Red yeast rice and grapefruit

Contents

Red Yeast Rice (Monascus Purpureus)

Red yeast rice is a product of yeast that is grown on rice. It is marketed as Cholestin, Monascus, Zhi Tai, hong qu, red koji, red rice, Xue Zhi Kang, and others.

Red yeast rice has been used with diet, exercise, and medical care to lower cholesterol and triglyceride levels. It may reduce levels of “bad” cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, and may also increase levels of “good” cholesterol (high-density lipoprotein, or HDL).

Not all uses for red yeast rice have been approved by the FDA. Red yeast rice should not be used in place of medication prescribed for you by your doctor.

Red yeast rice is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Red yeast rice may also be used for other purposes not listed in this product guide.

Not all uses for red yeast rice have been approved by the FDA. Red yeast rice should not be used in place of medication prescribed for you by your doctor.

Red yeast rice is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Some cholesterol-lowering medications can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call your doctor right away if you have unexplained muscle pain, tenderness, or weakness especially if you also have fever, unusual tiredness, and dark colored urine.

Avoid drinking alcohol while using red yeast rice. Alcohol may increase your risk of liver damage.

Do not take red yeast rice if you are allergic to it, or if you have a history of liver disease.

Before taking red yeast rice, talk to your doctor, pharmacist, herbalist, or other healthcare provider. You may not be able to use this product if you have:

  • asthma;
  • kidney disease;
  • a serious infection, disease, or medical condition;
  • if you are pregnant;
  • if you have recently had surgery or an organ transplant; or
  • if you drink more than 2 alcoholic beverages per day.

Some cholesterol-lowering medications can cause a condition that results in the breakdown of skeletal muscle tissue, leading to kidney failure. Call a doctor at once if you have unexplained muscle pain or tenderness, muscle weakness, fever or flu symptoms, and dark colored urine.

Do not take red yeast rice without telling your doctor if you are pregnant or plan to become pregnant during treatment. Red yeast rice may be harmful to an unborn baby.

It is not known whether red yeast rice passes into breast milk or if it could harm a nursing baby. Do not use this product without telling your doctor if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without the advice of a doctor.

GENERIC NAME: RED YEAST RICE (MONASCUS PURPUREUS) – ORAL

Medication Uses | How To Use | Side Effects | Precautions | Drug Interactions | Overdose | Notes | Missed Dose | Storage

USES: Red yeast rice has been used for lowering cholesterol levels.Some supplement products have been found to contain possibly harmful impurities/additives. Check with your pharmacist for more details regarding the particular brand you use.The FDA has not reviewed this product for safety or effectiveness. Ask your doctor or pharmacist for more details.

HOW TO USE: Take this product by mouth with food. Follow all directions on the product package, or if your doctor prescribed this product, take as directed by your doctor. If you are uncertain about any of the information, ask your doctor or pharmacist.Avoid eating grapefruit or drinking grapefruit juice while using this product unless your doctor instructs you otherwise. Grapefruit can increase the amount of this product in your bloodstream. Consult your doctor or pharmacist for more details.If your condition persists or worsens, or if you think you may have a serious medical problem, seek immediate medical attention.

SIDE EFFECTS: Abdominal/stomach pain may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.Tell your doctor immediately if you have any of these rare but serious side effects: muscle pain/tenderness/weakness (especially with fever or unusual tiredness), change in the amount of urine, signs of liver problems (such as severe stomach/abdominal pain, persistent nausea/vomiting, yellowing eyes/skin, dark urine).A very serious allergic reaction to this product is rare. However, seek immediate medical attention if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before taking this product, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.If you have any of the following health problems, consult your doctor or pharmacist before using this product: liver disease, kidney disease, alcohol use.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Limit alcoholic beverages. Daily use of alcohol may increase your risk for liver problems, especially when combined with this product. Ask your doctor or pharmacist for more information.Red yeast rice must not be used during pregnancy. It may harm an unborn baby. If you become pregnant or think you may be pregnant, tell your doctor immediately.It is unknown if this product passes into breast milk. Because of the possible risk to the infant, breast-feeding while using this product is not recommended. Consult your doctor before breast-feeding.

Natural supplements may seem benign, but as highlighted in a new case report, that’s not always the case. A woman in Michigan developed sudden liver damage after taking a red yeast rice supplement, doctors reported.

The 64-year-old woman had recently been to the doctor and was told she had high cholesterol levels. But she was hesitant to start taking statins — the common drugs prescribed to lower cholesterol. So instead, she turned to a supplement called red yeast rice, a type of fermented rice that’s marketed to lower cholesterol.

However, many patients and doctors may not be aware that red yeast rice can naturally contain a compound called monacolin K, which is identical to the active ingredient in the statin drug lovastatin, the report said. Red yeast rice supplements with monacolin K come with the same risks as drugs containing lovastatin, which can include liver damage.

Indeed, six weeks after she started taking the supplement, the woman went to the emergency room with signs of liver injury, including fatigue, dark urine and jaundice, which is a yellowing of the skin and eyes.

After a battery of tests, including a liver biopsy, the woman was diagnosed with “acute drug-induced liver injury,” or liver damage due to a drug or supplement. In this case, red yeast rice supplements were the most likely cause of the woman’s illness, given the sudden onset of her symptoms and her recent use of the supplement, according to the report, published today (March 25) in the journal BMJ Case Reports.

Doctors issue warning

The woman’s case prompted the doctors who treated her to issue a warning about the potential harm of red yeast rice supplements.

“Physicians and patients should be made aware that red yeast rice is not a harmless supplement, and those choosing to use it should watch for symptoms of hepatotoxicity ,” the authors, from Henry Ford Health System in Detroit, wrote in their report.

The woman also reported drinking two glasses of red wine a day, which may have contributed to her disease, the report said. Drinking alcohol while taking red yeast rice supplements may increase the risk of liver damage, according to Mayo Clinic.

But the woman’s case isn’t the first instance of this supplement causing liver problems; indeed, there have been multiple reports that have linked the use of red yeast rice supplements to such problems. For example, a recent study in Italy found 10 cases of liver damage tied to the supplement over a 13-year period.

The National Center for Complementary and Integrative Health (NCCIH) warns that red yeast rice supplements may not be safe and may have the same side effects as lovastatin.

Technically, the U.S. Food and Drug Administration (FDA) doesn’t allow products to be sold as dietary supplements if they contain more than trace amounts of monacolin K, according to NCCIH. But despite FDA actions, some red yeast rice supplements may still contain the compound. A 2017 study found that levels of monacolin K in red yeast rice supplements sold in the U.S. ranged from undetectable to nearly 11 milligrams per daily recommended dose, which is on a par with dosages of lovastatin.

“Consumers have no way of knowing how much monacolin K is present in most red yeast rice products, and therefore have no way of knowing whether a particular product is safe, effective, or legal,” the NCCIH says on its website. People should not use red yeast rice to replace standard medical care or to postpone going to the doctor; and they should tell their doctor about any supplements they are taking, the NCCIH says.

