Should You Take CoQ10 or PQQ with SS-31 for Energy?

None of the studies we reviewed tested whether CoQ10 or PQQ adds energy on top of SS-31 (elamipretide), so any extra benefit from taking them together is a guess. SS-31 did not beat placebo for fatigue in its largest trial, and lab research suggests it does little in mitochondria that already work normally. Oral CoQ10 is the cheaper option with some human fatigue data. That data comes from one 8-week trial in chronic fatigue syndrome, where CoQ10 was paired with NADH.

Has anyone tested CoQ10 or PQQ with SS-31?

No. None of the trials we reviewed gave people SS-31 together with CoQ10 or PQQ and then measured their energy. Any extra lift from the combination has not been tested.

The idea comes from peptide forums, where each new mitochondrial product gets treated as one more layer. One user on r/Peptides, already taking tirzepatide, oral NAD+ and MOTS-c, asked whether SS-31 was needed: “is SS-31 "mandatory" for those who are taking MOTS? Or do I still get the benefits without it?” No trial we reviewed answers that question either.

CoQ10 and SS-31 work in the same spot: the inner membrane of your mitochondria, the parts of your cells that make energy. CoQ10 is an electron carrier in that membrane, and your cells can't make ATP without it. ATP is the energy your cells run on. SS-31 attaches to a fat in that same membrane called cardiolipin, and its FDA label says it improves how mitochondria are shaped and how they work. Because the two work in the same place, nobody knows whether their effects add up or overlap.

Does SS-31 give you more energy on its own?

Not in its largest trial. In MMPOWER-3, a phase 3 placebo-controlled trial, SS-31 did not improve walking distance or fatigue more than placebo after 24 weeks. The people in that trial had primary mitochondrial myopathy, a genetic disease that leaves muscles short on energy. In a 6-minute walking test, people on SS-31 walked 14.1 meters farther than when they started. People on placebo walked 17.3 meters farther.

An earlier 4-week crossover trial in adults with the same disease was more hopeful. In a crossover trial, each person takes the drug for one stretch and placebo for another. On daily SS-31 injections, people scored 4 points lower on a fatigue questionnaire than they did on placebo. The researchers called that result nominally significant. The trial's main measure, the walking test, did not reach statistical significance.

The same paper notes that in lab studies, SS-31 had no observed effect on mitochondria that were working normally, and the authors say it has little effect in normally functioning systems. If you're tired but otherwise healthy, that matters. The people in these trials had mitochondria that don't work properly because of a genetic disease.

The FDA approved elamipretide as FORZINITY only to improve muscle strength in Barth syndrome, a rare genetic disorder, in patients who weigh at least 30 kg. It is an accelerated approval, so keeping that approval can depend on further trials. In its randomized trial, it was not superior to placebo on walking distance or fatigue. The label dose is 40 mg injected under the skin once a day. The most common side effects are injection site reactions.

Compounded SS-31 is also sold through telehealth. TelaCure lists it at $310 a month as an injection vial, prescription only, prepared by a 503A/503B compounding pharmacy. TelaCure states that compounded medications are not FDA-approved.

How do CoQ10, PQQ and SS-31 compare for fatigue?

The CoQ10 trial gave CoQ10 and NADH together, so it can't tell you how much of the drop in fatigue came from CoQ10. If you're over 40, the ubiquinol form is somewhat better absorbed than ubiquinone, according to SupplementScore.

What should you try first if you're always tired?

When you're exhausted, adding one more product can feel like the fastest fix. A Reddit user with ME/CFS (chronic fatigue syndrome) who was considering MOTS-c, SS-31 and other peptides wrote: “I don't want to do anything super risky, but am also desperate to get well and have my life back.” These steps help you get relief without guessing:

1. Tell your clinical team about your tiredness. Say when it started, how you sleep and what you've already tried, so they can look for a cause before you add products.
2. Start one thing at a time. In the 4-week SS-31 trial, people kept taking the supplements and antioxidants they were on when they joined, which may have affected the results. There were too few people in the trial to tell what those supplements did. With several new products at home, it's even harder to tell what's working.
3. Give each change as long as its study ran. The CoQ10 trial lasted 8 weeks, so track your energy on a calendar for about that long before you judge it.
4. Mention pregnancy or breastfeeding first. If you're pregnant, planning a pregnancy or breastfeeding, raise it before you start anything. The 4-week SS-31 trial excluded women in those groups.

If you want more energy by the afternoon, take the quiz. Your clinical team looks at why you're tired and builds a plan around your goal. That plan can include energy treatments like NAD+ or MOTS-c if they fit you.