Long COVID, CoQ10 and Alpha Lipoic Acid

A new study entitled, “Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome” has been published in the journal Clinical and Experimental Medicine which found that supplementation with Coenzyme Q10 (CoQ10) and alpha lipoic acid (ALA) may be helpful in Long COVID.

COVID-19 can deplete CoQ10 levels and damage the mitochondria which are important for energy production and immune system function. CoQ10 and alpha lipoic acid can both be helpful in protecting and supporting mitochondrial function by reducing oxidative stress.

CoQ10 deficiency can lead to decreased energy production resulting in fatigue and increased free radical production. Fatigue is by far the most common symptom reported in Long COVID so CoQ10 is at the top of the list of supplements to try with this condition.

Alpha lipoic acid is a powerful antioxidant, and it is involved in mitochondrial energy production. ALA also has immunomodulatory properties and may actually be an anti-viral as well. The properties of both nutrients in theory make them a promising combination in the treatment of Long COVID.

How was the study done?

174 patients (51% male and 49% female) aged 18-81 (mean of 51) who had COVID-19 previously and met the 2015 National Academy of Medicine diagnostic criteria of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

52% had comorbidities including chronic lung disease (16%, 28/174), diabetes mellitus (13%,23/174), psychiatric diseases (7.5%, 13/174), and rheumatic diseases (9.8%, 17/174).

17.8% (31) of patients had been previously hospitalized for severe respiratory SARS-CoV-2 pneumonia.

82.2% had mild/moderate symptoms during the acute phase.

The mean duration of Long COVID symptoms was 5.9 months.

The most common symptoms were fatigue (80%), impaired concentration (68%), sleep disorders (85%) disturbed smell and/or taste (60%), memory loss (45%), dyspnea (21%) and arthromyalgias (64%).

Patients were divided into two groups. The first one (116 patients) received coenzyme Q10 (ubiquinone form) and alpha lipoic acid taken every day for two months at a dose of 100 mg of CoQ10 and 100 mg of alpha lipoic acid twice a day. The control group of 58 patients did not take either supplement.

The characteristics of the patients in the two groups were similar at baseline. Patients in both groups also received a variety of medications including paracetamol, codeine, NSAIDS, antidepressants (duloxetine), anticonvulsants and analgesics (pregabalin and gabapentin). They also undertook psychological and psychiatric counseling, physio-kinesiotherapy, yoga, and Pilates.

What were the results?

“The primary end-point was to evaluate the effectiveness of the association of coenzyme Q10 and alpha lipoic acid in reducing fatigue, expressed as a reduction in Fatigue Severity Scale (FSS), at the second month (T1), of at least 50% (complete response) from the baseline (T0) or at least 20% (partial response) from the baseline (T0). A reduction in FSS < 20% from baseline at T1 was considered as a non-response.

A complete FSS response was reached most frequently in the treatment group compared to the control group. An FSS complete response was reached in 62 (53.5%) patients in the treatment group and in two (3.5%) patients in the control group. A reduction in FSS score < 20% from baseline at T1 (non-response) was observed in 11 patients in the treatment group (9.5%) and in 15 patients in the control group (25.9%) (p < 0.0001).”

Author’s Conclusion

“Despite the short follow-up period, we demonstrated a clinical benefit, suggesting the rapid effect of this therapy. On the other hand, because of the short follow-up duration, we do not know if this clinical benefit persists over time. Our results, all based on subjective indices, were definitely in favor of the treatment group.”

Dr. Hedberg’s Comments on Long COVID, CoQ10, and Alpha Lipoic Acid

This study shows promising results in the use of coenzyme Q10 and alpha lipoic acid for Long COVID. Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) have many clinical and biochemical similarities so it makes sense that these nutrients may be helpful.

I have used CoQ10 and ALA in my patients with ME/CFS with good results and I am also seeing improvements in my patients with Long COVID.

The form of CoQ10 used in this study was ubiquinone instead of the more active ubiquinol. Ubiquinol is basically an activated form of ubiquinone so the body doesn’t have to do a conversion. Some patients don’t convert ubiquinone to ubiquinol as well as others. 100 mg of CoQ10 twice a day is the dose I use in practice.I use CoQH Select by Moss Nutrition, dosed 1 capsule twice a day with meals. This product contains 100 mg per capsule of ubiquinol – the more active form of CoQ10.

Coenzyme Q10 Select by Moss Nutrition contains 100 mg of CoQ10 per capsule in the form of ubiquinone which was the form used in this study for about half the price. This is certainly an option if the patient needs to save money.

The dose of alpha lipoic acid was only 100 mg twice a day, but I use 300 mg twice a day with meals. I use Lipoic Acid 300 mg by Moss Nutrition which contains 300 mg of ALA per capsule dosed 1 capsule twice a day with meals.

The mitochondria are vital for energy production and immune system function so they need support in patients with Long COVID and ME/CFS. These two compounds have a long history of use in ME/CFS and in patients who have fatigue.

This study provides supporting evidence that CoQ10 and ALA may be helpful to your patients with Long COVID who suffer from ongoing fatigue.

Hedberg Institute Members have access to my courses and documents on how to treat Long COVID. Click here to learn more about becoming a member today, so you can learn how to change patient’s lives for the better.


Barletta MA, Marino G, Spagnolo B, et al. Coenzyme Q10 + alpha lipoic acid for chronic COVID syndrome. Clin Exp Med. 2023;23(3):667-678. doi:10.1007/s10238-022-00871-8