The woman was treated with steroids, which helped improve her liver function, and she was monitored weekly after she left the hospital. The report notes it can take months to fully recover from liver damage tied to red yeast rice supplements.

  • 7 Foods You Can Overdose On
  • 9 Disgusting Things That the FDA Allows in Your Food
  • Wishful Thinking: 6 ‘Magic Bullet’ Cures That Don’t Exist

Originally published on Live Science.

Overview

Red yeast rice

Also listed as:

Table of Contents > Supplements > Red yeast rice

Overview Therapeutic Uses Dietary Sources Dosage and Administration Precautions Interactions and Depletions Supporting Research

Red yeast rice, also called Went Yeast, has been used for centuries in China as both food and medicine. It is made by fermenting a type of yeast called Monascus purpureus over red rice. In Chinese medicine, red yeast rice is used to lower cholesterol, improve blood circulation, and improve digestion.

Red yeast rice contains chemicals that are similar to prescription statin medications. One of these, called monacolin K, has the same makeup as the drug lovastatin (Mevacor). Doctors prescribe statins to lower LDL (“bad”) cholesterol levels and help reduce the risk of heart disease.

Researchers are not sure if red yeast rice lowers cholesterol because of the statin-like chemical or because of other things in red yeast rice, such as unsaturated fatty acids, isoflavones, and phytosterols. But because many red yeast rice supplements did have monacolin, the Food and Drug Administration (FDA) considered them to be drugs. Manufacturers were supposed to remove any red yeast rice products with monacolin from the market. As a result, many of the red yeast rice products you can buy may not contain monacolin. Unfortunately, there is no way to tell whether a product contains moacolin because it is not listed on the label.

Therapeutic Uses

Prevention

Several studies have shown that red yeast rice lowers LDL (“bad”) cholesterol levels. High cholesterol levels raise the risk of heart disease. Red yeast (Monascus purpureus) stops the action of an enzyme in the body that helps make cholesterol.

Red yeast rice contains substances known as monacolins. One of these, monacolin K, has the same chemical makeup as lovastatin (Mevacor), a prescription drug that lowers cholesterol. Some researchers think that is why red yeast rice lowers cholesterol. Others point out that the amount of monacolin in red yeast rice is less than you would find in the prescription drug. They think there may be other substances in red yeast rice that help lower cholesterol. More research is needed.

Treatment

Several studies suggest that red yeast rice reduces high cholesterol. However, most of the studies have used a formulation of red yeast rice, Cholestin, which is no longer available in the U.S. You can still buy Cholestin, but it no longer has any red yeast rice. The FDA requires any red yeast product that has monacolin to be taken off the market.

These studies support the claim that red yeast rice lowers cholesterol:

  • One study by UCLA School of Medicine involved 83 people with high cholesterol levels. Those who took red yeast rice over a 12 week period had lower levels of total cholesterol, LDL cholesterol, and triglycerides (fats in the blood) compared to those taking placebo. HDL (“good”) cholesterol levels did not change in either study group.
  • A study presented to the American Heart Association showed that red yeast rice lowered LDL cholesterol. In the study, 187 people had mild-to-moderately high levels of total cholesterol and LDL cholesterol. The study showed that taking red yeast rice reduced total cholesterol by more than 16%, LDL cholesterol by 21%, and triglycerides by 24%. HDL cholesterol also went up by 14%.
  • In another 8-week study of 446 people with high cholesterol, those who took red yeast rice had a drop in cholesterol levels compared to those who took placebo. Total cholesterol fell by 22.7%, LDL by 31%, and triglycerides by 34% in the red yeast rice group. HDL cholesterol went up by 20% in the red yeast rice group as well.

Dietary Sources

Asia, and Chinese communities in North America, use red yeast rice in powdered form as a food coloring for fish, alcoholic beverages, and cheese.

Dosage and Administration

Red yeast rice is an ingredient in several supplements advertised to promote heart health. Red yeast rice is also available in commercial preparations. One of the proprietary products most often studied was Cholestin, which contained monacolin. However, that product is no longer on the market. The current ingredients in Cholestin do not include red yeast rice.

Pediatric

People younger than 20 should not use red yeast rice supplements.

Adult

In Traditional Chinese Medicine (TCM), the dosage of dietary or supplemental red yeast rice can be quite high. But the right dose for adults may be different, depending on the form of the supplement. Most studies have used standardized extract: 600 mg, 2 to 4 times daily.

Precautions

Researchers do not know whether it is safe to use red yeast rice for longer than 12 weeks.

People with liver disease, and those at risk for liver disease, should not take red yeast rice. Red yeast rice may affect the function in the same way prescription drugs to lower cholesterol can.

These people should not take red yeast rice: people with kidney disease, thyroid problems, or musculoskeletal disorders, or those at higher risk of cancer.

People who drink more than two alcoholic beverages a day, have a serious infection or physical condition, or have had an organ transplant should also avoid using red yeast rice.

Side Effects

Side effects of red yeast rice are rare but can include:

  • Headache
  • Stomachache or bloating
  • Gas
  • Dizziness
  • Heartburn
  • Muscle aches and weakness. This can lead to a rare but serious condition called rhabdomyolysis. Stop taking red yeast rice immediately and call your doctor

Pregnancy and Breastfeeding

Pregnant and breastfeeding women should not take red yeast rice.

Pediatric Use

People under 20 should not take red yeast rice until more research is done.

Geriatric Use

No studies have looked at the safety of red yeast rice in older adults. However, elderly people who took 1,200 mg per day of red yeast rice in an 8 week study had no major side effects.

Interactions and Depletions

Cholesterol-lowering medications: If you take drugs to lower your cholesterol, you should not take red yeast rice unless your doctor tells you to. Red yeast rice may make the effect of these drugs stronger, increasing the risk of liver damage. If you are already taking a statin or other drug to lower cholesterol, talk to your doctor before taking red yeast rice.

Anticoagulants (blood-thinners): Red yeast rice may increase the risk of bleeding. Blood thinners include warfarin (Coumadin), clopidogrel (Plavix), and daily aspirin.

Grapefruit juice: If you take a statin, grapefruit and grapefruit juice can increase the amount of the drug in your blood. That can give you a greater chance of side effects and liver damage. Because red yeast rice may act like statins in the body, you should not drink grapefruit juice or eat grapefruit while taking red yeast rice.

Coenzyme Q10 (CoQ10): Statins can lower the amount of CoQ10 in the body. CoQ10 is very important in heart and muscle health and in energy production. Not having enough CoQ10 can cause fatigue, muscle aches and pains, and muscle damage. Red yeast rice also may lower amounts of CoQ10 in the body. Ask your doctor if you need to take CoQ10 while you are taking red yeast rice products.

