Coenzyme Q10 Supplementation in Orthostatic Hypotension and Multiple-System Atrophy: A Report on 7 Cases

Multiple-system atrophy is a neurologic disorder characterized by orthostatic hypotension, Parkinsonian signs, and cerebellar signs. Mutations in COQ2, an enzyme involved in coenzyme Q10 synthesis, were recently associated with familial and sporadic cases of multiple-system atrophy. I hypothesized that people with orthostatic hypotension with or without other symptoms of multiple-system atrophy might benefit from oral coenzyme Q10 administration. Seven patients with symptomatic orthostatic hypotension were treated in an unrandomized manner with 257 ± 37 mg coenzyme Q10 daily for 10 ± 3 months. Before starting coenzyme Q10, patients' systolic blood pressure fell 30 ± 4 mm Hg upon standing from a sitting position. After treatment with coenzyme Q10, their systolic blood pressure decreased 7 ± 5 mm Hg upon standing from a sitting position (P = .007 for change in systolic blood pressure decrease by paired t test). These data suggest that orthostatic hypotension could improve with coenzyme Q10 administration and that a randomized clinical trial to test this hypothesis should be begun.