 2 diabetes. However, some research suggests a possible benefit on insulin resistance. Details: Although a recent meta-analysis and some individual clinical research shows that coenzyme Q10 modestly reduces fasting glucose levels and glycated hemoglobin (HbA1c) in patients with type 1 or type 2 diabetes, most clinical research shows that coenzyme Q10 has no clinically meaningful effect on these parameters (456,492,2126,9890,96544,97911,97918,99636,11877,17704,44023,103778,109389). However, a recent meta-analysis in patients with type 1 or type 2 diabetes shows that improvements in insulin resistance may be clinically meaningful when compared with placebo (109389). In people with type 2 diabetes and nephropathy requiring hemodialysis, coenzyme Q10 120 mg orally daily for 12 weeks does not improve blood glucose levels, HbA1c, or lipid levels when compared with placebo, although it is associated with a decrease in serum insulin levels and insulin resistance (99636).
Parkinson disease. Most clinical research does not show any benefit with the use of oral coenzyme Q10 in patients with Parkinson disease. Details: While some conflicting evidence exists (8938,15255), a large clinical trial and a meta-analysis of 8 small clinical studies in patients with Parkinson disease show that taking coenzyme Q10 300-2400 mg daily for up to 2 years does not improve Parkinson disease symptoms at any stage of the disease, or slow progression of the disease, when compared with placebo (89421,95610). In addition, a clinical study in patients with mid-stage Parkinson disease shows that taking a specific nanoparticulate coenzyme Q10 supplement (Nanoquinon, MSE Pharmazeutilka) 100 mg orally three times daily does not reduce symptoms when compared with placebo (15395).
Post-polio syndrome. Muscle function in people with post-polio syndrome is not improved by oral coenzyme Q10. Details: Clinical research shows that taking coenzyme Q10 100 mg twice daily for 12 weeks does not improve muscle strength when compared with baseline, nor does it improve muscle function or muscle endurance when compared with placebo, in patients with post-polio syndrome (44054). Other clinical research shows that taking coenzyme Q10 100 mg daily for 60 days does not improve levels of fatigue when compared with placebo in patients with post-polio syndrome (97917).