Other medications: Because it acts like a statin, red yeast rice may pose the same potential risk of liver damage that statins do, when combined with other prescription medications that also affect the liver. Some of these include:

  • Azathioprine (Imuran)
  • Cimetidine (Tagamet)
  • Clarithromycin (Biaxin)
  • Cyclosporine
  • Diclofenac (Voltaren)
  • Erythromycin
  • Gemfibrozil (Lopid)
  • Itraconazole (Sporanox)
  • Ketoconazole (Nizoral)
  • Methotrexate (Rheumatrex)
  • Rosiglitazone (Avandia)
  • Valproic acid

Supporting Research

Becker DJ, Gordon RY, Morris PB, Yorko J, Gordon YJ, Li M, Iqbal N. Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc. 2008 Jul;83(7):758-64.

Bonovich, K, Colfer H, Davidson M, Dujovne C, Greenspan M, Karlberg R, et al. A Multi-Center, Self-Controlled Study of Cholestin In Subjects With Elevated Cholesterol. American Hear Association. 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, Orlando, Fl. March 1999.

Havel R. Dietary supplement or drug? The case of cholestin. Am J Clin Nutr. 1999;69(2):175-176.

Huang CF, Li TC, Lin CC, Liu CS, Shih HC, Lai MM. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. Eur J Cardiovasc Prev Rehabil. 2007 Jun;14(3):438-40.

Li C, Zhu Y, Wang Y, Zhu J, Chang J, Kritchevsky D. Monascus Purpureus-Fermented Rice (Red Yeast Rice): A natural food product that lowers blood cholesterol in animal models of hypercholesterolemia. Nutrition Research. 1998;18(1):71-81.

Liu J, Zhang J, Shi Y, Grimsgaard S, Alraek T, Fønnebø V. Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med. 2006 Nov 23;1:4.

Mark D. All red yeast rice products are not created equal. The Am J of Cardiol. 106(3).

Mueller PS. Symptomatic myopathy due to red yeast rice. Ann Intern Med. 2006;145(6):474-5.

Qin S, Zhang W, Qi P, Zhao M, Dong Z, Li Y , et al. Elderly patients with primary hyperlipidemia benefited from treatment with a Monacus purpureus rice preparation: A placebo-controlled, double-blind clinical trial. American Heart Association. 39th Annual conference on Cardiovascular Disease Epidemiology and Prevention, Orlando, Fl. March 1999.

Shamim S, Al Badarin FJ, DiNicolantonio JJ, Lavie CJ, O’Keefe JH. Red yeast rice for dysipidemia. Mo Med. 2013;110(4):349-54.

Vercelli L, Mongini T, Olivero N, Rodolico C, Musumeci O, Palmucci L. Chinese red rice depletes muscle coenzyme Q10 and maintains muscle damage after discontinuation of statin treatment. J Am Geriatr Soc. 2006;54(4):718-20.

Review Date: 3/24/2015
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only — they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

Bi JZ, Ma SZ Li YQ. Observations on the therapeutic effects of Diao Zhibituo for treatment of hyperlipidemia. Shiyong Zhongxiyi jiehe Zazhi 1996;9(12):729.

Cai MX, Deng JX Lu LF. : Clinical observations on Diao Zhibituo for treatment of hyperlipidemia. Fujian Yiyao Zazhi 1997;19(2):83-84.

Chen FJ, Ruan Q Qi HW Yuan PY. Clinical observation of Xuezhikang in treating middle and old age hyperlipidemia. Shanghai Yufangyixue Zazhi 2003;15(5):222-223.

Chen GY. Observations on the therapeutic effects of Zhibituo for treatment of hyperlipidemia in the elderly. Guizhou Yiyao 1999;23(4):307-308.

Chen L, Qin YW Guo RB. Clinical efficacy of capsule Xuezhikang in treatment of hypercholesterolemia. Yaoxue Fuwu Yu Yanjiu 2002;2(1):39-40.

Chen L, Qin YW Zheng X. Effects of lipid modification of Diao Zhibituo capsules. Zhongguo Zhongxiyi Jiehe Zazhi 2003;23(5):389.

Chen LL, Liu J. Effects of Xuezhikang on hypercholesterolemia. Yiyao Daobao 2002;21(1):31-32.

Chen LL, Liu J. The lipid regulation function of Xuezhikang on hypercholesterolemia. Herald of Medicine 2002;21(1):31-32.

Chen ZL. Controlled study of Diao Zhibituo and alginic sodium diester for lipid lowering effect. Henan Shiyong Shenjingbing Zazhi 1998;1(2):20.

Chen ZM. Comparison of the therapeutic effects of simvastatin and Zhibituo for treatment of hyperlipidemia. Guangxi Yike Daxue Xuebao 2001;18(4):543.

Cheng XM, Yu ZM Luo HD Qiu YH Chen MX. Effect of Xuezhikang on endothelial function in patients with hyperlipidemia. Chin J Arterioscler 2001;9(3):235-237.

China Coronary Secondary Prevention Study Group. China coronary secondary prevention study (CCSPS). Lipid regulating therapy with xuezhikang for secondary prevention of coronary heart disease. Chin J Cardiol (Chin) 2005;33:109-115.

Cong B. Observations on the therapeutic effects of Zhibituo for treatment of hyperlipidemia. Hebei Yiyao 1999;5(3):60-61.

Deng YM, Meng MK Liao YZ. Clinical observation of Xuezhikang on treatment of elderly patients with primary mixed hyperlipidemia. Chinese Journal of Gerontology 2006;26(11):1566-1567.

Ding W, Zhou Y. Xuezhikang on treatment of hypercholesterolemia. China Medical News 1999;32(21):21.

Feng JC, Wang JS Wang CP Jiang YJ Tan GZ. Effects of conjugated estrogen and Xuezhikang in low dosage on blood lipid in postmenopausal women. 2000, 9(23):2334-5. Xiandai Zhongxiyi jiehe Zazhi 2000;9(23):2334-2335.

Feng XY, Wang XF Li X. Analysis of 116 cases of hyperlipemia in treatment with Xuezhikang. Medical Information 2006;19(3):512-513.

Fu G, Liu WJ Wang GT. Comparison of Zhibituo and fish oil capsules for treatment of hyperlipidemia. Heilongjiang Yiyao 2000;23(5):93-94.

Gu ZY, Lu ZF Zhu HQ. Observations on the therapeutic effects of Zhibituo for treatment of 158 patients with hyperlipidemia. Nantong Yixueyuan Xuebao 1998;18(3):374-375.

Guo WC, Feng WJ. Clinical observations of statin alone or combined with unsaturated fatty acids for the treatment of combined hyperlipidemia in elderly people. Beijing Yixue 2003;25(1):25-27.

Guo XL, Li Y Yin GN. Xuezhikang for treatment of 30 cases of hyperlipidemia. Ningxia Yixue Zazhi 1999;21(7):418.

Guo XM, Tu L Mi S. Comparison of the therapeutic effects of Zhibituo and simvastatin for regulating dyslipidemia. Zhongyao Yaoli Yu Linchuang 1999;15(6):46-48.

