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in quantities lower than 300 mg per day.  There have been no reports of significant toxicity with this dosage in studies lasting up to one year.(1,3,11,14,15)  However, in dosages exceeding 300 mg per day, coenzyme Q-10 may adversely affect the liver (see laboratory interactions). In rare instances coenzyme Q-10 has been reported to cause gastric distress (0.39%), loss of appetite (0.23%), nausea (0.16%) and diarrhea (0.12%).(1-3) ARE THERE ANY REPORT- ED INTERACTIONS WITH HERBS, SUPPLEMENTS OR DRUGS? Herb and supplement inter- actions: Drug interactions: Insulin requirements may be reduced in people with dia- betes and therefore may require more frequent glu- cose monitoring and alter- ations in insulin dosing (3). Warfarin (Coumadin) effec- tiveness may be reduced when used together with coenzyme Q-10.  Vitamin K- like properties have been attributed to coenzyme Q-10, possibly resulting in an increase in blood clotting.  In fact, four patients have expe- rienced decreased effective- ness from warfarin while tak- ing coenzyme Q-10 (18,19). Increased monitoring with more frequent laboratory testing is thus appropriate in patients taking warfarin together with coenzyme Q- 10. Coenzyme Q-10 used together with antihyper- tensive medications (med- ications to reduce blood pressure) may lead to fur- ther reductions in blood pressure.  Thus caution is warranted when coenzyme Q-10 is administered while taking any such drug (17). "Statin"  cholesterol-low- ering medications such as cerivastatin (Baycol), flu- vastatin (Lescol), lovas- tatin (Mevacor), pravas- tatin (Pravachol), sim- vastatin (Zocor) and atorvastatin (Lipitor) may all reduce coenzyme Q-10 levels; however, the clini- cal significance of this find- ing has not been estab- lished (20). Oral hypoglycemic drugs used for glucose control in people with adult onset diabetes - drugs such as glyburide (Micronose), acetohexamide (Dymelor) and tolaza- mide (Tolinase) - have been found to reduce coenzyme Q-10 levels. However, chlorpropamide (Diabinese), glipizide (Glucotrol), and tolbu- tamide (Orinase) have not been found to reduce coenzyme Q-10 serum lev- els.  There is no data medications. But as with other conditions where coen- zyme Q-10 appears to be beneficial, it should be con- sidered as a supplement to proven medical therapy. High Blood Pressure High blood pressure, the most common cause of stroke, remains a major risk factor for heart disease as well.  For a patient with high blood pressure, the desired systolic blood pressure (blood pressure measured during heart contraction) should be less than 140 mm Hg, and diastolic blood pressure should be less than 90 mm Hg.  In order to achieve these goals, many patients require several medications, and all medications have potential side effects.  Therefore, tradi- tional drug therapy for high blood pressure may be sup- plemented with coenzyme Q- 10 in hopes of limiting the number and dosage of med- ications required, but it should never be utilized by itself for this purpose, nor substituted for proven thera- pies.  Limited research has been performed in this area, and more information is required in order to better understand the role of coen- zyme Q-10 in treating high blood pressure. IS IT SAFE? Coenzyme Q-10 is generally considered safe when used

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