LIKELY INEFFECTIVE

Athletic performance. There is some evidence that exercise can deplete coenzyme Q10 and that supplementation will prevent this depletion. However, there is no evidence that taking coenzyme Q10 is beneficial. Details: Clinical research shows that taking coenzyme Q10 orally does not improve aerobic or anaerobic power or perceived exertion in athletes and non-athletes (2109,2110,8911,44122,44227). While some evidence suggests coenzyme Q10 slightly improves tolerance to higher workloads, more research is needed to tell if coenzyme Q10 is effective for this purpose (8911). One clinical study shows that taking coenzyme Q10 300 mg orally daily for 8 days reduces exercise-induced fatigue when compared with placebo (44006); other research shows that doses of 100-200 mg do not have this effect (44122,44233,44299). Taking the ubiquinol form of coenzyme Q10 200 mg orally daily for one month prevents exercise-induced coenzyme Q10 depletion and decreases levels of reactive oxygen species in blood mononuclear cells in young male athletes performing an intense long-distance run. However, it does not affect physical performance or markers of muscle damage (99429).
Huntington disease. The ubiquinol form of coenzyme Q10 does not seem to improve function in people with this condition. Details: Ubiquinol, a reduced form of coenzyme Q10, has been evaluated for use in Huntington disease (11873). However, a large, high-quality study shows that taking coenzyme Q10 2.4 grams orally daily for up to 5 years does not slow the progression or functional decline in patients with Huntington disease (96538). Other studies using doses up to 600 mg daily also show no benefit (1357,8940).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Age-related macular degeneration (AMD). Oral coenzyme Q10 has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in adults with early AMD shows that taking a specific combination product (Phototrop, Sigma-tau Health Science Ltd.) containing coenzyme Q10 10 mg, acetyl-L-carnitine 100 mg, and omega-3 fatty acids 530 mg orally daily for 12 months seems to reduce the percentage of patients who experience deterioration of vision by about 50%, and the percentage who have reduced light sensitivity by about 39%, when compared with placebo (43946). The effects of coenzyme Q10 alone are unclear.
Aging. Although there has been interest in using oral coenzyme Q10 for aging, there is insufficient reliable information about the clinical effects of coenzyme Q10 for this purpose.
Angina. There is some limited clinical evidence that coenzyme Q10 can improve exercise tolerance and symptoms in people with this condition. Details: Preliminary clinical research shows that taking coenzyme Q10 50 mg three times daily orally for 4 weeks improves exercise tolerance in people with angina by about 18% (2121). Also, taking 60 mg once daily for 4 weeks improves heart failure scores, angina symptoms, and heart volume when compared to baseline in patients with stable angina (44336). The validity of these findings is limited by the lack of a comparator group.
Anthracycline cardiotoxicity. Evidence on the use of coenzyme Q10 to protect against anthracycline cardiotoxicity in adults and children is conflicting. Details: Preliminary clinical research in children aged 3-12 years shows that taking coenzyme Q10 orally 100 mg twice daily might protect against anthracycline cardiotoxicity (44279). However, evidence from larger clinical trials evaluating patients aged 16-77 years is conflicting. Results from one of these studies suggests that intravenous administration of coenzyme Q10 1 mg/kg daily the day before, the day of, and for 2 days after anthracycline treatment does not protect against cardiotoxicity (44267). Differences between the studies may be due to methodological problems, or differences in doses, route of administration, and age of participants.
Asthma. Oral coenzyme Q10 has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking a combination of coenzyme Q10 (Q-Gel, Tishcon Corporation) 120 mg, vitamin E 400 mg, and vitamin C 250 mg orally daily in addition to conventional anti-asthmatic therapy for 16 weeks might reduce the dosage of corticosteroids required by patients with mild to moderate asthma. However, it does not appear to improve lung function any more than standard therapy alone (43969).
Attention deficit-hyperactivity disorder (ADHD). It is unclear if oral coenzyme Q10 is beneficial in children with ADHD. Details: A small clinical study in children aged 6-16 years with ADHD who are unresponsive to atomoxetine therapy shows that taking coenzyme Q10 1-3 mg/kg with atomoxetine 0.5-1.8 mg/kg daily for 6 months improves parent-rated symptoms of ADHD, particularly hyperactivity-related symptoms, when compared with placebo plus atomoxetine (107449).
Autism spectrum disorder. It is unclear if the ubiquinol form of coenzyme Q10 taken orally is beneficial in children aged 3-6 years with this condition. Details: A small clinical study in children aged 3-6 years suggests that taking the reduced form of coenzyme Q10, ubiquinol (Li-QH, Tishcon Corporation), 50 mg orally once daily for one week followed by 50 mg twice daily for 11 weeks, improves symptoms of autism spectrum disorder, including communication with parents, ability to play with friends, verbal communication, sleeping, food rejection, aggressiveness, and self-harm, when compared with baseline, per parent assessment (89419). The validity of these findings is limited by the small study size, the use of parent assessment, and the lack of a comparator group.
Bipolar disorder. It is unclear if oral coenzyme Q10 is beneficial for bipolar disorder in older adults. Details: Preliminary clinical research in people 55 years of age or older with bipolar disorder shows that taking coenzyme Q10 800 mg orally daily for 4 weeks improves symptoms of depression when compared with baseline (95606). The validity of this finding is limited by the lack of a comparator group.
Breast cancer. Low coenzyme Q10 levels may be associated with an increased risk of breast cancer. The benefit of coenzyme Q10 supplementation is unclear. Details: Population research in Chinese women has found that low plasma coenzyme Q10 levels are associated with an increased risk of breast cancer (44194).
Cancer. Low coenzyme Q10 levels may increase the risk of cancer development and progression. Details: Population research has found that low coenzyme Q10 levels are associated with increased risk of metastatic melanoma (43959). Preliminary clinical research suggests that taking coenzyme Q10 150 mg twice daily along with vitamins A, C, and E, selenomethionine, beta-carotene, and folic acid extends survival time by 40% when compared with predicted survival in patients with end-stage cancer from various different primary sites (44159). It is unclear if this effect is due to coenzyme Q10, other ingredients, or the combination.
Cardiovascular disease (CVD). It is unclear whether oral coenzyme Q10 has a role in preventing complications from CVD. Details: Preliminary clinical research shows that taking coenzyme Q10 300 mg 2 hours prior to an elective percutaneous coronary intervention does not reduce periprocedural myocardial injury or prevent major adverse cardiac events during one month of follow-up (96543). Other clinical research shows that taking a combination of coenzyme Q10 (Bio-Quinon, Pharma Nord) 100 mg twice daily plus organic selenium yeast tablets (SelenoPrecise, Pharma Nord) 200 mcg daily for 4-5 years reduces the risk of death from CVD by 7% when compared with placebo in elderly people living in Sweden (92904). This benefit appears to persist even after supplement discontinuation, with an 18% reduction at 10 years and an 11% reduction at 12 years (96546,97466,97906). In this same trial, post-hoc subgroup analyses in patients with elevated baseline D-dimer levels and/or hypertension or ischemic heart disease shows that taking this combination reduces cardiovascular mortality when compared with placebo (105874). It is unclear if these benefits are due to coenzyme Q10, selenium, or the combination.
Cataracts. It is unclear if coenzyme Q10-containing eye drops are beneficial in patients undergoing cataract surgery. Details: Clinical research suggests that administering an ophthalmic solution containing coenzyme Q10 and vitamin E D-alpha-tocopheryl polyethylene glycol 1000 succinate twice daily for 9 months increases the speed of nerve regeneration when compared with saline solution in post-cataract surgery patients (44228).
Cerebellar ataxia. It is unclear if coenzyme Q10 is beneficial for this condition. Details: Preliminary clinical research in patients with cerebellar ataxia shows that coenzyme Q10 30 mg/kg daily for 2 years improves ataxia scores by 48%, posture scores by 63%, and kinetic function scores by 37% when compared with baseline, but only in patients who are coenzyme Q10 deficient (44177). The validity of these findings is limited by the lack of a comparator group.
Chronic fatigue syndrome (CFS). Oral coenzyme Q10 has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients with CFS shows that taking coenzyme Q10 200 mg plus NADH 20 mg daily for 8 weeks does not improve measures of fatigue, sleep, or quality of life when compared with placebo (107448).
Chronic obstructive pulmonary disease (COPD). It is unclear if coenzyme Q10 is beneficial for improving exercise tolerance in people with COPD. Details: Preliminary clinical research suggests that taking coenzyme Q10 90 mg daily for 8 weeks reduces lactate production during anaerobic exercise in people with COPD, but does not improve oxygen consumption or exercise performance, when compared with baseline (44293). The validity of these findings is limited by the lack of a comparator group.
Cocaine dependence. Oral coenzyme Q10 has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: One clinical study in patients with cocaine dependence shows that taking a combination of coenzyme Q10 200 mg and L-carnitine 500 mg orally daily for 8 weeks does not reduce cocaine use when compared with placebo, as measured by urine benzoylecgonine levels and self-reported usage (43940).
Coronavirus disease 2019 (COVID-19). It is unclear if oral coenzyme Q10 is beneficial for patients with persistent symptoms after COVID-19 infection. Details: Clinical research in individuals with previous confirmed COVID-19 infection and continued symptoms lasting more than 12 weeks shows that taking coenzyme Q10 (Pharma Nord) 100 mg five times daily for 6 weeks does not reduce the number or severity of symptoms when compared with placebo. The most common symptoms were concentration problems, mental and physical fatigue, headache, and/or muscle weakness (109392).
Critical illness (trauma). It is unclear if oral coenzyme Q10 is beneficial in patients hospitalized due to acute trauma. Details: Preliminary clinical research in patients who are mechanically ventilated due to acute trauma and have low baseline coenzyme Q10 plasma levels shows that taking sublingual coenzyme Q10 (Nutri Q10, Nutri Century) 400 mg daily for 7 days reduces the duration of intensive care stay, mechanical ventilation, and hospitalization by 4 days, 2 days, and 6 days, respectively, when compared with placebo. Patients taking coenzyme Q10 also demonstrated larger improvements in organ function scores and coma scores than those taking placebo (105875).
Cyclic vomiting syndrome (CVS). Limited evidence suggests oral coenzyme Q10 may reduce episodes of CVS. Details: Preliminary clinical research shows that taking coenzyme Q10 10 mg/kg orally twice daily is comparable to amitriptyline 0.5-1 mg/kg/day for reducing the number of CVS episodes in both children and adults (17703).
Diabetic nephropathy. Although there has been interest in using oral coenzyme Q10 for diabetic nephropathy, there is insufficient reliable information about the clinical effects of coenzyme Q10 for this purpose.
Dilated cardiomyopathy. Very small clinical studies suggest that children and adolescents with dilated cardiomyopathy may benefit from oral coenzyme Q10. Details: Preliminary clinical research in children with dilated cardiomyopathy suggests that taking coenzyme Q10 3-10 mg/kg daily, divided into 2-3 doses for up to 9 months, improves ejection fraction and New York Heart Association (NYHA) classification when compared to baseline (12199,13223). Also, in people under 20 years of age, taking a specific oral liquid formulation of coenzyme Q10 (QuinoMit Q10 Fluid, MSE Pharmazeutika GmbH), 10 mg/kg daily for 24 weeks produces a small increase in ejection fraction and improves NYHA class from II to I in 30% of patients (99427). The validity of these findings is limited by the lack of comparator groups.
Dry eye. Ophthalmic coenzyme Q10 has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research has evaluated the use of a specific eye drop (VisuXL, Visufarma) containing coenzyme Q10 and cross-linked hyaluronic acid, in a 1:1 ratio with alpha-tocopherol polyethylene glycol succinate. One study in menopausal women receiving antidepressants shows that placing 1 drop in each eye twice daily for 8 weeks reduces dry eye severity by 17% and improves tear break-up time when compared to 5 drops daily of carmellose eye drops (104553). In addition, another study in adults with mild to moderate dry eye shows that placing 1 drop in each eye four times daily for 12 weeks reduces dry eye severity by 14% and decreases some laboratory markers of dry eye when compared to hyaluronic acid alone. Both groups demonstrated similar improvement in meibomian gland function and tear break-up time (97909). The effect of coenzyme Q10 when used alone is unclear.
Dry mouth. It is unclear if oral ubiquinol or ubiquinone improves salivary secretion. Details: Preliminary clinical research suggests that taking coenzyme Q10, as the reduced ubiquinol form or as the oxidized ubiquinone form, 100 mg orally daily for one month, improves salivary secretion by 72% to 82% when compared with baseline in patients with dry mouth (44191). The validity of these findings is limited by the lack of a comparator group.
Erectile dysfunction (ED). It is unclear if oral coenzyme Q10 is beneficial in patients with ED. Details: A small, open-label study in patients with hypertension and complaints of ED shows that taking coenzyme Q10 200 mg daily for 3 months along with current antihypertensive therapy does not improve symptoms of ED when compared with antihypertensive therapy alone (107447).
Fatigue. It is unclear if oral coenzyme Q10 is beneficial for reducing fatigue. Details: A meta-analysis of low- to moderate-quality clinical research in mixed populations shows that taking coenzyme Q10 modestly reduces feelings of fatigue when compared with placebo. This improvement was consistent between groups of healthy individuals and individuals with fatigue related to disease. However, a sub-group analysis shows that benefits are limited to studies in which coenzyme Q10 was studied as a single ingredient. Doses of coenzyme Q10 ranged from 60 mg to 500 mg daily for 4-12 weeks with treatment effects appearing to be both dose- and duration-dependent (109387).
Friedreich ataxia. Oral coenzyme Q10 has been evaluated in combination with vitamin E; its effect when used alone is unclear. Details: Preliminary clinical research shows that taking coenzyme Q10 (Bio-Quinon Q10, Pharma Nord) 200 mg orally twice daily plus vitamin E (Bio-E-Vitamin, Pharma Nord) 1050 IU twice daily for 47 months improves measures of cardiovascular function by 20% when compared with baseline. However, it does not improve posture or gait, or prevent deterioration of posture, gait, speech, or eye function, when compared with baseline (43943,44064). It is unclear if these benefits are due to coenzyme Q10, vitamin E, or the combination. Also, the validity of these findings is limited by the lack of a comparator group.
Hearing loss. There is conflicting evidence regarding the effects of oral coenzyme Q10 on hearing loss of various etiologies. Details: Some clinical research shows that taking coenzyme Q10 terclatrate (Qter), a water-soluble formulation of coenzyme Q10, 160 mg orally daily for 30 days improves hearing thresholds when compared to baseline in patients with age-related hearing loss (44171,44184). However, taking coenzyme Q10 terclatrate 200 mg daily for 7 days does not significantly improve hearing thresholds when compared with placebo in patients with noise-induced hearing loss (44143). Also, combining coenzyme Q10 with conventional steroid therapy for 2 weeks does not improve hearing when compared with steroid therapy alone in patients with sudden sensorineural hearing loss (44185).
Hepatitis C. It is unclear if oral coenzyme Q10 is beneficial in patients with this condition. Details: Clinical research shows that taking coenzyme Q10 up to 80 mg orally daily for 28 days does not reduce serum liver enzymes when compared with placebo in patients with chronic hepatitis C who are unresponsive to conventional treatment (44172).
Hyperlipidemia. There is conflicting evidence regarding the effects of coenzyme Q10 on cholesterol levels in adults. However, any changes are unlikely to be clinically meaningful. Details: A meta-analysis of 50 moderate-quality clinical trials shows that taking coenzyme Q10 has small beneficial effects on levels of total cholesterol, low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides when compared with a control, usually placebo (109394). However, whether coenzyme Q10 produces clinically meaningful changes is unclear. In a subgroup of patients with dyslipidemia, coenzyme Q10 does not seem to have significant beneficial effects on total cholesterol (109394). Also, previous individual clinical trials and meta-analyses in specific populations, including studies in which lipoprotein A was measured, as well as populations with diabetes, coronary artery disease, and others, have not shown beneficial effects on plasma lipids (17704,44187,96545,97918,109394). The effect of coenzyme Q10 on lipoprotein A has also been investigated. Individual studies and a meta-analysis show that taking coenzyme Q10 slightly reduces plasma levels of lipoprotein A when compared with placebo (17704,44187,96545). Most studies have used doses of 100-500 mg daily for 4-24 weeks (17704,44187,96545,96547,97910,109394). Coenzyme Q10 has also been studied in combination with other ingredients. A moderate-sized, open-label clinical study in adults with mild hypercholesterolemia and low cardiovascular disease risk shows that taking a combination product containing coenzyme Q10 2 mg, red yeast rice, grape seed extract, olive tree leaf extract, and B vitamins (Arichol, Epsilon Health) daily for 8 weeks reduces total cholesterol and LDL cholesterol, but not HDL cholesterol or triglycerides, when compared with placebo (111559). The validity of this effect is limited by a lack of blinding. It is unclear if this effect is due to coenzyme Q10, other ingredients, or the combination.