Heber D, Yip I, Ashley J, and et al. A chinese red yeast rice dietary supplement significantly reduces cholesterol levels . FASEB J 1998;12:1201.

Hua D. Comparative Observation of simvastatin and Xuezhikang for patients with hyperlipidemia. Herbei Medicine 2008;14(7):879-881.

Huang GZ, Yang S Wu ZG. Observation on therapuetic effect of Zhibituo for treatment of hyperlipidemia. Dier Junyi Daxue Xuebao 1998;19(1):94-95.

Huang LJ, Chen MS. Comparison of Diao Zhibituo and Inositol nicotinate for the lipid lowering effects. Zhongyuan Yikan 1997;24(1):8-10.

Huang YL, Zhou JG Zhang HF Shi YX Wang MS. Comparison of the therapeutic effects of simvastatin and Zhibituo for the elderly with hyperlipidemia. Yixue Yu Gongcheng 2001;3(1):24-27.

Jiang HP. Comparison of the therapeutic effects and compliance of Xuezhikang and Fenofibrate in patients with hyperlipidemia. Xiandai Zhenduan Yu Zhiliao 2001;12 (Suppl):29.

Jin W, Yang H Zhang C Zhang CJ Xu YH. Therapeutic observations of Xuezhikang for treatment of primary hyperlipidemia. Zhongguo Zhongxiyi Jiehe Zazhi 1997;17(7):434-435.

Jin WQ, Li CW Xu M Gao YX Xu XW. Comparison of Zhibituo and Duoxikang in treating 108 patients with hyperlipidemia. Zhongguo Xinyao Yu Linchuang Zazhi 1997;16(1):61-62.

Knecht, A. and Humpf, H. U. Cytotoxic and antimitotic effects of N-containing Monascus metabolites studied using immortalized human kidney epithelial cells. Mol Nutr Food Res 2006;50(4-5):406-412. View abstract.

Knecht, A., Cramer, B., and Humpf, H. U. New Monascus metabolites: structure elucidation and toxicological properties studied with immortalized human kidney epithelial cells. Mol Nutr Food Res 2006;50(3):314-321. View abstract.

Kong YM, Gao H Liu XL. Clinical observations of the lipid-lowering effects of Xuezhikang and elastase. Zhongguo Yaoshi 1999;8(3):56.

Lei HZ. Effects of Xuezhikang on endothelial function in aged patients with hyperlipidemia. Guangxi Yixue 2004;26(4):495-497.

Li BH, Zheng GJ Zhang WG Xu M Ren P. Clinical observations of Ruanmaijianzhi capsule in the treatment of dyslipidemia. Hebei Zhongyi Zazhi 2004;26(9):657-659.

Li DX, Li YF Lu HY. Comparison of the effects of Xuezhikang with inositol hexanicotinate on lipid profile modification. Henan Zhigong Yixueyuan Xuebao 2000;12(1):17-18.

Li FL, Zeng WH. Comparison of Zhibituo and Inositol nicotinate for treatment of hyperlipidemia. Nongken Yixue 2002;24(3):198-199.

Li GR, Li JP Mai WY Zeng Y. Micronised fenofibrate for treatment of mixed type of hyperlipidemia. Guangdong Yixue 1999;20(11):895-896.

Li KL. Comparison study on the effect of Xuezhikang and simvastatin for treatment of primary hypercholesterolemia. China Medical Herald 2006;3(17):22-23.

Li LH, Deng GL Chen YZ. CIinical comparative study of simvastatin and Xuezhikang and pravastatin in common doses on primary hyperlipidemia. Journal of Chongqing Medical University 2005;30(2):278-284.

Li Y, Min YB Fan XJ. Comparison of the therapeutic effects of Zhibituo and fish oils for treatment of 30 cases of hyperlipidemia. Guangdong Yaoxue Zazhi 2000;10(1):43-45.

Li YM, Sun RX. Therapeutic observations on Xuezhikang for treatment of hyperlipidemia. Zhongguo Shiyong Xiangcun Yisheng Zazhi 2004;11(8):25-26.

Li YS, Lei HZ Zhu MJ. Clinical observations of 41 cases of elderly with hyperlipidemia treated with Xuezhikang. Zhongguo Quanke Yixue 2003;6(2):163.

Li, J., Tatsanavivat, P., Wang, J., and et al. Comparison of the efficacy and safety of xuezhikang and lovastatin in hyperlipidemic patients with hypertension . Global Meeting ICLEN XVI, March 1999;

Liu L, Li JP Shen PN. Clinical observations of Xuezhikang for treatment of mixed type of hyperlipidemia. Zhonghua Shiyong Yixue 2000;16(12):1047-1048.

Liu ZB. Xuezhikang for treatment of 40 cases of hyperlipidemia. Linchuang Huicui 1998;13(8):367-368.

Liu, Y. and Zhao, J. B-mod ultrasonogram change of 276 cases of fatty liver patients treated by xuezhikang. Chinese Journal of Internal Medicine 1999;38(8):554-555.

Liu, Z. and Zhang, Y. Clinical observation of treatment of hyperlipidemia with Xuezhikang. Clin Med News 1996;11:12-13.

Liu, Z. M., Li, Z., Zhang, H., and et al. The clinical observation of the medical treatment for hyperlipidemia with Xuezhikang. Unpublished data, reported by Institute for Natural Products Research (INPR) 2001;

Liu. Pharmanex report: PN0128. 1997;

Lu GP, Huo ShQ. Comparison of the effects of Xuezhikang with simvastatin on lipid profile modification in patients with hypercholesterolemia. Chinese Journal of Internal Medicine 1998;37(6):371-373.

Lu GP, Huo SQ Shen YC Gong LS. Comparison of the effects of Xuezhikang with simvastatin on lipid profile modification in patients with hypercholesterolemia. Zhonghua Neike Zazhi 1998;37(6):371-373.

Lu WX, Wang JX Zhu JG Xu DS Yang MJ Wang HW Wang RZ Zheng R. Zhibituo capsules in treatment of hyperlipidemia: a multi-centre clinical trial. Zhongguo Xinyao Yu Linchuang Zazhi 1999;18(6):365-367.

Lu YS, Gu JS Zhou WG. Comparison of the therapeutic effects of Xuezhikang and Zhibituo in treatment of adults with hyperlipidemia. Zhongguo Zhongxiyi Jiehe Zazhi 1998;18(8):467.

Lu, G. and Gong, L. The comparison of hypolipidemic effects of Xue-Zhi-Kang and simvastatin on patients with hypercholesterolemia. Scientific Report Number PN0134

Lu, Z. L., Xu, S., and Kou, W. R. The clinical observation of treatment of hyperlipidemia with different dose of Xuezhikang. National Symposium of Clinical Therapies for Cardiovascular Diseases 1995;1997:53-57.

