Coenzyme Q10 and long COVID

Even years after the initial pandemic, the struggles of COVID live on through the condition known as long COVID. Long COVID, put simply, is the lingering COVID symptoms (such as fatigue, issues with sleep, and brain fog) months or even years after the initial infection. Studies suggest a link between long COVID and mitochondrial dysfunction, and thus, the question naturally arises: Can coenzyme Q10 help treat the symptoms of long COVID?

Key takeaways

• Long COVID is associated with persistent symptoms like fatigue and brain fog. This may be linked to problems with how the mitochondria produce energy.
• Coenzyme Q10 is vital for helping your cells make energy. It also acts as a powerful antioxidant to protect against cell damage.
• Inflammation and reduced ATP production are thought to be significant causes of ongoing symptoms in long COVID.
• Clinical studies show that taking CoQ10 and alpha-lipoic acid together can significantly improve fatigue in people with long COVID.
• Using a buccal CoQ10 patch allows for better and faster absorption than traditional tablets, helping you get more benefit from the supplement.

What is long COVID? 

COVID-19 (also known as the SARS-CoV-2 virus) was a major pandemic which led to a vast number of mortalities worldwide.  

The initial symptoms start around 4 to 5 days after exposure, and they consisted of: 

• “Flu-like” symptoms 
• Headaches 
• A loss of smell 
• Coughs 
• A sore throat 
• A loss of appetite 
• Chest pain 
• Fatigue 
• Muscle pain 
• Hoarseness 

Long COVID doesn’t refer to the COVID-19 infection itself, but rather, it’s known as the persistent symptoms which persevere weeks or even months after the initial infection has passed.

Those with “Long COVID” tend to come out as PCR negative (their swab test doesn’t indicate that they have COVID). Thus, it can be defined as the time lag between the microbiological recovery and clinical recovery (when the pathogen is gone but symptoms are still lingering) [1]. 

What are the symptoms of long COVID? 

The symptoms of long COVID have been reported to range from mental to physiological. The 10 most prevalent symptoms are commonly known to be: 

• A shortness of breath 
• Fatigue 
• Muscle pain 
• Joint pain 
• Headache  
• Cough  
• An altered sense of smell 
• An altered sense of taste 
• Chest pain 
• Diarrhea 

In other words, the symptoms of long COVID are (unsurprisingly) virtually the same as the regular acute symptoms of COVID-19.

However, on top of these symptoms, those suffering from long COVID also frequently report an impaired quality of life as well as a recession in their mental health [2].  

What causes long COVID? 

Long COVID is theorised to be caused by the body’s ongoing response to COVID, as when the SARS-CoV-2 (the COVID pathogen) enters the cells through the ACE2 receptor (angiotensin-converting enzyme 2) [3]. This can lead to a “cytokine storm” which results in the overproduction of inflammatory chemicals [4]. 

These inflammatory chemicals then reduce the body’s ATP production, lowering its energy content and causing symptoms of fatigue and exhaustion, which are heavily associated with long COVID [5].  

Mitochondrial dysfunction 

Mitochondria are the organelles responsible for energy production in cells. Inflammation stemming from COVID-19 can reduce this energy production, leading to fatigue, among other issues.  

Studies have shown that issues with mitochondria frequently affect the duration and safety of COVID-19 symptoms [6]. 

When a mitochondrion doesn’t age well or malfunctions, it creates harmful oxygen radicals. These can damage cells, trigger inflammation, and even cause cell death.

Due to this fact, mitochondria are seen as important regulators in the body’s immune system as well as its inflammatory response.

Studies also suggest that an improvement in mitochondrial function can also help reduce inflammation as well as restore the body’s regular immune response. 

Faulty mitochondria not only worsen the initial symptoms of COVID-19, but they also can lead to the longer-lasting symptoms found in long COVID. 

Who gets long COVID 

Some people who get infected by COVID may suffer from long-lasting symptoms (long COVID), which can last for months after the initial symptoms develop. 

In Wuhan, a study of 1,733 COVID-19 survivors with an average (median) age of 57 years showed that 52% of patients reported fatigue or muscle weakness after 186 days of their symptoms first appearing. Of these, 26% had sleeping difficulties, and a further 23% experienced either anxiety or depression [7]. 

The severity of illness seemingly scaled with worse long-term conditions, as 56% of those in the most severe group suffered from long-term impaired lung function compared to 22% in the mild group. In other words, their chances of developing further lung problems were 1.61 times more likely for moderate cases and 4.60 times higher for severe cases. 

On top of this, the antibody levels in these patients dropped significantly from the acute phase, and some even had reduced kidney function. 

These results highlight the long-term effects of COVID-19. Particularly those who initially suffered severally from the illness, as well as the necessity for long-term recovery strategies to be put in place [8]. 

Is long COVID the same as chronic fatigue syndrome? 

Simply put, no, they’re not quite the same.   