Hypertension. Most research suggests that oral coenzyme Q10 may reduce systolic blood pressure (SBP), but not diastolic blood pressure (DBP). Details: Most clinical research shows that taking coenzyme Q10 100-900 mg orally daily in divided doses, either alone or with conventional medications, for up to 12 weeks significantly lowers SBP (2122,3365,9890,17702,17650,17651,44343,109393). One meta-analysis of moderate quality clinical research in patients with cardiometabolic disorders shows that supplementation with coenzyme Q10, especially 100-200 mg daily for at least 12 weeks, reduces SBP by 5 mmHg (109393). However, some studies show conflicting results. Most clinical research shows that coenzyme Q10 supplementation does not reduce DBP (8907,96541,109393). Also, a meta-analysis of two clinical studies (17651,44211) shows that taking coenzyme Q10 100-200 mg orally daily has no significant effect on blood pressure when compared with placebo (95607). Conflicting results may be due to differences in the severity of hypertension at baseline, adjustments made to conventional medications during studies, and the presence of a variety of concomitant conditions. Some data also suggest that effects may be greater in people with low baseline levels of coenzyme Q10 (2122,17650,17651).
Hypertrophic cardiomyopathy. It is unclear if oral coenzyme Q10 is beneficial for this condition. Details: A very small clinical study of 7 patients suggests that taking coenzyme Q10 (Vitaline) 120-240 mg orally daily with the goal of raising blood levels above 2 mcg/mL, might improve symptoms of hypertrophic cardiomyopathy, including dyspnea and fatigue, and decrease cardiac wall thickness, when compared to baseline (11031). The validity of these findings is limited by the small size of the study and the lack of a comparator group.
Infertility. It is unclear if oral coenzyme Q10 helps women undergoing assisted reproductive technology (ART) treatment. Details: A meta-analysis of 5 small clinical studies in infertile women undergoing ART treatment shows that although coenzyme Q10 increases the odds of clinical pregnancy more than 2-fold, it does not seem to affect the rate of live births or miscarriages when compared with placebo or no treatment (103780).
Kidney failure. Oral coenzyme Q10 has been reported to improve renal function in people with kidney failure, but not in those with less severe kidney disease. Details: Preliminary clinical research in patients with kidney failure shows that taking coenzyme Q10 180 mg orally daily for 28 days improves blood urea nitrogen, serum creatinine, and creatinine clearance when compared with placebo (44347). However, other clinical research in patients with less severe kidney disease shows that taking coenzyme Q10 200 mg daily for 8 weeks does not significantly improve kidney function parameters, including urinary albumin, total protein, or glomerular filtration rate, when compared with placebo (44128).
Lichen planus. It is unclear if topical coenzyme Q10 is beneficial for oral lichen planus. Oral coenzyme Q10 has not been studied for this condition. Details: A small clinical study in patients with oral lichen planus conducted in Egypt shows that applying topical coenzyme Q10 (ubiquinol) 120 mg as a mucoadhesive tablet 3 times daily for 4 weeks does not improve pain scores or lesion size when compared with topical corticosteroid paste (111617).
Male Infertility. Oral coenzyme Q10 may improve some measures of sperm function in males with infertility, but there is no convincing evidence that it can increase pregnancy rates. Details: One small clinical study in males with idiopathic asthenozoospermia shows that coenzyme Q10 200 mg orally daily for 6 months improves sperm motility when compared with baseline (12169). The validity of this finding is limited by the lack of a comparator group. Coenzyme Q10 has also been studied in males with idiopathic oligoasthenoteratozoospermia, but results are conflicting. Studies have used coenzyme Q10 or its reduced form, ubiquinol, in doses of 200-300 mg orally daily for 26 weeks. Sperm density and motility are increased when compared with placebo, but pregnancy rates do not seem to improve (17413,89422). Three studies have used coenzyme Q10 200-400 mg orally daily for 12-26 weeks, with two reporting increased sperm concentration and motility when compared to baseline, but the other finding no improvements when compared with placebo (44190,102008,107444). Coenzyme Q10 has also been investigated in combination with other ingredients. In one preliminary clinical trial, taking coenzyme Q10 10 mg and vitamin E 100 mg three times daily for 3 months modestly increases levels of testosterone and improves progressive sperm motility and morphology when compared with baseline. However, taking an L-carnitine nutrient complex 15 grams twice daily was more effective for increasing testosterone and for improving sperm parameters (109390). Other small and preliminary clinical studies have investigated the effects of a specific combination product providing coenzyme Q10 20 mg twice daily for 6 months, along with acetyl-L-carnitine, L-carnitine, selenium, zinc, vitamin C, folic acid, vitamin B12, and citric acid (Proxeed Plus). Taking this combination product has been shown to improve measures of sperm quality such as sperm count, sperm concentration, total motility, and progressive motility when compared to baseline. The effect on sperm volume and morphology is unclear. Most research has been conducted in patients with oligoasthenozoospermia, although some benefit has also been shown in patients with varicocele-related infertility, especially those with more severe varicocele (102017,107395,111296). The validity of these findings is limited by the lack of comparator group. Also, it is unclear if these effects are due to coenzyme Q10, other ingredients, or the combination.
Maternally inherited diabetes mellitus and deafness (MIDD). It is unclear if oral coenzyme Q10 is beneficial for MIDD. Details: One small clinical study shows that taking coenzyme Q10 150 mg orally daily for 3 years might prevent progressive insulin secretory defect, exercise intolerance, and hearing loss when compared with baseline in people with this rare form of diabetes (2125).
Metabolic syndrome. It is unclear if oral coenzyme Q10 is beneficial in patients with metabolic syndrome. Details: A small clinical study in patients with metabolic syndrome receiving healthy dietary recommendations shows that taking coenzyme Q10 60 mg daily for 12 weeks does not have beneficial effects on blood glucose, cholesterol, waist circumference, or blood pressure when compared with placebo (109284).
Myocarditis. It is unclear if oral coenzyme Q10 is beneficial in patients with acute viral myocarditis. Details: A small observational study in Chinese patients with acute viral myocarditis has found that taking coenzyme Q10 10 mg and trimetazidine 20 mg three times daily for 2 weeks, along with standard care, is associated with higher rates of resolution and improved quality of life when compared with coenzyme Q10 plus standard care alone (107443). While coenzyme Q10 alone appeared to improve symptoms and markers of cardiac function when compared to baseline in some patients, the validity of these findings is limited by a lack of placebo control.
Nonalcoholic fatty liver disease (NAFLD). Coenzyme Q10 may reduce liver enzymes and the severity of NAFLD. Details: Preliminary clinical research in adults with NAFLD shows that taking coenzyme Q10 100 mg orally daily for 12 weeks reduces the clinical grade of NAFLD and decreases plasma levels of liver enzymes when compared with placebo (97907).
Obesity. Oral coenzyme Q10 does not seem to improve weight loss in adults. Details: A meta-analysis of small, highly heterogeneous clinical trials shows that taking coenzyme Q10 100-300 mg daily for up to 24 weeks does not reduce weight or body mass index when compared with placebo. However, the included studies were not designed to assess for weight loss and involved patients with type 2 diabetes, metabolic syndrome, kidney disease, liver disease, rheumatoid arthritis, and other conditions (105067).
Periodontitis. Data on the effects of oral or topical coenzyme Q10 are conflicting. It is unclear if coenzyme Q10 is beneficial for periodontitis. Details: Some very small, low-quality studies suggest that taking coenzyme Q10 orally, 50 mg daily for 3 weeks, might be beneficial for periodontitis (8917,8918). Preliminary research with topical coenzyme Q10 suggests it is ineffective (2107,2108). However, a meta-analysis of 11 clinical trials evaluating coenzyme Q10 topical gel shows reductions in plaque index, bleeding index, pocket index, clinical attachment level, and gingival index when compared with placebo gel or scaling and root planing alone. The greatest effects are seen when coenzyme Q10 gel is applied directly into the periodontal pocket daily for at least six weeks in combination with scaling and root planing (108958). The validity of these findings is limited by a high risk of bias and the overall low quality of the included studies. Coenzyme Q10 has also been studied in combination with other ingredients for periodontitis. A small clinical study in patients with moderate or advanced periodontitis shows that taking a supplement containing 30 mg of coenzyme Q10 in addition to alpha-lipoic acid, cranberry extract, grapeseed extract, selenium, vitamin C, vitamin E, and zinc twice daily for 8 weeks in addition to standard nonsurgical therapy does not improve periodontal indices including bleeding on probing, gingival recession, plaque index, or inflammation, among others, when compared with placebo (111708).
Physical performance. It is unclear if oral coenzyme Q10 improves physical performance in older adults with chronic kidney disease (CKD). Details: A small clinical study in mostly older adults with CKD shows that taking coenzyme Q10 1200 mg daily for 6 weeks does not improve measures of physical exercise endurance including aerobic capacity, total work, and work efficiency when compared with placebo (111558). The validity of these effects is limited by the small sample size and short study duration.
Polycystic ovary syndrome (PCOS). Most clinical studies suggest that oral coenzyme Q10 modestly improves symptoms in patients with PCOS. Details: A meta-analysis of clinical trials in patients with PCOS shows that taking coenzyme Q10 modestly improves measures of glycemic response, as well as plasma lipids and some sex hormones, when compared with placebo (109384). However, any changes are small and the clinical relevance is unclear. Also, although nine studies were included in the review, the number of studies included for each endpoint was much lower. Most clinical studies included in the analysis used 100-200 mg daily for 8-12 weeks (107446,109384). An additional small clinical study also shows that taking coenzyme Q10 (Nature Made) 100 mg orally daily for 12 weeks reduces fasting plasma glucose, insulin, and total cholesterol and improves insulin sensitivity when compared with placebo. This study also found that taking coenzyme Q10 reduces alopecia by about 33% and acne by 48% when compared with placebo (97914). Another small clinical study shows that taking coenzyme Q10 100 mg daily for 12 weeks reduces depression, anxiety, and hirsutism when compared with placebo (107446).
Prader-Willi syndrome (PWS). It is unclear if oral coenzyme Q10 is beneficial in patients with PWS. Details: Preliminary clinical research in children with Prader-Willi syndrome shows that taking coenzyme Q10 2.5 mg/kg orally daily for one year improves psychomotor development similarly to growth hormone therapy, although this might reflect natural changes in the condition occurring over time (44005).
Pre-eclampsia. Taking coenzyme Q10 orally seems to reduce the rate of pre-eclampsia in women at risk for the condition. Details: Clinical research shows that taking coenzyme Q10 (Q-absorb, Jarrow Formulas) 100 mg orally twice daily during pregnancy, starting at 20 weeks gestation and continuing until term, reduces the rate of pre-eclampsia by about 44% when compared with placebo in women at risk for developing this condition (17201).
Schizophrenia. It is unclear if oral coenzyme Q10 improves symptoms in patients with schizophrenia or schizoaffective disorder. Details: A small clinical study in patients with schizophrenia or schizoaffective disorder shows that taking coenzyme Q10 300 mg daily for 6 months does not improve attention, working memory, negative symptoms, mood disorders, or quality of life when compared with placebo (105069). This finding is limited by insufficient power and poor protocol adherence, with only 61% of the participants taking at least 90% of the study treatment.
Sepsis. There is no strong evidence that coenzyme Q10 is helpful in the management of sepsis or septic shock. Details: Patients with septic shock have been shown to have low levels of coenzyme Q10, but the effects of supplementation are unclear. Some preliminary clinical research shows that taking coenzyme Q10 100 mg orally twice daily for 7 days reduces the risk of in-hospital mortality by 69% and improves markers of inflammation, but does not reduce length of ICU stay, when compared with conventional treatment alone (102548). However, other preliminary research shows that taking coenzyme Q10 as ubiquinol 200 mg twice daily for 7 days has no effect on inflammatory or vascular endothelial biomarkers, mortality, or length of stay when compared with placebo (96540). Both studies were small and likely underpowered to detect a meaningful change in clinical outcomes.
Statin-induced myalgia. There is conflicting evidence regarding the effects of oral coenzyme Q10 on statin-associated muscular adverse effects, such as myalgia. Details: Some clinical research shows that taking coenzyme Q10 (Q-Sorb softgel, Nature's Bounty) 100 mg orally daily for 30 days reduces pain intensity when compared with baseline or vitamin E control in patients with statin-induced myalgia (16008,44345). Other clinical research shows that taking coenzyme Q10 (MGC Company) 50 mg orally twice daily for 30 days reduces muscle pain and pain interference with daily activities by 30% to 40% when compared with placebo (95604). One small study in adults with statin-induced myalgia shows that taking liquid coenzyme Q10 (Q-Factor, Giellepi S.p.A) 100 mg orally daily for 3 months modestly reduces pain scores, but not plasma creatine kinase (CK) levels, when compared with placebo (102007). Other clinical research shows that taking coenzyme Q10 (Bio-Quinon, Pharma Nord) 100 mg twice daily, with or without selenium, for 3 months, reduces muscle pain and weakness, cramps, and tiredness when compared with placebo (92909). However, not all studies have shown benefit. Meta-analyses of several small randomized controlled trials show that taking coenzyme Q10 100-600 mg daily for 1-3 months does not improve muscle pain, statin tolerability, or plasma CK activity in patients with statin-induced myalgia when compared with placebo (95602,103781,106050). However, the validity of these results is limited by small population size and high heterogeneity. Other clinical research shows that taking coenzyme Q10 60 mg twice daily for 3 months does not improve muscle pain when compared with placebo (44218). Also, taking coenzyme Q10 (Q-Gel, Tishcon Corporation) 200 mg daily for 12 weeks does not affect myalgia scores when compared with placebo in patients taking simvastatin (44346). Additionally, taking high doses of coenzyme Q10 600 mg daily for 8 weeks does not affect the incidence, severity, or time to onset of statin-induced myalgia when compared with placebo in patients taking simvastatin (95603). Reasons for these conflicting findings are not entirely clear. The inconsistent results do not appear to be related to the dose of coenzyme Q10 or plasma CK levels. About 50% of patients who experience statin-induced myalgia will tolerate a statin re-challenge with a lower or equivalent dose of the same or alternative statin after a statin-free interval, which is a higher response rate than seen in currently available studies with the use of coenzyme Q10. Taking coenzyme Q10 for 30 days may be a reasonable option if other attempts to improve tolerance have failed. If a significant improvement in pain related to statin use is not seen after 30 days of taking coenzyme Q10, it is unlikely to be beneficial (96548).
Statin-induced myopathy. There is conflicting evidence regarding the effects of coenzyme Q10 on statin-associated muscular adverse effects, including myopathy. Details: Clinical research shows that taking coenzyme Q10 (Bio-Quinon, Pharma Nord) 100 mg orally twice daily, with or without selenium, for 3 months, reduces muscle weakness and pain, cramps, and tiredness when compared with placebo in patients with statin-induced myopathy due to atorvastatin, fluvastatin, rosuvastatin, or simvastatin (92909). Preliminary clinical research also shows that taking coenzyme Q10 60 mg orally four times daily decreases the rate of dose-limiting statin-induced myopathy in patients taking high-dose lovastatin as an investigational treatment for cancer (11899,11900). However, when coenzyme Q10 (Myoquinon, Pharma Nord,) 400 mg orally daily is used in combination with selenium for 12 weeks, it does not affect atorvastatin-induced myopathy when compared with placebo (92908).
Toxin-induced liver damage. Oral coenzyme Q10 has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small clinical study in patients being treated with anti-tuberculosis drugs shows that taking coenzyme Q10 200 mg, acetyl-L-carnitine 250 mg, and alpha-lipoic acid 250 mg twice daily for 2 weeks reduces the risk of drug-induced liver injury by 73% when compared with placebo (107445). It is unclear if these findings are due to coenzyme Q10, other ingredients, or the combination.
Ulcerative colitis. It is unclear if oral coenzyme Q10 is beneficial in patients with ulcerative colitis. Details: Preliminary clinical research in adults with ulcerative colitis shows that taking oral coenzyme Q10 (Nutri Q10, Nutri Century Company) 100 mg twice daily for 8 weeks modestly improves ulcerative colitis disease activity and quality of life scores when compared with placebo. Taking coenzyme Q10 also reduces systolic and diastolic blood pressure by 4 mmHg and 2 mmHg, respectively, when compared with placebo (106049). The clinical relevance of these changes is unclear.
Wrinkled skin. It is unclear if topical application of coenzyme Q10 cream can reduce wrinkles. Details: A small clinical study shows that applying a coenzyme Q10 1% cream to the skin twice daily for 5 months reduces objective wrinkle scores when compared to baseline (44082). The validity of this finding is limited by the lack of a comparator group. More evidence is needed to rate coenzyme Q10 for these uses.