Lu, Z. The clinical examinations of Xue-Zhi-Kang in the treatment for hypercholesterolemia. Beijing University, Wei-Xin data 2002;

Ma F, Ma XH. Clinical observation of Finofibrate and Xuezhikang for treatment of hyperlipidemia. Zhongguo Hangtianye Yiyao 2003;5(1):55-56.

Ma L, Gao Y Li BZ. Observations of the therapeutic effects of Zhibituo for treatment of 50 patients with hyperlipidemia. Xibei Yaoxue Zazhi 2000;15(3):126.

Ma YL. Observation of 30 cases of hypercholesterolemia in treatment with Xuezhikang. Journal of Practical Traditional Chinese Medicine 2002;18(3):48.

O’Mathuna DP. Cholestin used to treat hypercholesterolemia. Drug Utilization Review 1999;15(5):71-75.

Peng DY. Observation on the effect of Zhibituo in treating hyperlipidemia. Zhongguo Yejin Gongye Yixue Zazhi 1998;15(4):201-203.

Qi MY, Z J X JG. Clinical observation of Xuezhikang on treatment of 112 cases of hypercholesterolemia. Practical Clinical Medicine (Jiangxi) 2004;5(6):20-22.

Qi P, Huang Y Deng J. Effects of Xuezhikang vs. Inositol niacinate in treating hyperlipidemia. Jiangxi Yixueyuan Xuebao 2002;42(4):24-25.

Qin SC, Zhang WQ Qi P Zhao ML Dong ZN Li YC Xu XM Fang X Fu L. Randomized, double blind, controlled trial for the clinical therapeutic effects of Xuezhikang in the elderly with hyperlipidemia. Zhonghua Neike Zazhi 1998;37(6):401-402.

Qin, S., Zhang, W., Qi, P., and et al. Elderly patients with primary hyperlipidemia benefited from treatment with a Monascus purpureus rice preparation: A placebo-controlled, double-blind clinical trial. Abstracts of the 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention, March 24-27 1999;99:1123 (Abstract P89).

Qiu JP, Wang ZJ Xu XP Ma SY Kuang RJ. Observations of Zhibituo on the therapeutic effects in treatment of 60 patients with hyperlipidemia. Shandong Yiyao 2002;42(6):45-46.

Quan SL, Wang W Qu XW Chen J. Controlled observation on therapeutic effects of Xuezhikang and simvastatin for treatment of hypercholesterolemia. Zhonghua Shiyong Yixue 2003;3(5):427.

Quan SL, Wang W Qu XW. The effect of Xuezhikang and simvastatin on lipid of hypercholesterolemia. China Clinical Practical Medicine 2008;2(11):91-92.

Rippe J, Bonovich K, Colfer K, and et al. A multi-center, self-controlled study of Cholestin in subjects with elevated cholestrol. Abstracts of the 39th Annual Conference on Cardiovascular Disease Epidemiology and Prevention 1999;99:1123 (Abstract P88).

Shen G, Wang J Wang JF. Comparison of the effects of the herbal lipid regulator decoction, Xuezhikang and simvastatin on lipid modulation in the middle-aged and elderly subjects with hyperlipidemia. Zhongguo Jiceng Yiyao 2000;7(4):280-281.

Shen MY. Comparison of the effects of Xuezhikang and atorvastatin for treatment of hyperlipidemia. Zhonghua Shiyong Yiyao Zazhi 2003;2(5):439-440.

Shen ZW, Yu PL Sun MZ Chi JM Zhou YF Zhu XS Yang CY He CF. Prospective study of Xuezhikang for treatment of primary hyperlipidemia. Natl Med J China 1996;76(2):156-157.

Smith, D. J. and Olive, K. E. Chinese red rice-induced myopathy. South.Med J 2003;96(12):1265-1267. View abstract.

Su, M. The clinical examinations of Xue-Zhi-Kang in the treatment for hypercholesterolemia. Beijing University, Wei-Xin data 2002;

Sun FF, Ding XF Wang M. Comparison of lipid-lowering effects of Xuezhikang and Zhibituo. Jiceng Yixue Luntan 2004;8(2):121-122.

Tang HL. Randomized controlled study of Diao Zhibituo for lipid modulation effect. Sichuan Yixue 2004;25(1):78-79.

Teng, S. S. and Feldheim, W. Anka and anka pigment production. J Ind Microbiol.Biotechnol 2001;26(5):280-282. View abstract.

Wang AH, Zhang GD. Comparison of the therapeutic effects of Xuezhikang and Lescol for treatment of hyperlipidemia. Zhongguo Zonghe Yixue 2002;3(7):617-618.

Wang CW, Gao FM You L. Clinical study on the therapeutic effects of Xuezhikang for treatment of hyperlipidemia. Mudanjiang Yixueyuan Xuebao 2000;21(3):13.

Wang DG, Li D Nie ZY. Application of cost-effectiveness analysis in Xuezhikang and pravastatin for the treatment hypercholesterolemia. Zhongguo Yaoshi 2003;12(9):53-55.

Wang DG, Li D Nie ZY. Cost-effectiveness analysis on Xuezhikang and pravastatin treatment of hypercholesterolemia. Chinese Medicine 2003;12(9):53-55.

Wang LB, Qiao JJ Li YM. Clinical evaluation of Zhibituo and concentrated fish oils for treatment of hyperlipidemia. Jiamusi Yixueyuan Xuebao 1998;21(1):62-63.

Wang SH, Sun JL Liu HQ. Therapeutic observations of Xuezhikang for treatment of 60 cases of elderly with hyperlipidemia. Anhui Linchuang Zhongyi Zazhi 2003;15(6):474-475.

Wang SX. Comparison of the therapeutic effects of Xuezhikang and lovastatin. Xiandai Zhongxiyi jiehe Zazhi 2004;13(20):2707.

Wang WH. Comparison of Xuezhikang and atorvastatin efficacy of treatment of hypercholesterolemia. Journal of Practical Traditional Chinese Medicine 2006;20(3):305.

Wang XL, Hu XM. Comparison of Xuezhikang and simvastatin in regulating lipids for hypercholesterolemia. Zhongxiyi Jiehe Xinnaoxueguanbing Zazhi 2004;2(6):319-320.

Wang YF, Yang CK Xu WJ Sun L Liu B Wang GG. Xuezhikang, gemfibrozil for regulation of hyperlipidemia in elderly and insulin sensitivity. Zhongguo Xinyao Zazhi 1998;7(3):209-211.

Wang, J. The clinical examinations of Xue-Zhi-Kang in the treatment for hypercholesterolemia. Beijing University, Wei-Xin data 2002;

Xia CH . Comparison of lipid modification of Xuezhikang and Duoxikang in hyperlipidemia. Suzhou Yixueyuan Xuebao 1999;19(9):1015-1016.

Xiao CL, Yao ZQ He SM. Comparison of the lipid modification effects of Xuezhikang and Zhibituo for hypercholesterolemia. Guangdong Yixue Zazhi 2000;21(5):430-431.

