A laboratory-made relative of coenzyme Q10 with a shorter tail, so it reaches the brain and eye. Approved in Europe for one rare inherited disorder of the optic nerve, where vision recovers more often with it than without. Elsewhere the evidence thins quickly, and for healthy adults there is no direct evidence. Side effects are usually mild. (Full Review)
| Marker | Target | Why |
|---|---|---|
| ALT | 10–26 U/L (women), 10–33 U/L (men) | Detects drug-related liver injury |
| AST | 10–26 U/L | Confirms liver origin when ALT rises |
| GGT | Below 20 U/L (women), below 30 U/L (men) | Most sensitive marker of bile-duct stress and oxidative load |
| Total bilirubin | 0.3–1.0 mg/dL | Flags impaired liver clearance |
| Neutrophil count | 1.8–5.5 ×10⁹/L | Detects the agranulocytosis and neutropenia listed post-marketing |
| Platelet count | 175–350 ×10⁹/L | Detects the thrombocytopenia listed post-marketing |
| Apolipoprotein B | Below 80 mg/dL, below 60 mg/dL at high cardiovascular risk | Captures the raised cholesterol and triglycerides listed post-marketing |
| Triglycerides | Below 100 mg/dL | Tracks the labelled triglyceride signal directly |
| eGFR | Above 90 mL/min/1.73 m² | Kidney clearance of the colored metabolites |
| Urine dipstick for blood | Negative for heme despite reddish-brown color | Separates harmless chromaturia from true hematuria |
| Plasma idebenone trough | No established target; track against the individual's own level at a dose already tolerated | Distinguishes poor absorption from poor response |
Cadence: Full panel before the first dose. Liver enzymes and a full blood count at 4 weeks and 3 months, then every 6 months while treatment continues. Lipid panel at 6 months and annually thereafter; kidney function annually, or every 3 months where it is already impaired. Urine dipstick typically once after starting. Plasma idebenone trough at 3 months where measurement is available.