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Red yeast may interact with products that cause liver damage or are broken down in the liver. Grapefruit juice may increase blood levels of red yeast. Milk thistle, St. John's wort, niacin, and vitamin A may interact with red yeast rice extract. Coenzyme Q10 levels may be lowered by red yeast rice extract. Cholesterol-lowering herbs and supplements such as guggul or fish oils may have increased effects when taken with red rice yeast. Although not well studied, red yeast may also interact with astaxanthin and zinc. Caution is advised. Certain herbs and supplements may interfere with the way the body processes red yeast using the liver's "cytochrome P450" enzyme system. Inhibitors of cytochrome P450 may increase the chance of muscle and kidney damage if taken with red yeast. In theory, red yeast may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases. Red yeast may also interact with digitalis (foxglove), or herbs and supplements that affect the thyroid or blood pressure. It may also have anti-inflammatory effects and should be used cautiously with other herbs or supplements that may have anti-inflammatory effects. Red yeast may alter blood sugar levels in the blood, and patients with diabetes or taking herbs and supplement to control blood sugar should use with caution. You should read product labels, and discuss all therapies with a qualified healthcare provider. Natural Standard information does not constitute medical advice, diagnosis, or treatment.