Xiao M, Ye P. Clinical observation of Xuezhikang for treatment of hyperlipidemia. Shuli Yixue Zazhi 2001;14(3):244-245.

Xu CB, Hu DY Kang LP Tian YW Gao MM Xu ZM Jin SY Ma FY Ma M Shi XY Zhang BH Long NZ Li L Xue L Zhang JH Chen XL Dai CX. Comparative study of relatively long-term therapy for dyslipidemia with low-dose Xuezhikang or pravastatin in Chinese patients. Zhongguo Yaoxue 2000;9(4):218-222.

Xu JM, Chen SX Hu WY Cai NS Xu Q Wu ZG Sun KX. Zhibituo vs. placebo treatment of hyperlipidemia a double blind randomized and multicenter study. Zhongguo Xinyao Yu Linchuang Zazhi 1997;16(1):47-51.

Xu SG. Analysis of therapeutic effect of Xuezhikang for treatment of primary hypercholesterolemia. Henon Yixue Xinxi 2002;10(13):6-7.

Xu WY, Yan YZ Tang ZH. Therapeutic observations on Xuezhikang capsules for treatment of hyperlipidemia. Haixia Yaoxue 2003;15(2):65-66.

Yan HD, Guo JH Jia ST. Observations of the short-term effects of Probucol in treatment of hyperlipidemia. Shanxi Linchuang Yixue 1999;8(2):103-104.

Yang MJ, Wang RZ. Zhibituo for treatment of 100 cases of hyperlipidemia. Zhongguo Xinyao Yu Linchuang Zazhi 1997;16(1):9-10.

Yang Q, Xue HQ. Observations on the therapeutic effects of Zhibituo for treatment of hyperlipidemia. Zhongguo Jiceng Yiyao 1999;6(3):129.

Yang SS. Xuezhikang for treatment of 76 patients with hyperlipidemia. Zhongchengyao 2002;24(10):815-816.

Yang WJ, Fu XJ. Comparison of the therapeutic effects of Zhibituo and simvastatin for treatment of hyperlipidemia. Zhongguo Xiandai Yiyao Yu Jishu 2003;3(2):2-4.

Yu CY, Zhang C Yang H Jin W. Observations of therapeutic effects of Xuezhikang for treatment of primary hyperlipidemia. Heilongjiang Yixue Zazhi 2004;17(2):151-152.

Yu HY, Li TH. Observations on the therapeutic effects of Zhibituo for treatment of hyperlipidemia. Xinxueguan Kangfu Yixue Zazhi 1999;8(1):30-31.

Zeng TK. Observation of the therapeutic effects of Xuezhikang for treatment of 77 elderly with hyperlipidemia. Shoudu Yiyao 1999;6(11):49.

Zhang G, M XY C XB H X M JK W MH. Study of Xuezhikang and atorvastatin on mixed type hyperlipidemia. Modern Journal of Integrated Traditional Chinese and Western Medicine 2005;14(2):154-155.

Zhang G, Zhang KX Xu Z Guang XF. Comparison of lipid-lowering effects of Xuezhikang and Simvastatin for hyperlipidemia. Shoudu Yiyao 1998;5(6):35-36.

Zhang GR . Comparison of Zhibituo and simvastatin for their effects on hyperlipidemia. Guangxi Yixue 2002;24(5):713-714.

Zhang JS . Comparison of Xuezhikang and inositol nicotinate for treatment of hyperlipidemia. Zhiye Yu Jiankang 2002;18(1):138-140.

Zhang QL. Comparative interventional therapies of dyslipidemia by simvastatin and Zhibituo with 60 cases. Guoji Yiyao Weisheng Daobao 2004;10(10):29-30.

Zhang WM, Yang JX Li F Zhang GW. Observations of Xuezhikang in treatment of hyperlipidemia and abnormal haemorheology. Henan Shiyong Shenjingbing Zazhi 2000;3(3):47-48.

Zhao XH, Jiang XM Ao LJ. Therapeutic observations of Xuezhikang for treatment of hyperlipidemia. Yunnan Yiyao 1998;19(1):26.

Zhao YL, Ouyang HB. Observation on therapeutic effects of Zhibituo for treatment of hyperlipidemia. Changchun Yixue Zazhi 1998;11(1):21.

Zheng CJ, Wang P. Zhibituo vs. simvastatin in treatment of hyperlipidemia. Zhongguo Yaoshi 2001;4(6):447-448.

Zheng FS, Long XD Liu HM Liu YL Bao YZ Yu M. Comparison of lovastatin and Chinese Xuezhikang in lipid modification for primary hyperlipidemia. Yunan Yixue 2000;21(5):442-443.

Zheng H, Dan XY Ning H Xue B. Observations of Xuezhikang on clinical effects and haemorheology. Hebei Yiyao 2001;7(1):46-48.

Zheng JR, Wang B. Effects of Xuezhikang on treatment of primary hyperlipidemia. Yixue Luntan Zazhi 2004;25(14):21-22.

Zheng Y, Luo XZ Wang SL Yang YJ. Clinical controlled study on the therapeutic effects of Xuezhikang and Simvastatin. Zhongguo Yaoshi 2001;36(10):715.

Zhiwei, S. A prospective study on Zhitai capsule in the treatment of primary hyperlipidemia. Natl Med J China 1996;76:156-157.

Zhou ZL, Liu CH. Xuezhikang for treatment of 20 cases of hyperlipidemia. Hunan Zhongyiyao Daobao 1999;5(7):25.

Zhu QF, Jiang L Wang Y. Effects of Xuezhikang and simvastatin on apolipoprotein B and A1 in patients with hyperlipidemia. Guangming Zhongyi 2003;18(5):24-25.

Zhu WM, Wu SR. Effects and safety of combined treatment by Xuezhikang and micronized fenofibrate in patients with hyperlipidemia. Zhongguo Linchuang Yixue Zazhi 2003;4(2):18-20.

Bargossi AM, Battino M, Gaddi A, et al. Exogenous CoQ10 preserves plasma ubiquinone levels in patients treated with 3-hydroxy-3-methyglutaryl coenzyme A reductase inhibitors. Int J Clin Lab Res 1994;24:171-6. View abstract.

Barrat E, Zaïr Y, Ogier N, et al. A combined natural supplement lowers LDL cholesterol in subjects with moderate untreated hypercholesterolemia: a randomized placebo-controlled trial. Int J Food Sci Nutr. 2013;64(7):882-9. View abstract.

Barrat E, Zaïr Y, Sirvent P, et al. Effect on LDL-cholesterol of a large dose of a dietary supplement with plant extracts in subjects with untreated moderate hypercholesterolaemia: a randomised, double-blind, placebo-controlled study. Eur J Nutr. 2013;52(8):1843-52. View abstract.