Chronic fatigue syndrome (also known as myalgic encephalomyelitis) is a condition which typically occurs sometime after other infections such as Epstein-Barr virus or SARS [9].  

Long COVID typically causes long-lasting fatigue, depression, muscle pain, and sleep problems like other conditions like fibromyalgia and chronic fatigue syndrome.

However, the key difference between chronic fatigue syndrome and long COVID is that chronic fatigue syndrome is diagnosed after the symptoms have lasted for at least six months. In contrast, the duration of Long COVID is still yet to be confirmed. 

 What is Coenzyme Q10 

Coenzyme Q10 (also known as ubiquinone and can be shortened as “CoQ10”) is a vitamin-like substance. It is naturally present in small amounts in food and is also synthesised within the body.  

Coenzyme Q10 plays a key role in how your cells make energy. Think of CoQ10 as a tiny “courier” inside your cells. It helps with carrying electrical energy from one part of the cell’s power plant to another. This happens within an area of the mitochondria known as the electron transport chain.

Coenzyme Q10 and ATP

This process is crucial because it helps your body produce ATP, which is the primary energy source your cells use to do their jobs—like helping your muscles move, your brain think, and your organs work properly.

Without enough CoQ10, your cells can’t make enough ATP, and your body might not have the energy it needs to function at its best.

That’s why Coenzyme Q10 is so essential for overall energy, heart health, and keeping your body running smoothly.

Free radicals and CoQ10

In addition to its role in energy production, it has also been found to act as a potent antioxidant. This makes CoQ10 a useful barrier against harmful free radicals [10]. 

How does Coenzyme Q10 generate energy? 

Coenzyme Q10 transports electrons from Complex I/II to Complex III within the electron transport chain found inside the mitochondria [11]. 

This pushing of electrons along the electron transport chain provides the energy which is needed to move the protons to the outside of the inner membrane of the mitochondria, producing a proton gradient.

Protons then travel along this gradient, allowing it to travel back inside the matrix of the mitochondria.

When these protons travel back down their proton gradient towards the matrix, they do so by crossing the ATPase, which is like a mini turbine.

As these protons flow through ATPase, they spin this protein turbine, which then generates the energy needed to create ATP—the primary fuel your cells use.

This process is similar to water turning a turbine in a dam to make electricity, but in your cells, it’s protons powering the ATPase to produce, which then causes them to generate a force that leads to the synthesis of ATP [12]. 

Coenzymes Q10’s role as an antioxidant 

Coenzyme Q10 ‘s role in oxidative phosphorylation isn’t only limited to being a carrier for the electrons to travel across complexes, but it also acts as an antioxidant when in its reduced form, hydroquinone (ubiquinol) [12]. 

 When your cells produce energy, electrons are passed along a series of complexes inside the mitochondria (the cell’s “power stations”). Sometimes, a few of these electrons escape or “leak out” before they reach their final destination. When this happens, these stray electrons can react with oxygen in the cell and create molecules known as free radicals.

Free radicals are highly reactive and unstable particles that can damage important parts of your cells, like DNA, proteins, and the cell membrane. Think of free radicals as tiny sparks that, if left unchecked, can cause wear and tear inside your cells over time. This type of damage is associated with ageing and various health issues.

Thankfully, your body has built-in antioxidants—natural protective substances that act like shields, like Coenzyme Q10.

These antioxidants help neutralise free radicals, stopping them from causing harm to the mitochondria and other cell parts. By keeping free radicals under control, antioxidants play a crucial role in protecting your cells and supporting your overall health [13]. 

On top of protecting the mitochondria from free radical damage, hydroquinone can also regenerate and recycle other antioxidants (e.g. tocopherol and ascorbate), as well as other critical cellular functions like cell signalling and gene expression [14]. 

Can Coenzyme Q10 and alpha-lipoic acid treat long COVID? 

Barletta M et al. researched the effect of treating 174 patients with long COVID using both Coenzyme Q10 and alpha-lipoic acid (ALA) [15]. 

The patients were split into two groups: 

The treatment group consisted of 116 patients who received both Coenzyme Q10 and alpha-lipoic acid (these patients were the group that received the treatment).  

The control group – consisted of 58 patients who received neither supplement (they were the group of patients who received no treatment). 

The results for how well either group recovered from their fatigue (which stemmed as a symptom from long COVID) by using a Fatigue Severity Scale (FSS).  

By the end of the study, the group that received treatment were shown to have superior results as 62 patients (53.5%) in the patient group made a complete response to the FSS. In contrast, only two patients (3.5%) in the control group completed the FSS [15]. 

 Coenzyme Q10 for long COVID

If you’re considering adding coenzyme Q10 (CoQ10) to your routine to help manage long COVID symptoms, there are a few important things to know.