(Read more about COENZYME Q10)

GRAPE

POSSIBLY EFFECTIVE

Chronic venous insufficiency (CVI). Oral grape leaf extract might improve CVI symptoms. It is unknown if other grape products are beneficial for CVI. Details: Some clinical trials in patients with CVI show that taking a specific grape leaf extract, known as red vine leaf extract (AS 195, Antistax, Boehringer Ingelheim), seems to improve leg edema after 6 weeks of treatment when compared with placebo. Doses of 360 mg and 720 mg daily were both effective, but the higher dose produced a slightly greater effect. Patients also reported decreases in subjective complaints such as tired or heavy legs, tension, and tingling and pain after 2-12 weeks of treatment (2538,52985,53005,53206).

POSSIBLY INEFFECTIVE

Allergic rhinitis (hay fever). Oral grape seed extract does not seem to improve hay fever symptoms. Details: A clinical study in patients with seasonal allergic rhinitis shows that taking grape seed extract 100 mg twice daily for 8 weeks before ragweed pollen season does not seem to decrease seasonal allergic rhinitis symptoms or antihistamine usage when compared with placebo (9182).
Chemotherapy-induced nausea and vomiting (CINV). Drinking grape juice does not seem to improve CINV. Details: Clinical research shows that taking 4 ounces of chilled Concord grape juice 30 minutes prior to meals for a week following each of four cycles of chemotherapy does not seem to reduce CINV when compared with placebo (53175).
Lower urinary tract symptoms (LUTS). Drinking grape juice does not seem to improve LUTS. Details: Clinical research in middle-aged and older men with LUTS shows that drinking 100% Concord grade juice 240 mL daily for 3 months does not improve symptoms when compared with placebo (96190).
Mastalgia. Oral grape seed extract does not seem to improve mastalgia symptoms. Details: Clinical research in patients treated for early breast cancer using high-dose radiotherapy shows that taking the grape seed extract constituent proanthocyanidin 100 mg orally three times daily for 6 months does not reduce breast tissue hardness, pain, or tenderness when compared with placebo (53048).
Obesity. Oral grape products do not seem to improve weight loss. Details: Clinical research in overweight or obese individuals shows that drinking Concord grape juice 480 mL daily for 12 weeks does not improve weight or body composition when compared to baseline (53181). Furthermore, taking grape pomace alone or in combination with schisandra fruit extract daily for 4-10 weeks does not improve body composition, abdominal fat, or body weight when compared with control (96200,99269,99270). Taking grape pomace 7-8 grams daily for 4-6 weeks seems to improve insulin resistance by about 33%, but does not affect blood lipids or blood pressure, when compared with placebo in overweight or obese adults with at least one metabolic syndrome factor (99269,99270).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Aging skin. Oral grape skin extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A small study in adults with signs of aging skin shows that taking a specific combination product (Celergen, Laboratories-Dom) containing grape skin extract 10 mg, marine collagen peptides 570 mg, coenzyme Q10 10 mg, luteolin 10 mg, and selenium 0.05 mg, one capsule with breakfast and dinner for 2 months, might improve skin elasticity when compared with baseline. However, there was no effect on moisture or biological skin age (97930). It is not clear if these effects are due to grape skin extract, the other ingredients, or the combination.
Age-related macular degeneration (AMD). Although there is interest in using oral grape seed for AMD, there is insufficient reliable information about the clinical effects of grape for this condition.
Atherosclerosis. Oral grape seed extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in postmenopausal adults shows that taking a specific combination product (Karinat, INAT-Farma) containing grape seed extract constituent proanthocyanidin 40 mg, garlic 100 mg, hops 160 mg, green tea 115 mg, vitamin C 30 mg, silicon 8 mg, vitamin E 6.6 mg, and beta-carotene 0.5 mg three capsules daily for 12 months might slow the progression of atherosclerosis as measured by mean carotid intima thickness when compared with placebo. However, the combination product does not seem to affect the growth of existing plaques, and it does not seem to improve lipid parameters (97929). It is not clear if these effects are due to grape seed extract, the other ingredients, or the combination.
Athletic performance. It is unclear if oral grape products are beneficial for athletic performance. Details: A small study in elite athletes shows that taking a specific grape extract (Powergrape, Naturex SA) 400 mg daily for one month can increase total power in a jumping task when compared with placebo, but has no effect on initial power and maintenance of power (53310). Another small study in recreationally active young adults shows that drinking juice prepared from 46 grams of a freeze-dried preparation of whole grapes daily for 6 weeks prior to a running exercise test does not improve maximal oxygen uptake or work capacity during exercise when compared with placebo (91540).
Atopic dermatitis (eczema). Topical grape products have only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research in patients with atopic dermatitis shows that twice daily application with a cream containing grape polyphenols, vitamin E, and epigallocatechin gallate for 28 days does not improve symptoms or reduce the affected area based on physician assessment when compared with placebo (96196).
Attention deficit-hyperactivity disorder (ADHD). Although there is interest in using oral grape seed for ADHD, there is insufficient reliable information about the clinical effects of grape for this condition.
Canker sores. Although there is interest in using oral grape seed for canker sores, there is insufficient reliable information about the clinical effects of grape for this condition.
Cardiovascular disease (CVD). It is unclear if oral grape products are beneficial for reducing CVD risk. Details: There is preliminary evidence that taking grape products, such as purple grape juice or red grape juice concentrate, might improve endothelium-dependent vasodilation, prevent low-density lipoprotein (LDL) oxidation, reduce markers of inflammation, and suppress platelet-mediated thrombosis. Theoretically, chronic ingestion of these products might reduce the risk of CVD in various patient populations, including adults with type 2 diabetes or hypercholesterolemia, those undergoing hemodialysis, and children with metabolic syndrome (8745,8746,52954,53030,53062,53106,53155,53174). However, a large meta-analysis shows that although taking grape products, including grape extract, grape juice, raisins, and grape seed extract, reduces levels of blood fats by a small amount in a mixed population of adults, these effects were not present in a subgroup of patients with CVD when compared with placebo. There was a small benefit on total cholesterol and high-density lipoprotein (HDL) cholesterol (102610).
Cognitive function. It is unclear if oral grape products improve cognitive function. Details: Clinical research in healthy adults aged 55-75 years with no cognitive decline shows that taking a specific grape fruit extract (Cognigrape, Bionap srl) 250 mg daily for 12 weeks improves cognitive functioning by 4.5%, and overall neuropsychological status, including attention, language, and recall, by 6%, compared with no change in the placebo group (96198). Also, a preliminary clinical study in middle-aged women under moderate stress shows that drinking Concord grape juice 355 mL daily for 12 weeks improves immediate spacial memory and may improve executive function and verbal recall when compared with placebo (96195).
Cognitive impairment. Small clinical studies suggest that oral grape products may not slow cognitive decline in older patients with cognitive impairment. Details: One very small study in in patients with mild cognitive decline shows that taking a freeze-dried grape powder 36 grams twice daily for 6 months does not improve most measures of cognitive function and memory, including immediate memory, delayed memory, speed of information processing, cognitive ability, or language, when compared with placebo (96199). Another very small study in older adults with signs of memory decline shows that drinking 100% Concord grape juice 6-9 mL/kg daily for 12 weeks does not improve delayed verbal recall or spatial memory when compared with placebo, although it does seem to moderately improve verbal learning (53166).
Colorectal cancer. Oral grape seed extract is has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Clinical research in patients with colorectal cancer shows that taking a product containing grape seed extract, turmeric extract, fermented soybean extract, green tea extract, spirulina, and Taiwanofungus camphoratus, 1920 mg three times daily for 16 weeks during a chemotherapy regimen might modestly increase the effectiveness of treatment when compared with placebo. No patients in the treatment group experienced disease progression, compared with 15.8% (6 patients) of the placebo group. However, there was no significant effect on overall survival or the best response to treatment (96183).
Constipation. Although there is interest in using oral grape products for constipation, there is insufficient reliable information about the clinical effects of grape for this condition.
Dental caries. Although there is interest in using topical grape seed for dental caries, there is insufficient reliable information about the clinical effects of grape for this purpose.
Diabetes. Oral grape extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large clinical study of males with type 2 diabetes mellitus and erectile dysfunction suggests that an oral combination product containing alpha lipoic acid, Gingko biloba, and grape extract (Blunorm Forte, Uriach S.p.A.) taken for 3 months may decrease fasting plasma glucose and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) score both alone and when combined with avanafil when compared with baseline and placebo (110707).
Diabetic retinopathy. It is unclear if oral grape seed extract is beneficial in patients with diabetic retinopathy. Details: A preliminary clinical study in patients with non-proliferative diabetic retinopathy shows that taking a specific grape seed proanthocyanidin extract (Entelon, Hanlim Pharm) 50 mg three times daily for 12 months reduces the severity of hard exudates when compared with calcium dobesilate or placebo. Grape seed extract had a treatment success rate 3-fold and 5.5-fold higher than those of calcium dobesilate and placebo, respectively. Treatment success was defined as a 2-grade decrease in hard exudate severity. No significant improvements in retinopathy grade or visual acuity were reported (100954). However, the study may not have been adequately powered to detect a difference in these outcomes.
Erectile Dysfunction (ED). Oral grape extract has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: A large study of males with type 2 diabetes mellitus and erectile dysfunction suggests that a specific combination product containing alpha lipoic acid, grape extract, and gingko biloba (Blunorm Forte, Uriach S.p.A.) administered orally for three months with avanafil prior to sexual acts improves International Index of Erectile Function (IIEF) scores when compared with either product alone, placebo, and baseline, and may reduce markers of ED including high sensitivity-c-reactive protein, nitrates/nitrites, and metalloproteinases-2 and -9. These results suggest that an oral combination nutraceutical consisting of alpha lipoic acid, grape extract, and gingko biloba (Blunorm Forte, Uriach S.p.A.) may react synergistically with avanafil to enhance sexual performance in males with type 2 diabetes and erectile dysfunction. It is unclear if this effect is due to the alpha lipoic acid, grape extract, or gingko biloba, but researchers theorize that it may be due to the inhibition of phosphodiesterase-5 enzymes by grape extract (110707).
Hemorrhoids. Although there is interest in using oral grape seed for hemorrhoids, there is insufficient reliable information about the clinical effects of grape for this purpose.
Hypercholesterolemia. Small clinical studies suggest that oral grape products reduce cholesterol levels by a small amount. Details: A large meta-analysis of heterogeneous clinical trials shows that taking grape products, including grape extract, grape juice, raisins, or grape seed extract, for 2-54 weeks reduces levels of total and low-density lipoprotein (LDL) cholesterol, as well as triglycerides, by a small amount when compared with placebo in a mixed population of adults. In a sub-group of patients with any hyperlipidemia, the mean decreases in LDL cholesterol and triglycerides were 11 mg/dL and 14 mg/dL, respectively. There was no effect on levels of high-density lipoprotein (HDL) in the mixed population or in adults with hyperlipidemia (102610). Although some individual studies disagree, the most evidence for benefit is related to use of whole grape extract or grape seed extract. It is not clear if benefit is dependent on dose or duration of use. These results suggest a benefit of grape products in patients with hypercholesterolemia, but any benefit is likely to be small (42585,96816,102610).
Hypertension. Some research suggests that oral grape products may modestly lower blood pressure; however, results are inconsistent. Details: Some clinical trials have shown modest benefit in patients with prehypertension, mild hypertension, or metabolic syndrome (18228,53149,96197), but conflicting results exists (91541,90079). A 2016 meta-analysis including 16 trials of 810 patients shows that when compared with placebo, grape seed extract or polyphenols reduces systolic blood pressure (SBP) and diastolic blood pressure (DBP) by about 6 mmHg and 3 mmHg, respectively, with greatest improvements observed in those with obesity or metabolic syndrome. This meta-analysis suggests that a minimum treatment duration of 8 weeks may be necessary before benefit is seen (96194). However, other research in adults with hypertension shows that taking grape seed polyphenols 1000 mg daily for 6 weeks does not alter blood pressure. Also, when grape seed polyphenols were combined with vitamin C 500 mg daily, some patients experienced an increase in blood pressure and worsening of nighttime and daytime variation in blood pressure (13162,90079). The reason for these conflicting findings is unclear but may due to patient characteristics and comorbidities. A meta-analysis of clinical research in various patient populations shows that taking grape seed extract 150-2100 mg for 2-25 weeks improves DBP and heart rate when compared with control, but does not improve SBP or flow-mediated dilation, regardless of dose, duration, sex, BMI, or health status. Additionally, subgroup analyses suggest that blood pressure effects may be greater in patients who are otherwise healthy, female, overweight, and/or under 50 years of age. Also, the use of lower doses and longer treatment durations may be associated with greater benefit (108090). The validity of these findings is limited by the high heterogeneity of included studies. A clinical study in adults with mildly elevated blood pressure shows that a specific grape seed extract (Enovita; Indena SpA) standardized to provide at least 95% oligomeric proanthocyanins, taken as 150 mg twice daily for 16 weeks, does not reduce SBP or DBP when compared with placebo. However, a subgroup analysis suggests that taking grape seed extract improves blood pressure in males, but not in females, when compared with placebo (108091). Some research has also evaluated the effects of grape juice on blood pressure. Two clinical studies in patients with hypertension show that drinking grape juice can reduce blood pressure when compared to baseline; however, another study shows that drinking grape juice does not reduce blood pressure when compared with placebo in these patients (53018,53156,53199).
Melasma. It is unclear if oral grape seed extract is beneficial in patients with melasma. Details: A very small clinical study in Japanese females with melasma shows that taking grape seed extract (Gravinol, Kikkoman Co) containing 54 mg of proanthocyanidins three times daily for 6-11 months reduces skin hyperpigmentation when compared to pretreatment (53016). The validity of this finding is limited by the lack of a control group.
Menopausal symptoms. It is unclear if oral grape seed extract is beneficial in patients with menopausal symptoms. Details: Preliminary clinical research in adults with at least one menopausal symptom shows that taking grape seed extract (Gravinol, Kikkoman Biochemifa Co) containing proanthocyanidin 200 mg daily for 8 weeks reduces anxiety when compared with placebo. It also reduces hot flashes and other physical symptoms when compared to baseline, but not when compared with placebo. A lower dose of proanthocyanidin 100 mg daily does not appear to improve these outcomes. Neither doses improved insomnia or depression (91542).
Metabolic syndrome. Small studies suggest that various oral grape products might improve lipid levels and blood pressure in patients with metabolic syndrome. Details: A meta-analysis of small clinical studies in adults with type 2 diabetes or metabolic syndrome shows that taking grape products, usually grape seed or grape extract, for 4-48 weeks reduces levels of total and low-density lipoprotein (LDL) cholesterol, as well as triglycerides, by a small amount when compared with placebo. The mean decreases in LDL cholesterol and triglycerides were 2.6 mg/dL and 11 mg/dL, respectively (102610). These findings are limited by significant heterogeneity of the included research. Also, a small clinical study in overweight or obese adults, most with metabolic syndrome, shows that taking grape pomace 8 grams daily for 6 weeks improves insulin resistance by about 33%, but does not affect blood lipids, blood pressure, or fasting glucose, when compared with placebo (99270). Some grape products have also shown benefit for improving blood pressure in patients with metabolic syndrome. One small clinical crossover study in males with metabolic syndrome shows that taking 46 grams daily of a freeze-dried, dehydrated preparation of grape polyphenols (equivalent to about 250 grams of fresh grapes daily) for 30 days seems to modestly lower systolic, but not diastolic, blood pressure, and increase brachial artery flow-mediated dilation (FMD) when compared with placebo (18228). Also, a small clinical study in adolescents with metabolic syndrome suggests that drinking natural grape juice 18 mL/kg daily for one month improves FMD when compared with baseline (53174).The validity of this finding is limited by the lack of a control group. A very small clinical study in patients with metabolic syndrome shows that taking a specific grape seed extract (Meganatural BP, Polyphenolics) 150-300 mg daily for 4 weeks modestly reduces blood pressure when compared with placebo (53149). The validity of this finding is limited due to small study size and because patients in the treatment groups had higher blood pressure at baseline.
Minor bleeding. Topical grape vine has only been evaluated in combination with other ingredients; its effect when used alone is unclear. Details: Preliminary clinical research shows that topically applying 4 mL of a specific product (Ankaferd blood stopper) containing grape vine, alpinia, licorice, thyme, and stinging nettle reduces bleeding, but does not improve the surgical time for episiotomy repair, when compared with saline (31010). It is unclear if this effect is due to grape vine, other ingredients, or the combination.
Muscle soreness. It is unclear if oral grape products improve muscle soreness. Details: One small study in active young adults shows that drinking juice, prepared from 46 grams of freeze-dried whole grapes, daily for 6 weeks prior to an eccentric arm exercise test does not reduce muscle inflammation or pain at 24 or 48 hours post-exercise when compared with placebo (91540).
Night vision. Although there is interest in using oral grape seed extract for improving night vision, there is insufficient reliable information about the clinical effects of grape for purpose.
Nonalcoholic fatty liver disease (NAFLD). It is unclear if oral grape seed extract reverses fatty liver in patients with NAFLD. Details: One small clinical study in adults with NAFLD shows that taking grape seed extract 1000 mg twice daily for 3 months improves some, but not all, markers of liver damage and improves the grade of fatty liver change when compared with vitamin C supplementation (53190).
Ocular stress. Although there is interest in using oral grape seed extract for ocular stress, there is insufficient reliable information about the clinical effects of grape for this purpose.
Premenstrual syndrome (PMS). Although there is interest in using oral grape seed extract for PMS, there is insufficient reliable information about the clinical effects of grape for this condition.
Wound healing. Limited research suggests that topical grape seed extract might improve wound healing. Details: A small clinical study in adults undergoing surgical removal of minor skin lesions shows that applying red grape seed extract 2% cream twice daily to the affected areas reduces the time to complete wound healing by about 6 days when compared with a placebo cream (91539). Also, preliminary clinical research in patients recovering from cesarean section shows that applying grape seed extract 5% ointment twice daily to cesarean section wounds for 14 days improves wound healing, as measured by a scoring system assessing redness, edema, ecchymosis, discharge, and wound closure, when compared with a placebo ointment. A 2.5% ointment did not improve wound healing measures when compared with placebo (100955). More evidence is needed to rate grape for these uses.