Becker DJ, Gordon RY, Halbert SC, et al. Red yeast rice for dyslipidemia in statin-intolerant patients: A randomized trial. Ann Intern Med 2009;150:830-9. View abstract.

Bliznakov EG. More on the Chinese red-yeast-rice supplement and its cholesterol-lowering effect. Am J Clin Nutr 2000;71:152-7. View abstract.

Cicero, AF, Rovati LC, and Setnikar I. Eulipidemic effects of berberine administered alone or in combination with other natural cholesterol-lowering agents. A single-blind clinical investigation. Arzneimittelforschung. 2007;57:26-30. View abstract.

Fang, Y. and Li, W. Effect of xuezhikang on lipid metabolism and Islet 3 cell function in type II diabetic patients. Journal of Capital Medicine 2000;7(2):44-45.

Folkers K, Langsjoen P, Willis R, et al. Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad Sci USA 1990;87:8931-4. View abstract.

Fu, H. and Zhang, B. Effect of xuezhikang on hyperlipidemia of chronic renal failure patients with peritoneal dialysis. Chinese New Drug Journal 1998;7(3):211-213.

Gordon RY, Cooperman T, Obermeyer W, Becker DJ. Marked variability of monacolin levels in commercial red yeast rice products: buyer beware! Arch Intern Med 2010;170:1722-7. View abstract.

Halbert SC, French B, Gordon RY, et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol 2010;105:198-204. View abstract.

Havel R. Dietary supplement or drug? The case of cholestin. Am J Clin Nutr 1999;69:175-6. View abstract.

Hebel SK, ed. Drug Facts and Comparisons. 52nd ed. St. Louis: Facts and Comparisons, 1998.

Heber D, Lembertas A, Lu QY, et al. An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents. J Altern Complement Med 2001;7:133-9. View abstract.

Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr 1999;69:231-6. View abstract.

Huang HN, Hua YY, Bao GR, Xie LH. The quantification of monacolin K in some red yeast rice from Fujian province and the comparison of the other product. Chem Pharm Bull (Tokyo) 2006;54:687-9. View abstract.

Jin W, Yang H, Zhang C, et al. A COMPARATIVE STUDY OF XUEZHIKANG AND MEVALOTIN IN TREATMENT OF ESSENTIAL HYPERLIPIDEMIA. Chinese Journal of New Drugs 1997;6:265-268.

Kantola T, Kivisto KT, Neuvonen PJ, et al. Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid. Clin Pharmacol Ther 1998 63:397-402. View abstract.

Karl M, Rubenstein M, Rudnick C, Brejda J. A multicenter study of nutraceutical drinks for cholesterol (evaluating effectiveness and tolerability). J Clin Lipidology 2012;6:150-158. View abstract.

Keithley J, Swanson G, Kessler H, and et al. A pilot study of the safety and efficacy of Cholestin® in treating HIV-related dylipidemia. Altern Ther Health Med 2001;7(3):s18.

Keithley JK, Swanson B, Sha BE, et al. A pilot study of the safety and efficacy of cholestin in treating HIV-related dyslipidemia. Nutrition 2002;18:201-4.. View abstract.

Kumari S, Sherriff JM, Spooner D, Beckett R. Peripheral neuropathy induced by red yeast rice in a patient with a known small bowel gastrointestinal tumour. BMJ Case Rep. 2013;2013. View abstract.

Lapi F, Gallo E, Bernasconi S, et al. Myopathies associated with red yeast rice and liquorice: spontaneous reports from the Italian Surveillance System of Natural Health Products. Br J Clin Pharmacol 2008;66:572-74. View abstract.

Liu J, Zhang J, Shi Y, et al. Chinese red yeast rice (Monascus purpureus) for primary hyperlipidemia: a meta-analysis of randomized controlled trials. Chin Med 2006;1:4. View abstract.

Lu, G., Shen, Y., and Lansheng, G. Comparison of the effects of Xuezhikang and Simvastatin on lipid profile modification in patients with hypercholesterolemia. Chin J Intern Med 1998;37(6)

Mazzanti G, Moro PA, Raschi E, Da Cas R, Menniti-Ippolito F. Adverse reactions to dietary supplements containing red yeast rice: assessment of cases from the Italian surveillance system. Br J Clin Pharmacol. 2017 Jan 17. doi: 10.1111/bcp.13171. View abstract.

Mortensen SA, Leth A, Agner E, Rohde M. Dose-related decrease of serum coenzyme Q10 during treatment with HMG-CoA reductase inhibitors. Mol Aspects Med 1997;18:S137-S144. View abstract.

Mueller PS. Symptomatic myopathy due to red yeast rice. Ann Intern Med 2006;145:474-5. View abstract.

Ogier N, Amiot MJ, Georgé S, et al. LDL-cholesterol-lowering effect of a dietary supplement with plant extracts in subjects with moderate hypercholesterolemia. Eur J Nutr. 2013;52(2):547-57. View abstract.

Patrick, L. and Uzick, M. Cardiovascular disease: C-reactive protein and the inflammatory disease paradigm: HMG-CoA reductase inhibitors, alpha-tocopherol, red yeast rice, and olive oil polyphenols. A review of the literature. Altern Med Rev 2001;6(3):248-271. View abstract.

Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St John’s wort. Lancet 2000;355:547-8. View abstract.

Prasad GV, Wong T, Meliton G, Bhaloo S. Rhabdomyolysis due to red yeast rice (Monascus purpureus) in a renal transplant recipient. Transplantation 2002;74:1200-1. View abstract.

Robbers JE, Tyler VE. Tyler’s Herbs of Choice: The Therapeutic Use of Phytomedicinals. New York, NY: The Haworth Herbal Press, 1999.

Rogers JD, Zhao J, Liu L, et al. Grapefruit juice has minimal effects on plasma concentrations of lovastatin-derived 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Clin Pharmacol Ther 1999;66:358-66. View abstract.

Roselle H, Ekatan A, Tzeng J, et al. Symptomatic hepatitis associated with the use of herbal red yeast rice. Ann Intern Med 2008;149:516-7. View abstract.

Ruscica M, Gomaraschi M, Mombelli G, Macchi C, Bosisio R, Pazzucconi F, Pavanello C, Calabresi L, Arnoldi A, Sirtori CR, Magni P. Nutraceutical approach to moderate cardiometabolic risk: results of a randomized, double-blind and crossover study with Armolipid Plus. J Clin Lipidol. 2014;8(1):61-8. View abstract.

Safety of red yeast rice. Pharmacist’s Letter / Prescriber’s Letter 2008;24(12):241203.

Wang J, Lu A, Chi J. Multicenter clinical trial of the serum lipid-lowering effects of a monascus purpureus (red yeast) rice preparation from traditional Chinese medicine. Cur Ther Res 1997;58:964-78.

Yu P, Shen Z, Sun M, et al. A clinical study of Xuezhikang on the treatment of primary hyperlipidemia. Chinese Circulation Journal 1997;12(1):16-19.