CoQ10 is a powerful supplement that supports energy levels and cell health, but it’s well known for being tricky to absorb when taken in tablet or capsule form. This slow and limited absorption is due to its large molecular weight and general hydrophobicity [16].

This means your body might not get the full benefit from traditional oral supplements.

A compounded Coenzyme Q10 solution

To solve this problem, Courier Pharmacy has partnered with APC Labs to offer a CoQ10 buccal (oral) patch.

This soluble patch is placed inside your cheek, where it dissolves and delivers CoQ10 straight into your bloodstream—bypassing the stomach and digestive system. This direct route means your body can absorb more CoQ10 efficiently, so you get the maximum benefit with less waste.

To learn more about the Courier Pharmacy CoQ10 buccal film, please complete the Coenzyme Q10 consultation.

Free long COVID consultation

If you’re struggling with long COVID and not sure what to do next, book a FREE consultation with one of our experienced prescribers. We’ll help you find the most effective, evidence-based treatments tailored to your needs and recommend compounded solutions specifically designed for you.

References: 

1. Chang, Y.C., Hung, C.H. and Lin, M.H., 2021. The study of a smart tourism platform to improve the competitiveness of tourism destinations. Journal of Ambient Intelligence and Humanized Computing, [online] Available at: https://www.sciencedirect.com/science/article/pii/S1871402121001193 [Accessed 4 Jun. 2025] 
2. Aiyegbusi, O.L. et al., 2021. Symptoms, complications and management of long COVID: a review. Journal of the Royal Society of Medicine, 114(9), pp.428–442. Available at: https://journals.sagepub.com/doi/full/10.1177/01410768211032850 [Accessed 4 Jun. 2025] 
3. Yan, Z., Yang, M. and Lai, C.-L., 2021. Long COVID-19 syndrome: A comprehensive review of its effect on various organ systems and recommendation on rehabilitation plans. Biomedicines, 9(8), 966. Available at: https://www.mdpi.com/2227-9059/9/8/966 [Accessed 4 Jun. 2025] 
4. Hu, B., Huang, S. and Yin, L., 2021. The cytokine storm and COVID?19. Journal of Medical Virology, 93(1), pp.250–256. Available at: https://onlinelibrary.wiley.com/doi/abs/10.1002/jmv.26232 [Accessed 4 Jun. 2025] 
5. Barletta, M.A. et al., 2023. Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome. Clinical and Experimental Medicine, 23(3), pp.667–678. Available at: https://link.springer.com/article/10.1007/s10238-022-00871-8 [Accessed 4 Jun. 2025] 
6. Tian, Y., Zhang, H. & Zhang, J., 2020. Age-related mitochondrial dysfunction as a key factor in COVID-19 pathogenesis. Mechanisms of Ageing and Development, 188, p.111254. Available at: https://doi.org/10.1016/j.mad.2020.111254 [Accessed 4 June 2025] 

7. Huang, C. et al., 2021. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. The Lancet, 397(10270), pp.220–232. Available at: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00810-3/fulltext [Accessed 4 Jun. 2025] 
8. Medical Mojo (2025) Coenzyme Q10 and long COVID. Available at: https://medicalmojo.co.uk/coenzyme-q10-and-long-covid/ (Accessed: 4 June 2025).
9. Jones, J.F. et al., 1985. Persisting illness and fatigue in adults with evidence of Epstein–Barr virus infection. Annals of Internal Medicine, 102(1), pp.7–16. Available at: https://doi.org/10.7326/0003-4819-102-1-7 [Accessed 4 Jun. 2025] 
10. Langsjoen, P.H., n.d. Introduction to Coenzyme Q10. [online] Available at: https://www.grc.com/sr6dev/misc/CoQ10/Coenzyme%20Q10.pdf [Accessed 4 Jun. 2025] 
11. Casagrande, D., Waib, P.H. and Jordão Júnior, A.A., 2018. Mechanisms of action and effects of the administration of Coenzyme Q10 on metabolic syndrome. Journal of Nutrition & Intermediary Metabolism, 13, pp.1–6. Available at: https://www.researchgate.net/publication/327035780_Mechanisms_of_action_and_effects_of_the_administration_of_Coenzyme_Q10_on_metabolic_syndrome [Accessed 4 Jun. 2025] 
12. Cogliati, S., Cabrera-Alarcón, J.L. and Enríquez, J.A., 2021. Regulation and functional role of the electron transport chain supercomplexes. Biochemical Society Transactions, 49(6), pp.2655–2668. Available at: https://doi.org/10.1042/BST20210460 [Accessed 4 Jun. 2025] 
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15. Barletta, M.A., Marino, G., Spagnolo, B., Bianchi, F.P., Falappone, P.C.F., Spagnolo, L., Gatti, P., 2023. Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome. Clinical and Experimental Medicine, 23(5), pp.667–678. Available at: https://doi.org/10.1007/s10238-022-00871-8 [Accessed 4 Jun. 2025] 
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