(Read more about GRAPE)

WINE (Red Wine)

POSSIBLY EFFECTIVE

Cardiovascular disease (CVD). In otherwise healthy adults, most population research shows that light to moderate consumption of alcoholic beverages, including wine, reduces the risk of developing coronary heart disease, myocardial infarction (MI), and ischemic stroke and reduces the risk of cardiovascular death. However, the definition of "moderate consumption" is unclear. Details: Consumption of alcoholic drinks, including wine, by otherwise healthy adults seems to reduce the risk of developing CVD. Moderate alcohol use (one to two drinks daily) reduces the risk of coronary heart disease, atherosclerosis, and MI by approximately 30% to 50% when compared with nondrinkers (2267,2268,2271,6888,6892,8648,8649,10128,11879,96690). Other observational research has found that drinking one or fewer glasses of wine weekly over 10 years is associated with a 60% lower risk of cardiovascular events. Light to moderate alcohol consumption also seems to reduce the risk of ischemic stroke (2271,2279,6834,6842,6893). But one large analysis has shown that individuals who report light to moderate consumption of alcohol have overall healthier lifestyles than those who abstain from alcohol and that adjusting for these lifestyle factors attenuates any of the cardioprotective epidemiological effects that have been associated with light to moderate alcohol intake (107884). Drinking more than one glass of wine weekly is not associated with lower cardiovascular risk when compared with abstaining from alcohol (102886).There is some evidence that light to moderate consumption of alcoholic drinks (one to two drinks daily), including wine, can also reduce the risk of all-cause mortality in people who are middle-aged or older (2058,6823,6837,6843). Conversely, consuming any amount of alcohol can increase the risk of hemorrhagic stroke (841,2271,6842). Light to moderate consumption of alcohol might also reduce the risk of cardiovascular mortality in otherwise healthy adults (2058,2270,6835,6837). Light to moderate alcohol consumption in the year prior to a first acute MI is associated with reduced cardiovascular and all-cause mortality risk when compared with non-drinkers (8650). Consumption of one alcoholic beverage daily or consuming alcohol on at least 3 to 4 days weekly is a good rule of thumb for people who drink alcohol. Tell patients not to exceed two drinks daily. More than two drinks daily can increase the risk of cardiovascular and overall mortality (841,2060,2261,6173,6890,8648,11879). Alcohol consumption has also been evaluated in patients with existing CVD, with some mixed findings. A meta-analysis of cohort data as well as published observational and randomized controlled studies in patients with existing CVD has found that consumption of 6-8 grams of alcohol daily is associated with a 21%, 27%, and 50% reduction in all-cause mortality, cardiovascular mortality, and cardiovascular events, respectively, when compared with non-drinkers (107817). Conversely, in males with established coronary heart disease (CHD), consumption of 1-14 alcoholic drinks weekly, including wine, does not seem to have any effect on CVD or all-cause mortality when compared with males who drink less than one drink weekly. Further, in males with a history of MI, consuming three or more drinks daily is associated with increased mortality (6173).
Cognitive function. Consumption of up to one alcoholic drink daily seems to improve general cognitive function in older males. Details: Observational research has found that elderly males who have a history of consuming up to one alcoholic drink daily seem to maintain better general cognitive function during their late 70s and 80s when compared with non-drinkers (6824,6829). However, consumption of more than four drinks daily during middle age seems to be associated with significantly poorer cognitive function in later life (6824).
Diabetes. Light to moderate consumption of alcohol, including wine, is associated with a reduced risk of developing type 2 diabetes and a reduced risk of coronary heart disease (CHD) in those with existing type 2 diabetes. However, the benefits of wine in the management of type 2 diabetes are unclear. Details: Observational research in healthy males has found that light to moderate alcohol consumption from wine and other sources is associated with a reduced risk of developing type 2 diabetes (6172,6891). A meta-analysis of 13 population studies has found that drinking about 1.5-2 five-oz glasses of wine daily is associated with the greatest reduction in the risk of developing diabetes in both males and females, with a 20% lower risk when compared with never drinking wine (96699). Additionally, in patients with a history of gestational diabetes, consuming approximately 3 servings of wine weekly is associated with a 44% to 54% lower risk of developing type 2 diabetes when compared with no consumption in age-adjusted and multivariate analyses, although this result was no longer significant when adjusted for BMI. Consumption of 1-2 servings of wine weekly was associated with a 42% lower risk of developing type 2 diabetes in age-adjusted analyses only (105948). Light to moderate alcohol consumption, including wine, is also associated with a reduced risk of coronary heart disease (CHD) in males and females with type 2 diabetes when compared with non-drinkers with type 2 diabetes. The risk reduction for CHD associated with light to moderate alcohol consumption in patients with type 2 diabetes is similar to that found in people without diabetes who consume light to moderate amounts of alcohol (8653,8654). Additionally, a cross-sectional study in patients with type 2 diabetes has found an inverse association between moderate alcohol consumption and carotid intima media thickness (107816). However, despite these promising results in observational research, clinical studies specifically addressing wine consumption in patients with type 2 diabetes show mixed results. A meta-analysis of 9 small clinical studies, most of which had a short follow-up period, shows that moderate wine consumption does not improve glycemic control, blood pressure, or lipid levels when compared with control beverages or alcohol abstinence in patients with type 2 diabetes (103187). However, another study not included in the above analysis that evaluated people with diabetes who abstained from alcohol prior to the study shows that drinking 5 oz of white wine, but not red wine, daily for 2 years reduces fasting blood glucose by 17 mg/dL and reduces homeostatic model assessment of insulin resistance (HOMA-IR) score by 1.2 when compared with drinking mineral water. In a subgroup analysis of slow ethanol metabolizers (homozygous carriers of the wild-type C alcohol dehydrogenase alleles, ADH1B*1), drinking red or white wine improves glycemic control when compared with patients that are fast ethanol metabolizers (homozygous for ADH1B*2) (96697). Another clinical study in patients with type 2 diabetes who are consuming a Mediterranean diet shows that drinking 150 mL of red or white wine daily with dinner for 2 years prevents progression of carotid atherosclerosis, though no progression occurred in a control group consuming 150 mL of mineral water daily with dinner (99641).
Helicobacter pylori. Moderate to high alcohol consumption seems to reduce the risk of Helicobacter pylori infection. Details: Observational research has found that moderate to high consumption of alcohol, more than 75 grams weekly, from beverages such as beer and wine, is associated with a reduced risk of Helicobacter pylori infection (8034).
Osteopenia. Observational research suggests that moderate alcohol consumption may improve bone mineral density (BMD) in postmenopausal patients. Details: Observational research has found that moderate alcohol consumption in postmenopausal patients is associated with increased BMD in the trochanter, femoral neck, mid-radius, and lumbar spine (6825,6836,8655). Alcohol intake of one-half to one drink daily seems to have the greatest effect on BMD when compared with non-drinkers and heavy drinkers of alcohol (8655).
Overall mortality. Light to moderate alcohol consumption seems to reduce the risk of all-cause mortality in middle-aged or older adults. Details: Observational research has found that light to moderate consumption of alcohol is associated with a reduced risk of all-cause mortality in people who are middle-aged or older (2058,6823,6837,6843).

INSUFFICIENT RELIABLE EVIDENCE to RATE

Alzheimer disease. It is unclear if wine consumption is beneficial for preventing Alzheimer disease. Details: A meta-analysis of observational research has found that light to moderate consumption of alcohol (less than 7.5 drinks weekly or 12.5 grams daily), preferably wine, is associated with a reduced risk of developing dementia, including Alzheimer disease, when compared with non-drinkers. The lowest risk of dementia was observed with consumption of 4 drinks weekly or 6 grams daily (97063).
Anxiety. It is unclear if alcohol consumption is beneficial for anxiety. Details: The effect of alcohol on anxiety is complex and may be affected by the psychological state of the user. It sometimes reduces anxiety, sometimes increases it, and sometimes has no effect (2266).
Atherosclerosis. It is unclear if moderate alcohol consumption is beneficial for atherosclerosis. Details: A cross-sectional study in patients with type 2 diabetes has found an inverse association between moderate alcohol consumption and carotid intima media thickness (107816).
Cancer. It is unclear if wine consumption is beneficial for preventing cancer or cancer-related mortality. The available evidence suggests variable effects depending on cancer type. Details: Observational research has found that intake of up to 21 alcoholic drinks weekly, including wine, might slightly reduce the risk of cancer-related mortality (6823). Moderate consumption of wine has also been associated with a DECREASED risk of developing bladder cancer (97989), brain cancer (96695), renal cell cancer (97060,97064), and multiple myeloma (97990). However, wine intake is not associated with changes in the risk of colorectal cancer (103189), endometrial cancer (97065) or gastric cancer (96694). Furthermore, wine consumption has been associated with an INCREASED risk of breast cancer (96686) and skin cancer (97991). Results of a meta-analysis suggest that moderate to heavy consumption of alcohol, including wine, in males is associated with an 11% reduction in the risk of developing non-Hodgkin lymphoma (99638).
Congestive heart failure (CHF). While light to moderate consumption of alcohol is associated with a reduced risk of developing CHF in older adults and a reduction in all-cause mortality in those with ischemic left ventricular (LV) dysfunction, it is unclear if moderate wine consumption is associated with these benefits. Details: Observational research in adults 65 years or older has found that consuming 1-4 alcoholic drinks daily is associated with a reduced risk of CHF (8104). There is conflicting evidence about whether moderate alcohol consumption improves outcomes in patients that already have CHF, although no exacerbation of CHF was found. Consumption of 1-14 alcoholic drinks per week is associated with reduced all-cause mortality in people with ischemic LV dysfunction when compared with non-drinkers with ischemic LV dysfunction. This benefit does not seem to occur for those patients with non-ischemic LV dysfunction (6827). However, other observational research has not found an inverse association between moderate wine consumption and rates of all-cause mortality, sudden death, or hospitalization in chronic heart failure patients (96689).
Dementia. It is unclear if wine consumption is beneficial for dementia. Details: A meta-analysis of observational research has found that light to moderate consumption of alcohol (less than 7.5 drinks weekly or 12.5 grams daily), preferably wine, is associated with a reduced risk of all-cause dementia when compared with non-drinkers. The lowest risk of dementia was observed with consumption of 4 drinks weekly or 6 grams daily. However, consumption of 23 or more alcoholic drinks weekly is associated with an increased risk of all-cause dementia (97063).
Depression. It is not clear if wine consumption is beneficial for depression. Details: Observational research has found that low to moderate consumption of wine (2-7 drinks weekly) is associated with a 32% lower rate of depression when compared with not consuming wine (96696).
Metabolic syndrome. There is limited evidence on the consumption of red wine for metabolic syndrome. Details: Observational research has found that moderate red wine consumption (at least one 5-ounce glass daily) is associated with a 44% lower odds of developing metabolic syndrome when compared with not drinking any red wine. The association appears to be strongest for females less than 70 years-old and for people who currently smoke or have a history of smoking. Drinking white wine does not seem to affect the risk of metabolic syndrome (97062).
Obesity. It is unclear if wine consumption is beneficial in patients with obesity. Details: Some observational research in non-smokers has found that higher wine consumption in adolescence is linked to lower mid-life body mass index (BMI) when compared with lower wine consumption. No association between wine consumption and mid-life BMI was reported in adolescent smokers over a 20-year follow-up (103188). It is unknown if wine consumption reduces the risk of developing obesity or improves weight loss in obese patients.
Systemic lupus erythematosus (SLE). It is unclear if wine consumption is beneficial in preventing SLE in females. Details: Observational research has found that modest daily alcohol consumption is associated with a reduced risk of developing SLE in females. When the data were stratified by alcohol type, 2 or more servings of wine weekly was associated with a 35% reduced risk of developing SLE when compared with not drinking alcohol (96684).
Wound healing. Although there has been interest in topical wine for wound healing, there is insufficient reliable information about the clinical effects of alcohol for this purpose. More evidence is needed to rate wine for these uses.

(Read more about WINE)

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Safety view details

Below is general information about the safety of the known ingredients contained in the product CoQ10 Energizer Formula. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ALPHA-LIPOIC ACID (Alpha Lipoic Acid)

POSSIBLY SAFE ...when used orally and appropriately. Alpha-lipoic acid has been used with apparent safety in doses of up to 2 grams daily for 3 months to 2 years. Lower doses of 600 mg daily have been used with apparent safety for up to 4 years (3540,3541,3542,20479,96449,97630,101867,101869,103327,103333)(103335,104651,104660). ...when used topically and appropriately. A cream containing alpha-lipoic acid 5% has been used with apparent safety in clinical trials lasting up to 12 weeks (12021). ...when given intravenously and appropriately. Intravenous alpha-lipoic acid has been used safely in doses of up to 6000 mg weekly in clinical trials lasting up to 3 weeks (3540,3557,10148,12106).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately. Alpha-lipoic acid has been used with apparent safety in doses of up to 600 mg daily for 3 months in children aged 10-17 years (103330).

CHILDREN: POSSIBLY UNSAFE
when used orally in amounts over 600 mg daily. At least five cases of alpha-lipoic acid intoxication have been reported for children aged 14 months to 16 years who consumed alpha-lipoic acid at doses up to 226 mg/kg (approximately 2400 mg). Symptoms of alpha-lipoic acid-induced intoxication included seizures, acidosis, vomiting, and unconsciousness (90444,96227,96234,104653).

PREGNANCY: POSSIBLY SAFE
when used orally and appropriately, short-term. Alpha-lipoic acid has been used safely during pregnancy at doses up to 600 mg daily for up to 4 weeks (96222).

LACTATION:
Insufficient reliable information available; avoid using.

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COENZYME Q10

LIKELY SAFE ...when used orally and appropriately. Coenzyme Q10 has been used safely in studies lasting up to 5 years (2134,6037,6038,6407,8163,8938,8939,8940,15395,17413,17716,96538)(109391). ...when used topically on the gums (2107,2108,8916,8917,8918).

CHILDREN: POSSIBLY SAFE
when used orally and appropriately. Coenzyme Q10 in doses of 1-10 mg/kg/day has been used safely for up to 9 months under medical supervision (12199,13223,15256,44005,107449).

PREGNANCY: POSSIBLY SAFE
when used orally and appropriately. Coenzyme Q10 100 mg twice daily has been used with apparent safety during pregnancy, starting at 20 weeks gestation until term (17201).

LACTATION:
Insufficient reliable information available; avoid using.

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GRAPE

LIKELY SAFE ...when used orally in amounts commonly found in foods. Grapes and grape skin extracts have Generally Recognized As Safe (GRAS) status for use in foods in the US (4912).

POSSIBLY SAFE ...when the whole fruit of the grape, or extracts of the fruit, seed, or leaf, are used orally and appropriately in medicinal amounts. Grape seed extracts have been used with apparent safety in doses up to 200 mg daily for up to 11 months (9182,53016) and in doses up to 2000 mg daily for up to 3 months (53149,53190). Specific grape fruit extracts (Stilvid, Actafarma; Cognigrape, Bionap srl) have been used with apparent safety in doses up to 250-350 mg daily for 3-12 months or 700 mg daily for 6 months (53254,53256,96198). A specific grape leaf extract (AS 195, Antistax, Boehringer Ingelheim) has been used with apparent safety in doses up to 720 mg daily for up to 3 months (2538,52985,53005,53206). A preparation of dehydrated whole grapes, equivalent to 250 grams of fresh grapes daily, has also been used with apparent safety for up to 30 days (18228). A specific grape seed extract (Enovita; Indena SpA) 150 mg twice daily, standardized to provide at least 95% oligomeric proanthocyanins, has been used with apparent safety for up to 16 weeks (108091) ...when used topically and appropriately. Creams and ointments containing grape seed extract 2% or 5% have been used topically with apparent safety for up to 3 weeks (91539,100955). There is insufficient reliable information available about the safety of other grape plant parts when used topically.

CHILDREN: LIKELY SAFE
when used orally in amounts commonly found in foods. Grapes and grape skin extracts have Generally Recognized As Safe (GRAS) status for use in foods in the US (4912). However, whole grapes should be eaten with caution in children aged 5 years and under. Whole grapes can be a choking hazard for young children (96193). To reduce the risk of choking, whole grapes should be cut in half or quartered before being given to children. There is insufficient reliable information available about the safety of grape when used in medicinal amounts in children.

PREGNANCY AND LACTATION: LIKELY SAFE
when used orally in amounts commonly found in foods. There is insufficient reliable information available about the safety of medicinal amounts during pregnancy and breast-feeding; avoid using in amounts greater than what is commonly found in foods.

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WINE (Red Wine)

LIKELY SAFE ...when used orally, responsibly, and in moderation (11880,97061).

POSSIBLY UNSAFE ...when used orally in excess of 1 to 2 five-oz glasses of wine daily. Larger amounts can cause significant adverse effects (11880). There is insufficient reliable information available about the safety of wine when used topically.

PREGNANCY: LIKELY UNSAFE
when used orally; alcohol is a teratogen. Use during pregnancy is associated with significant risk of spontaneous abortion, fetal alcohol syndrome, and developmental and behavioral dysfunction in infants and children exposed to alcohol in utero (8100); avoid using.

LACTATION: LIKELY UNSAFE
when used orally. Alcohol is secreted in breast milk. Chronic use can cause abnormal psychomotor development and disrupt the infant's sleep-wake pattern. Alcohol also seems to reduce milk production (11878); avoid using.

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Interactions with Drugs view details

Below is general information about the interactions of the known ingredients contained in the product CoQ10 Energizer Formula. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ALPHA-LIPOIC ACID (Alpha Lipoic Acid)

ALKYLATING AGENTS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, the antioxidant effects of alpha-lipoic acid might alter the effectiveness of alkylating agents.

Details

The use of antioxidants like alpha-lipoic acid during chemotherapy is controversial. There are concerns that antioxidants could reduce the activity of chemotherapy drugs that generate free radicals (391). However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells (14012,14013). More evidence is needed to determine what effect, if any, antioxidants such as alpha-lipoic acid have on chemotherapy. Advise patients to consult their oncologist before using alpha-lipoic acid.

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, alpha-lipoic acid may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.

Details

In vitro, alpha-lipoic acid inhibits platelet aggregation (98682).

ANTIDIABETES DRUGS

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = B

Theoretically, taking alpha-lipoic acid with antidiabetes drugs might increase the risk of hypoglycemia.

Details

Although some small clinical studies have suggested that alpha-lipoic acid can lower blood glucose levels (3545,3874,3875,3876,20490,20493,104650), larger clinical studies in patients with diabetes have shown no clinically meaningful effect (20494,20495,20496,90443,90445,110118). Additionally, co-administration of single doses of alpha-lipoic acid and glyburide or acarbose did not cause detectable drug interactions in healthy volunteers (3870).

ANTITUMOR ANTIBIOTICS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, the antioxidant effects of alpha-lipoic acid might alter the effectiveness of antitumor antibiotics.

Details

The use of antioxidants like alpha-lipoic acid during chemotherapy is controversial. There are concerns that antioxidants could reduce the activity of antitumor antibiotic drugs, which work by generating free radicals (391). However, some researchers theorize that antioxidants might make chemotherapy more effective by reducing oxidative stress that might interfere with apoptosis (cell death) of cancer cells (14012,14013). More evidence is needed to determine what effect, if any, antioxidants such as alpha-lipoic acid have on chemotherapy involving antitumor antibiotics. Advise patients to consult their oncologist before using alpha-lipoic acid.

THYROID HORMONE

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, alpha-lipoic acid might decrease the effects of thyroid hormone drugs.

Details

Animal research suggests that co-administration of thyroxine with alpha-lipoic acid reduces conversion into the active T3 form (8946).

(Read more about ALPHA-LIPOIC ACID)

COENZYME Q10

ALKYLATING AGENTS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Coenzyme Q10 has antioxidant effects. Theoretically, this may reduce the activity of chemotherapy drugs that generate free radicals.

Details

Theoretically, antioxidants such as coenzyme Q10 might protect tumor cells from chemotherapeutic agents that work by inducing oxidative stress, such as alkylating agents (e.g., cyclophosphamide) and radiation therapy (5158,5159). The clinical importance of this interaction is unknown.

ANTIHYPERTENSIVE DRUGS

Interaction Rating = Minor Be watchful with this combination.

Severity = Mild • Occurrence = Possible • Level of Evidence = B

Theoretically, coenzyme Q10 might have additive effects with antihypertensive drugs.

Details

Some clinical research shows that coenzyme Q10 can significantly lower blood pressure (2122,3365,8907,9890,17702,17650,17651,44343,96541), although other studies have shown conflicting results (17651,44211,95607).

WARFARIN (Coumadin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Coenzyme Q10 is chemically similar to menaquinone and might have vitamin K-like procoagulant effects, which could decrease the effects of warfarin.

Details

Concomitant use of coenzyme Q10 and warfarin might reduce the anticoagulant effects of warfarin (2128,6048,6199). Four cases of decreased warfarin efficacy thought to be due to coenzyme Q10 have been reported (2128,6048,11048). However, there is some preliminary clinical research that suggests coenzyme Q10 might not significantly decrease the effects of warfarin in patients who have a stable INR (11905).

(Read more about COENZYME Q10)

GRAPE

ANTICOAGULANT/ANTIPLATELET DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = D

Theoretically, grape extracts may have antiplatelet effects and may increase the risk of bleeding if used with anticoagulant or antiplatelet drugs.

Details

In vitro evidence suggests that grape extracts might decrease platelet aggregation (53017,53087).

CYCLOSPORINE (Neoral, Sandimmune)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Ingesting grape juice with cyclosporine can reduce cyclosporine absorption.

Details

A small pharmacokinetic study in healthy young adults shows that intake of purple grape juice 200 mL along with cyclosporine can decrease the absorption of cyclosporine by up to 30% when compared with water (53177). Separate doses of grape juice and cyclosporine by at least 2 hours to avoid this interaction.

CYTOCHROME P450 1A2 (CYP1A2) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Theoretically, grape juice might reduce the levels of CYP1A2 substrates.

Details

A small pharmacokinetic study in healthy adults shows that ingestion of 200 mL of grape juice decreases phenacetin plasma levels. This is thought to be due to induction of CYP1A2 (2539).

CYTOCHROME P450 2C9 (CYP2C9) SUBSTRATES

Interaction Rating = Minor Be watchful with this combination.

Severity = Moderate • Occurrence = Unlikely • Level of Evidence = D

It is unclear if grape juice or grape seed extract inhibits CYP2C9; research is conflicting.

Details

In vitro evidence shows that grape seed extract or grape juice might inhibit CYP2C9 enzymes (11094,53011,53089). However, a small pharmacokinetic study in healthy adults shows that drinking 8 ounces of grape juice once does not affect the clearance of flurbiprofen, a probe-drug for CYP2C9 metabolism (11094). The effects of continued grape juice consumption are unclear.

CYTOCHROME P450 2D6 (CYP2D6) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, grape seed extract may increase the levels of CYP2D6 substrates.

Details

In vitro evidence suggests that grape seed extract might inhibit CYP2D6 enzymes (53011). However, this interaction has not been reported in humans.

CYTOCHROME P450 2E1 (CYP2E1) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, grape seed extract might increase the levels of CYP2E1 substrates.

Details

In vitro and animal research suggests that grape seed proanthocyanidin extract inhibits CYP2E1 enzymes (52949). However, this interaction has not been reported in humans.

CYTOCHROME P450 3A4 (CYP3A4) SUBSTRATES

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

It is unclear if grape seed extract inhibits or induces CYP3A4; research is conflicting.

Details

In vitro evidence suggests that grape seed extract might inhibit CYP3A4 enzymes (53089). However, evidence from animal research shows that grape seed extract may induce CYP3A4 in the liver (53011). So far, these interactions have not been reported in humans.

MIDAZOLAM (Versed)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, long-term intake of grape seed extract might decrease the effects of midazolam.

Details

Animal research shows that subchronic ingestions of grape seed extract can increase the elimination of intravenous midazolam by increasing hepatic CYP3A4 activity. Single doses of grape seed extract do not appear to affect midazolam elimination (53011).

PHENACETIN

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Grape juice might decrease phenacetin absorption.

Details

A small pharmacokinetic study in healthy adults shows that ingestion of 200 mL of grape juice decreases phenacetin plasma levels. This is thought to be due to induction of cytochrome P450 1A2 (CYP1A2) (2539).

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WINE (Red Wine)

ACITRETIN (Soriatane)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = B

Concomitant use increases the risk of long-term teratogenic effects.

Details

Alcohol increases the transesterification of acitretin to etretinate, which is a teratogen that can remain in the body for years after discontinuation of acitretin. Patients of reproductive potential should avoid alcohol completely while taking acitretin and at least 2 months after discontinuation (108003).

ANTIDIABETES DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = C

Concomitant use may interfere with blood glucose control.

Details

Alcohol can impair gluconeogenesis and may increase the risk of acute hypoglycemia when used concomitantly with antidiabetes drugs (2262). However, the carbohydrates in wine may also worsen glycemic control in patients with diabetes.

ANTIHYPERTENSIVE DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = B

Theoretically, concomitant use may interfere with blood pressure control.

Details

Clinical research suggests that consumption of alcohol can increase both systolic and diastolic blood pressure (34015,34050,34052,34053). However, acute alcohol intoxication can also increase the risk of hypotension and additive effects with antihypertensive drugs (2262).

ASPIRIN

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = C

Concomitant use may increase the risk of gastrointestinal (GI) bleeding.

Details

Concomitant use of aspirin with alcohol may increase the risk of GI bleeding (2262).

BUPROPION (Wellbutrin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use may increase the risk of adverse effects from alcohol.

Details

In patients taking bupropion, there have been rare reports of adverse psychiatric events or reduced alcohol tolerance. Additionally, in chronic alcohol users, abrupt discontinuation of alcohol while taking bupropion may increase the risk of seizure (108023).

CEFAMANDOLE (Mandol)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = C

Concomitant use may cause a disulfiram-like reaction.

Details

Cefamandole can cause a disulfiram-like reaction when taken with alcohol (2262).

CEFOPERAZONE (Cefobid)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = C

Concomitant use may cause a disulfiram-like reaction.

Details

Cefoperazone can cause a disulfiram-like reaction when taken with alcohol (2262).

CETIRIZINE (Zyrtec)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use might increase the risk of CNS impairment.

Details

Cetirizine may cause somnolence in some patients. There is some concern that taking cetirizine in conjunction with alcohol might reduce alertness and impair CNS performance (108022).

CHLORPROPAMIDE (Diabinese)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = C

Concomitant use may cause a disulfiram-like reaction.

Details

Chlorpropamide can cause a disulfiram-like reaction when taken with alcohol (506).

CISAPRIDE (Propulsid)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = B

Concomitant use may increase blood alcohol levels and adverse effects.

Details

Concomitant use of alcohol can increase blood alcohol levels and adverse effects (2262). Also, red wine increases plasma cisapride concentrations, possibly by reducing metabolism (1383).

CITALOPRAM (Celexa)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use might increase the risk of adverse effects from alcohol.

Details

Some case reports suggest that citalopram may reduce alcohol tolerance and increase the risk of adverse effects from alcohol (108024).

CNS DEPRESSANTS

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Likely • Level of Evidence = C

Concomitant use may increase sedative and other adverse effects.

Details

Concomitant use of alcohol with CNS depressants can increase sedative and other adverse effects, potentially through inhibition of the metabolism of certain CNS depressants (2262).

CYCLOSPORINE (Neoral, Sandimmune)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = B

Red wine can reduce the levels and clinical effects of cyclosporine.

Details

Red wine reduces plasma cyclosporine concentrations, possibly by reducing cyclosporine absorption. There is evidence the reduction in cyclosporine AUC by red wine is less in Asians (8% to 14%) than Caucasians (35% to 36%) (1384,1387,8977).

DISULFIRAM (Antabuse)

Interaction Rating = Major Do not take this combination.

Severity = Moderate • Occurrence = Likely • Level of Evidence = C

Concomitant use may cause a disulfiram reaction.

Details

Disulfiram can cause a disulfiram reaction when taken with alcohol (2262). Patients taking disulfiram should not consume any alcohol.

DOXYCYCLINE (Vibramycin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = B

Chronic alcohol use might reduce the levels and clinical effects of doxycycline.

Details

Although acute alcohol ingestion does not seem to significantly impact the pharmacokinetics of doxycycline, chronic alcohol ingestion has been shown to significantly reduce the half-life and serum concentration of doxycycline (107998).

ELUXADOLINE (Viberzi)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = A

Chronic or excessive alcohol use might increase the risk of pancreatitis from eluxadoline.

Details

In clinical studies, the risk of pancreatitis with eluxadoline was increased in chronic alcohol users and in those with acute intake of 3 or more alcoholic beverages daily (108004).

ERYTHROMYCIN

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = C

Concomitant use may increase blood alcohol levels and adverse effects.

Details

Concomitant use of erythromycin with alcohol can increase blood alcohol levels and adverse effects (2262).

FELODIPINE (Plendil)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = B

Consumption of red wine can rapidly increase felodipine levels and adverse effects.

Details

Red wine taken on an empty stomach can cause "dose dumping" of extended-release felodipine, possibly by changing absorption or metabolism. Red wine can delay the appearance of felodipine in plasma until 4 hours after dosing and can rapidly increase its plasma concentration, producing peak serum levels 3 to 4 times higher than when felodipine is given with water. This can cause an increase in adverse effects 5 hours after dosing (11976).

FLIBANSERIN (Addyi)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = A

Concomitant use increases the risk of severe hypotension and syncope.

Details

Alcohol use is contraindicated in patients taking flibanserin due to the risk of severe hypotension and syncope (108002).

GRISEOFULVIN (Fulvicin)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = C

Concomitant use may cause a disulfiram-like reaction.

Details

Griseofulvin can cause a disulfiram-like reaction, including tachycardia and facial flushing, when taken with alcohol (2262).

H2-BLOCKERS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = C

Concomitant use might increase blood alcohol levels and adverse effects.

Details

Concomitant use of the H2-blockers cimetidine and ranitidine with low doses of alcohol (0.15 grams/kg) might increase blood alcohol levels and adverse effects. Effects with higher doses of alcohol (0.3-1.5 grams/kg) are variable (2262).

HEPATOTOXIC DRUGS

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = C

Concomitant use of alcohol with hepatotoxic drugs may increase the risk of hepatotoxicity.

Details

Concomitant use of excessive amounts of alcohol with potentially hepatotoxic drugs can increase the risk of liver damage (2262).

LEVOCETIRIZINE (Xyzal)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use might increase the risk of CNS impairment.

Details

Levocetirizine may cause somnolence in some patients. There is some concern that taking levocetirizine in conjunction with alcohol might reduce alertness and impair CNS performance (108026).

LEVOMILNACIPRAN (Fetzima)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use may increase the absorption and elimination of levomilnacipran.

Details

In vitro research shows that alcohol increases the release of levomilnacipran from extended-release capsules, resulting in complete drug release in 4 hours (108024). This effect has not been evaluated in humans.

METFORMIN (Glucophage)

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = C

Concomitant use may increase the risk of lactic acidosis.

Details

Concomitant consumption of large amounts of alcohol can increase the risk of lactic acidosis with metformin (107995).

METRONIDAZOLE (Flagyl)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = C

Concomitant use may cause a disulfiram-like reaction.

Details

Although there is some disagreement over the likelihood of a disulfiram-like reaction with concomitant use of alcohol and metronidazole (108000), prescribing materials recommend discontinuing alcohol intake during the use of metronidazole. In the US, it is recommended to discontinue alcohol during and for at least three days after therapy with metronidazole (107999); in Canada, it is recommended to discontinue alcohol during and for at least 1 day after therapy with metronidazole (108001).

MONOAMINE OXIDASE INHIBITORS (MAOIs)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = D

Concomitant use may cause hypertensive crisis.

Details

Wine contains tyramine (105702), which is metabolized by monoamine oxidase. Concurrent use of MAOIs with tyramine-containing beverages can lead to elevated levels of tyramine in the body. This can increase the effects of tyramine, which has been reported to cause hypertension, headache, and hypertensive crisis in numerous cases (100189,100192,101010). Sensitivity to tyramine can increase up to 10-fold to 100-fold in people using an MAOI (100189,101010).

NARCOTIC DRUGS

Interaction Rating = Moderate Be cautious with this combination.

Severity = High • Occurrence = Possible • Level of Evidence = C

Concomitant use of large amounts of alcohol may decrease the metabolism of narcotic drugs.

Details

Concomitant consumption of large amounts of alcohol can decrease the metabolism of narcotic drugs (2262).

NONSTEROIDAL ANTI-INFLAMMATORY DRUGS (NSAIDs)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = C

Concomitant use may increase the risk of gastrointestinal (GI) bleeding.

Details

Concomitant use of NSAIDs with alcohol may increase the risk of GI bleeding (2262).

PHENYTOIN (Dilantin)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = C

Concomitant use may decrease the effectiveness of phenytoin.

Details

Chronic, heavy alcohol use can induce the metabolism, reducing therapeutic effectiveness of phenytoin (2262).

SECNIDAZOLE (Solosec)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Concomitant use may cause a disulfiram-like reaction.

Details

Although high quality evidence is lacking, there is concern that secnidazole can cause a disulfiram-like reaction when taken with alcohol. Prescribing materials in the US recommend discontinuation of alcohol during and for at least two days after therapy with secnidazole (107996).

SULFONAMIDE ANTIBIOTICS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = C

Concomitant use may cause a disulfiram-like reaction.

Details

Sulfonamide antibiotics can cause a disulfiram-like reaction when taken with alcohol (2262).

TINIDAZOLE (Tindamax)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Concomitant use may cause a disulfiram-like reaction.

Details

Although high quality evidence is lacking, there is concern that tinidazole can cause a disulfiram-like reaction when taken with alcohol. Prescribing materials in the US recommend discontinuation of alcohol during and for at least three days after therapy with tinidazole (107997).

TOLBUTAMIDE (Orinase)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = C

Theoretically, concomitant use may cause a disulfiram-like reaction.

Details

Tolbutamide can cause a disulfiram-like reaction when taken with alcohol (2262).

VARENICLINE (Chantix)

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Possible • Level of Evidence = D

Theoretically, concomitant use may increase the risk of adverse effects from alcohol.

Details

There have been reports of patients experiencing increased effects from alcohol while taking varenicline. Some cases involved unusual and sometimes aggressive behavior and were accompanied by amnesia (108021). Caution patients to use alcohol with caution when taking varenicline, as it may alter alcohol tolerance.

VASODILATORS

Interaction Rating = Moderate Be cautious with this combination.

Severity = Moderate • Occurrence = Probable • Level of Evidence = C

Concomitant use may increase the risk of acute hypotension.

Details

Acute alcohol intoxication can increase the risk of hypotension and additive effects with vasodilators (2262).

WARFARIN (Coumadin)

Interaction Rating = Major Do not take this combination.

Severity = High • Occurrence = Probable • Level of Evidence = C

Alcohol can alter the effects of warfarin, although the exact effect depends on the nature of alcohol consumption.

Details

Acute alcohol intoxication can decrease metabolism and increase the effects of warfarin. In contrast, chronic, heavy alcohol use can induce metabolism of warfarin, reducing therapeutic effectiveness (2262).

(Read more about WINE)

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Adverse Effects view details

Report an Adverse Reaction to CoQ10 Energizer Formula

Below is general information about the adverse effects of the known ingredients contained in the product CoQ10 Energizer Formula. Some ingredients may not be listed. This information does NOT represent a recommendation for or a test of this specific product as a whole.

ALPHA-LIPOIC ACID (Alpha Lipoic Acid)

General ...Alpha-lipoic acid appears to be generally well tolerated when used orally, intravenously, or topically.
Most Common Adverse Effects:
Orally: Headache, heartburn, nausea, and vomiting.
Topically: Irritation and rash.
Intravenously: Nausea and vomiting.
Serious Adverse Effects (Rare):
Orally: Case reports have raised concerns about insulin autoimmune syndrome (IAS).

Cardiovascular ...Orally, hypotension has been reported rarely in a clinical trial (104650).

Dermatologic ...Orally, skin rash and itching have been reported after use of alpha-lipoic acid (16391,20490,21674,96233,104650). Topically, alpha-lipoic acid can cause local irritation, including burning, stinging, mild rash, or contact dermatitis (12021,30836,111701). In one case, an 86-year-old female developed allergic contact dermatitis with severe itching and oozing after applying alpha-lipoic acid 5% cream to her lower extremities. The patient had a positive skin patch test for alpha-lipoic acid, confirming the causative agent (111701). In another case, a 47-year-old female developed contact dermatitis characterized by a pruritic rash and labial adhesions hours after applying a 5% vulvar serum containing lipoic acid 0.9 grams, vitamin E, vitamin C, hyaluronic acid, and retinol palmitate to the vulva to treat vulvar lichen sclerosis. Testing confirmed that the causative agent was alpha-lipoic acid (111704). Intravenously, local allergic reactions have occurred at the injection site (1547).

Endocrine ...Orally, at least 50 published cases of insulin autoimmune syndrome (IAS) thought to be associated with use of alpha-lipoic acid have been reported (16392,104656,104657,104658,104659,107893,112941). Most reported cases have been associated with alpha-lipoic acid supplements or enriched foods; IAS has not been reported with intake of alpha-lipoic acid in food. IAS has been linked to compounds, such as alpha-lipoic acid, that contain sulfhydryl groups, but it is unclear if taking alpha-lipoic acid with other drugs known to trigger IAS increases the risk (107893,112941). IAS is characterized by very high serum insulin levels and high titers of autoantibodies against endogenous insulin. Sulfhydryl groups interact with disulfide bonds of insulin, increasing its immunogenicity (112941). Symptoms include severe spontaneous hypoglycemic episodes, as well as hunger and neuroglycopenic symptoms such as blurred vision, weakness, confusion, dizziness, sweating, and palpitations (104656,104657,107893,112941). Time to onset of IAS ranges from 1 week to 4 months (107893). Most cases of IAS have been reported in Japan and have occurred in individuals with the human leucocyte antigen (HLA)-DRB1*04:06 allele (16392,104656,107893). For patients of European decent, cases of IAS have mainly occurred in individuals with the HLA-DRB1*04:03 allele (104656,104658,104659,107893). This suggests that either of these alleles might produce a genetic predisposition to alpha-lipoic acid-associated IAS. Reported doses of alpha-lipoic acid have ranged from 200-800 mg daily, most commonly 600 mg daily (104656,104658,104659,107893). IAS-related hypoglycemic episodes have been treated with oral or intravenous glucose or sucrose, as well as prednisone. Episodes decline following discontinuation of alpha-lipoic acid, and insulin values normalize within 3-9 months (104656,104658,104659,107893).

Gastrointestinal ...Orally, heartburn, nausea, and vomiting have been reported after use of alpha-lipoic acid (3557,12106,16391,20475,30844,96225,101868,103327,103328,103333)(103335,104650,104654,104655). Higher doses (1200-1800 mg daily) seem to cause more severe effects than lower doses (600 mg daily) (3557,20475,30844,96225). Alpha-lipoic acid may also cause a burning sensation from the throat to the stomach, abdominal discomfort, or bitter taste when used orally (20478,20490,21664,96225). Intravenously, alpha-lipoic acid can cause gastrointestinal upset, including nausea and vomiting. Adverse effects are more common in patients receiving higher intravenous doses (3557) and may be more common in the elderly (96225).

Genitourinary ...Orally, alpha-lipoic acid may cause urinary disorders (20479). Oral alpha-lipoic acid has also been associated with a change in urine odor (96225,103327).

Neurologic/CNS ...Orally, alpha-lipoic acid may cause headache (21664,103328,104655) or dizziness (104650).
Intravenously, paresthesias have been reported to worsen temporarily at the beginning of therapy. Also, intravenous alpha-lipoic acid can cause headache. Adverse effects are more common in patients receiving higher intravenous doses (3557).

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COENZYME Q10

General ...Orally, coenzyme Q10 is generally well tolerated. In clinical studies, no serious adverse effects have been reported.
Most Common Adverse Effects:
Orally: Gastrointestinal side effects such as appetite suppression, diarrhea, epigastric discomfort, heartburn, nausea, and vomiting. These generally occur in less than 1% of patients. Some of these adverse effects can be minimized if daily doses above 100 mg are divided.

Cardiovascular ...Palpitations have been reported as being possibly associated with coenzyme Q10 treatment (89421). Death due to myocardial infarction occurred in one Parkinson disease patient taking coenzyme Q10; causality is unclear (15395).

Dermatologic ...Two of 143 participants in a case series reported skin itching after starting treatment with oral coenzyme Q10 (6047). Allergic rash has also been reported (6409,11872). An itching exanthema was seen in two heart failure patients treated with intravenous coenzyme Q10 (44284).

Gastrointestinal ...Gastrointestinal side effects of coenzyme Q10 have included nausea (3365,6409,8907,10152,43982,44172,44179,44330,89421,109392), vomiting (3365,10152,44330,89421), epigastric discomfort (3365,44179,44330,89421), constipation (109392), diarrhea (44179,92904,89421,109392), stomach upset (8940,12170,109387,109388,109392), loss of appetite (2121), heartburn (2121,44179,109392), and flatulence (43982), although this occurs in less than 1% of patients. In one clinical study, gastrointestinal bleeding in association with angiodysplasia has been reported to be possibly related to coenzyme Q10 treatment (89421).

Genitourinary ...An uncomplicated urinary infection was reported in a patient taking oral coenzyme Q10 (nanoQuinon, MSE Pharmazeutika) (44020).

Hematologic ...Thrombocytopenia was noted in one patient treated with oral coenzyme Q10 (44296); however, other factors (viral infection, other medications) may have been responsible for this adverse effect.

Musculoskeletal ...Increased plasma creatine kinase with high-intensity exercise has been reported in patients taking coenzyme Q10 (44303). Muscle pain has been reported rarely in one clinical trial (109392).

Neurologic/CNS ...Headache and dizziness have been reported in human research (3365,11872,43982,44330,109392). Insomnia has been reported as being possibly associated with coenzyme Q10 treatment (89421). Cognitive decline, depression, and sudden falls were reported rarely in a clinical trial of patients with Huntington disease (8940). Increased lethargy was reported for one patient treated with oral coenzyme Q10 (44042). Feeling of internal trembling has been reported in a clinical trial for one patient treated with coenzyme Q10 (44020).

Ocular/Otic ...Visual sensitivity to light has been reported for a patient treated with coenzyme Q10. However, the association of this effect with coenzyme Q10 treatment was not clear (6409).
A burning sensation has been reported for 10% of patients treated with a topical eye solution containing coenzyme Q10 and alpha-tocopheryl polyethylene glycol 1000 succinate following cataract surgery (44228).

Psychiatric ...Worsening depression has been reported as being possibly associated with oral coenzyme Q10 treatment (89421).

Pulmonary/Respiratory ...Drug-induced pneumonitis was diagnosed in a 61 year-old woman who had been taking coenzyme Q10 and perilla leaf extract for two months (43978). Symptoms improved after she stopped taking the supplements and began taking oral prednisone. Causation from coenzyme Q10 was unclear.

Other ...In a case report, a naval aviator using a supplement containing coenzyme Q10 and niacin had reduced G tolerance (44186). G tolerance was regained with cessation of the supplement.

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GRAPE

General ...Orally, the whole fruit, as well as the seed, fruit, and leaf extracts, seem to be well tolerated. Topically, grape seed extracts seem to be well tolerated.
Most Common Adverse Effects:
Orally: Abdominal pain, diarrhea, dry mouth, dyspepsia, headache, joint pain, and nausea.
Serious Adverse Effects (Rare):
Orally: Anaphylaxis to grape skin has been reported.

Dermatologic ...Orally, mild hair thinning has been reported in a patient taking a specific grape leaf extract AS195 KG) (2538). Urticaria (hives) has also been reported with this same extract (53206). Cases of contact dermatitis have been reported in grape workers, including those working in California vineyards (53270,53272,53275).

Gastrointestinal ...Orally, abdominal pain and nausea have been reported with use of grape seed extract, but these effects typically occur at rates similar to placebo (9182,13162). In a case report of a 57-year-old man, intermittent nausea, vomiting, and diarrhea occurred over a 10-day period and improved once grape seed extract was stopped (96764). Gastrointestinal adverse effects have also been reported with use of a different grape seed extract (Entelon, Hanlim Pharm). However, the specific types of gastrointestinal effects were not described (100954). A specific grape leaf extract AS195 (Antistax, Boehringer Ingelheim Pharma GmbH & Co. KG) has reportedly caused flatulence, mild constipation, gastrointestinal discomfort, diarrhea, dyspepsia, dry mouth, and retching (2538,52985,53206). Diarrhea, gastrointestinal distress, indigestion, and aversion to taste have been reported with use of Concord grape juice (52972,53166,53175,53181,53199). Loose stools have been reported in a clinical trial of grape pomace (99270). Bowel obstruction caused by intact grapes and grape seeds has been described in case reports (53241,53284,53278). Excessive consumption of grapes, dried grapes, raisins, or sultanas might cause diarrhea due to laxative effects (4201).

Hematologic ...Orally, one case of leg hematoma following a minor trauma was reported in a person using grape leaf extract (2538). Also, one case of bruising was reported in a person drinking Concord grape juice daily for 2 weeks (52972).

Immunologic ...Orally, there is one report of an anaphylactic reaction to oral grape skin extract, which included urticaria and angioedema (4073).

Musculoskeletal ...Orally, musculoskeletal disorders, including back pain, have been reported with use of a specific grape leaf extract AS195 KG) (2538,53206). Joint pain and lumbago have been reported with use of grape seed extract, but these effects occur at rates similar to placebo (91541).

Neurologic/CNS ...Orally, headache has been reported with use of grape seed extract, but this effect occurs at rates similar to placebo (9182,91541). A specific grape leaf extract AS195 (Antistax, Boehringer Ingelheim Pharma GmbH & Co. KG) has reportedly caused dizziness, tiredness, headache, and sleep problems (2538,53206). As a class, nervous system adverse effects have been reported with use of a specific grape seed extract (Entelon, Hanlim Pharm). However, the specific types of adverse neurologic effects were not described (100954).

Ocular/Otic ...Orally, ocular adverse effects have been reported with use of a specific grape seed extract (Entelon, Hanlim Pharm). However, the specific types of ocular adverse effects were not described (100954).

Pulmonary/Respiratory ...Orally, nasopharyngitis and oropharyngeal pain have been reported with use of a specific grape leaf extract AS195 KG) (53206). Sore throat, cough, allergic rhinitis, and nasopharyngitis have been reported with use of grape seed extract, but these effects occur at rates similar to placebo (9182,91541). One case report describes a 16-year-old female who developed increased levels of immunoglobulin E (IgE) following skin-prick exposure to grape vine pollen, as well as positive test responses following bronchial and conjunctival provocation (53301). Reduced forced vital capacity has been described in California grape workers (53080,53081). Occupational eosinophilic lung was diagnosed in a grape grower with a history of asthma. Respiratory exposure to sulfites in grape was implicated as the cause of the adverse reaction (53285).

Other ...Orally, grape products can cause adverse effects due to contamination with pesticides or mycotoxins. Some evidence has shown that pesticides used in vineyards may remain on grape surfaces post-harvesting. For example, the fungicide folpet sprayed on grapevines has been shown to remain on the grape surface. Although there was minimal penetration of the epicuticular wax, it showed high resistance to washing (52935). Carbaryl has been identified in over 58% of juice samples collected in Canada. This pesticide reportedly occurred more frequently in grape than in other juices. However, estimates of short-term intake were below proposed acute reference doses (53003).
Ochratoxin A is a mycotoxin that is suspected to be nephrotoxic, teratogenic, hepatotoxic and carcinogenic and has been identified in grape juice, frozen grape pulps, and red and white wine sold in Rio de Janeiro, Brazil. However, the highest levels identified in grape products were lower than the established virtually safe dose of 5 ng/kg of body weight daily (53010,53004). Ochratoxin A has also been identified in red, but not white, grape juice marketed in Switzerland, Canada, and the U.S. (53292,53020).

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WINE (Red Wine)

General ...Orally, the side effects of wine depend on the amount of alcohol ingested and can vary among individuals.
Most Common Adverse Effects:
Orally: Most adverse effects are associated with alcohol content and include abdominal pain, aggression, blackouts, central nervous system (CNS) depression, confusion, diarrhea, drowsiness, emotional lability, flushing, hypoglycemia, hypothermia, indigestion, lack of coordination and trouble walking, migraines, nausea, neuropathies, perceptual and sensational disturbances, and vomiting.
Serious Adverse Effects (Rare):
Orally: Chronic heavy alcohol ingestion (three or more drinks daily) can lead to amnesia, cardiac myopathy, cirrhosis, dementia, hepatotoxicity, malnutrition, myocardial infarction (MI), physical dependence, and somnolence. Other effects of chronic use are chronic cerebellar syndrome, hypomagnesemia, Korsakoff's psychosis, pancreatitis, skeletal myopathies, various types of cancer, and Wernicke's encephalopathy.
Chronic ingestion of three or more alcoholic beverages daily is associated with an increased risk of all-cause mortality, ischemic stroke, and hypertension. Consumption of any amount of alcohol can increase the risk of hemorrhagic stroke.

Cardiovascular ...Orally, chronic heavy alcohol ingestion of three or more drinks daily is associated with an increased risk of all-cause mortality, atrial fibrillation, cardiac myopathy, hypertension, ischemic stroke, and myocardial infarction (MI) (2261,6843,6892,8102,9004,33984,34028,34054,34058,34059). Consumption of any amount of alcohol can increase the risk of hemorrhagic stroke (841,2271).

Gastrointestinal ...Orally, wine can cause a variety of side effects which depend on the amount of alcohol ingested and can vary among individuals. Some common side effects include abdominal pain, diarrhea, indigestion, nausea, and vomiting. (6843,8972,9004,34013,34031). Chronic alcohol use is also associated with pancreatitis (6843,9004).

Hepatic ...Orally, chronic heavy alcohol ingestion (three or more drinks daily) can lead to cirrhosis and hepatotoxicity (6843,9004).

Immunologic ...People who are allergic to sulfites and/or yeast might react to wine. Wine is associated with triggering asthmatic reactions in people with a history of asthma, possibly due to salicylates and/or added sulfites contained in wines (6174). A case report describes a 33-year-old female who developed allergic reactions ranging from mild symptoms to anaphylaxis after consumption of beer or wine. The allergy was attributed to the yeast Saccharomyces cerevisiae, which is used in the fermentation of both beverages (107819).

Musculoskeletal ...Orally, wine can cause a variety of side effects which depend on the amount of alcohol ingested and can vary among individuals. Some common side effects include lack of coordination and trouble walking. Other effects of chronic use include skeletal myopathies (6843,8972,9004).

Neurologic/CNS ...Orally, wine can cause a variety of side effects which depend on the amount of alcohol ingested and can vary among individuals. Some common side effects include blackouts, central nervous system (CNS) depression, drowsiness, lack of coordination and trouble walking, migraines, neuropathies, and perceptual and sensational disturbances. Chronic heavy alcohol ingestion (three or more drinks daily) can lead to amnesia, dementia, physical dependence, and somnolence. Other effects of chronic use are chronic cerebellar syndrome, Korsakoff's psychosis, and Wernicke's encephalopathy (6843,8972,9004,34055,34068).
Heavy alcohol consumption (fifteen or more drinks weekly) is also associated with a higher percentage of white matter changes and larger ventricular and sulcal size on magnetic resonance imaging (MRI) of the brain. This suggests that heavy alcohol consumption decreases cerebral blood flow and may contribute to brain atrophy (8651). Consumption of any amount of alcohol can increase the risk of hemorrhagic stroke (841,2271).

Oncologic ...There is evidence that heavy alcohol consumption is associated with the mutation of the p53 gene in individuals with esophageal carcinoma (9005). There is also some evidence that heavy consumption of wine is associated with the highest risk of esophageal cancer when compared with heavy consumption of beer and spirits (8972,9004). Chronic heavy alcohol ingestion (three or more drinks daily) can lead to mouth cancer, esophageal cancer, pharyngeal cancer, laryngeal cancer, and liver cancer (6843,8972,9004,31557,33977,34010,34037,34045,34061,34065,34069,34085). Some research suggests an association between alcohol consumption and an increased risk of pancreatic cancer, but other studies do not support this association (8038). Daily consumption of one or more alcoholic drinks in females might increase the risk of breast cancer by 2% to 15% and increase mortality from breast cancer by as much as 30% (6843,8100,8974,9006,96686). There is also evidence suggesting that females who consume alcohol daily have an increased risk of developing breast cancer when the daily intake of folate is 300 mcg or less (8974,9006). However, the association of wine intake and breast cancer risk in females may vary depending on the type of wine. Red wine results in higher levels of free testosterone and luteinizing hormone (LH) and lower hormone binding globulin (SHBG) levels when compared with white wine. This suggests that red wine has similar activity to aromatase inhibitors and may not increase the risk of breast cancer unlike white wine (97992).
Observational research has found that wine consumption is associated with a higher risk of developing skin cancer in females and a higher risk of invasive melanoma in both males and females (97055,97991).

Psychiatric ...Orally, wine can cause a variety of side effects which depend on the amount of alcohol ingested and can vary among individuals. Some common side effects include aggression, confusion, and emotional lability (6843,9004,34040). Chronic heavy alcohol ingestion (three or more drinks daily) can lead to dementia, physical amnesia, and somnolence (6843,8972,9004).

Pulmonary/Respiratory ...Orally, wine can cause a variety of side effects due to the alcohol content. The side effects depend on the amount ingested and can vary among individuals. A common side effect includes respiratory depression (6843,8972,9004). Wine is also associated with triggering asthmatic reactions in people with a history of asthma, possibly due to salicylates and/or added sulfites contained in wines (6174).

Other ...Orally, chronic heavy alcohol ingestion (three or more drinks daily) can lead to malnutrition and poor glycemic control (6843,8972,9004).
There is some evidence consumption of more than six beers per week is associated with a larger waist-to-hip ratio than those consuming an equivalent amount of hard liquor or wine. However, an association between moderate alcohol intake equivalent to approximately three beers per week or less and waist-to-hip ratio does not seem to exist (10164,10165). It is also unclear whether waist-to-hip ratios associated with the intake of wine, beer, or other alcoholic beverages have any clinical significance (9007).

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