Red Yeast Rice capsules

What is this medicine?

RED YEAST RICE (red yeest rahys) is intended to be used by healthy adults to help lower blood cholesterol in conjunction with a healthy diet and a regular exercise program. The FDA has not approved this supplement for any medical use. If medical treatment is needed for cholesterol control or any other disease, you should contact your doctor or health care professional regarding the use of this product.

This supplement may be used for other purposes; ask your health care provider or pharmacist if you have questions.

This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

COMMON BRAND NAME(S): Red Yeast Rice

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:

  • frequently drink alcoholic beverages

  • kidney disease

  • liver disease

  • muscle aches or weakness

  • other medical condition

  • an unusual or allergic reaction to red yeast rice, went yeast, lovastatin, other ‘statin’ medications, other medicines, foods, dyes, or preservatives

  • pregnant or trying to get pregnant

  • breast-feeding

How should I use this medicine?

Take this supplement by mouth with a glass of water. Follow the directions on the package labeling, or take as directed by your health care professional. Do not take this supplement more often than directed.

Contact your pediatrician or health care professional regarding the use of this supplement in children. Special care may be needed. This supplement is not recommended for use in children.

Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.

NOTE: This medicine is only for you. Do not share this medicine with others.

What if I miss a dose?

If you miss a dose, take it as soon as you can. If it is almost time for your next dose, take only that dose. Do not take double or extra doses.

What may interact with this medicine?

Do not take this medicine with any of the following medications:

  • clarithromycin

  • delavirdine

  • erythromycin

  • grapefruit juice

  • protease inhibitors used to treat HIV infection

  • medicines for fungal infections like itraconazole, ketoconazole, posaconazole, and voriconazole

  • mibefradil

  • nefazodone

  • other medicines for high cholesterol

  • telithromycin

  • troleandomycin

This medicine may also interact with the following medications:

  • alcohol

  • amiodarone

  • colchicine

  • cyclosporine

  • danazol

  • diltiazem

  • fenofibrate

  • fluconazole

  • gemfibrozil

  • mifepristone, RU-486

  • niacin

  • St. John’s wort

  • verapamil

  • voriconazole

  • warfarin

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular check-ups. You may need regular tests to make sure your liver is working properly.

Tell you doctor or health care professional right away if you get any unexplained muscle pain, tenderness, or weakness, especially if you also have a fever and tiredness.

Some drugs may increase the risk of side effects from this supplement. If you are given certain antibiotics or antifungals, you should stop taking this supplement during those treatments. Check with your doctor or pharmacist for advice.

If you are scheduled for any medical or dental procedure, tell your healthcare provider that you are taking this supplement. You may need to stop taking this supplement before the procedure.

Do not use this drug if you are pregnant or breast-feeding. Serious side effects to an unborn child or to an infant are possible. Talk to your doctor or pharmacist for more information.

Herbal or dietary supplements are not regulated like medicines. Rigid quality control standards are not required for dietary supplements. The purity and strength of these products can vary. The safety and effect of this dietary supplement for a certain disease or illness is not well known. This product is not intended to diagnose, treat, cure or prevent any disease.

The Food and Drug Administration suggests the following to help consumers protect themselves:

  • Always read product labels and follow directions.

  • Natural does not mean a product is safe for humans to take.

  • Look for products that include USP after the ingredient name. This means that the manufacturer followed the standards of the US Pharmacopoeia.

  • Supplements made or sold by a nationally known food or drug company are more likely to be made under tight controls. You can write to the company for more information about how the product was made.

What side effects may I notice from receiving this medicine?

Side effects that you should report to your doctor or health care professional as soon as possible:

  • allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue

  • dark urine

  • fever

  • joint pain

  • muscle cramps, pain

  • redness, blistering, peeling or loosening of the skin, including inside the mouth

  • trouble passing urine or change in the amount of urine

  • unusually weak or tired

  • yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):

  • constipation

  • headache

  • stomach gas, pain, upset

  • nausea

  • trouble sleeping

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of the reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Throw away any unused medicine after the expiration date.

NOTE: This sheet is a summary. It may not cover all possible information. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider.

Share Facebook Twitter LinkedIn Email Get useful, helpful and relevant health + wellness information enews

Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy

InteractionsDepletions

Possible Interactions with: Red Yeast Rice

Also listed as:

Table of Contents > Supplement Interactions > Possible Interactions with: Red Yeast Rice

Cholesterol-lowering medications

Red yeast rice should not be taken with cholesterol-lowering (statin) medications unless supervised by your doctor, because the supplement may enhance their effect, therefore increasing the risk of liver damage. If you are already taking a statin, talk to your health care provider before adding red yeast rice to your regimen.

Grapefruit juice

Grapefruit and grapefruit juice can enhance the effects of statins and significantly increase their blood levels, increasing the risk of side effects and liver damage. Because red yeast rice may act similarly in the body to statins, you should avoid drinking grapefruit juice or eating grapefruit or marmalade while taking red yeast rice.

Coenzyme Q10

Statins may deplete the coenzyme called CoQ10 from the body. CoQ10 is very important in heart and muscle health and in energy production. Side effects of CoQ10 depletion include fatigue, muscle aches and pains, and muscle damage. Red yeast rice also may deplete CoQ10 from the body. It is important to supplement your diet with CoQ10, 150 – 200 mg at night, while you are taking red yeast rice products, and for 4 weeks after you stop taking red yeast rice.

What Are the Risks of Taking Red Yeast Rice?

  • Side effects. Red yeast rice side effects are usually mild. It might cause headaches and upset stomach. Not much is known about the long-term safety of red yeast rice. Since red yeast rice contains naturally occurring components which are very similar to statin medications, the same side effects may occur, including but not limited to muscle pain and liver injury.
  • Interactions. Do not take red yeast rice if you are using statins, drugs that suppress the immune system, antifungal drugs, certain antibiotics, or protease inhibitors (for HIV). People taking red yeast rice should avoid grapefruits. Also, alcohol may increase the risk of liver damage from red yeast rice. Check with your doctor or pharmacist first if you are taking any other prescription medicines or over the counter medicines or supplements.
  • Risks. People with liver disease, kidney disease, and allergies to fungus or yeast should not use red yeast rice. People with very high cholesterol, diabetes, or a high risk of heart attack or stroke may need a more powerful prescription drug like a statin instead of red yeast rice.

Given the lack of evidence about its safety, red yeast rice is not recommended for children or for women who are pregnant or breastfeeding.

Red yeast rice, a natural source of lovastatin, may lower cholesterol and decrease fat buildup, but it’s much more difficult to find in the United States than it used to be. Read on to learn more about the history of this intriguing supplement and discover who might benefit.

What is Red Yeast Rice?

Red yeast rice is produced when a mold called Monascus purpureus colonizes and ferments rice. The mold turns the rice dark red and produces a medicinal compound called monacolin K. Red yeast rice has been a part of traditional Chinese medicine for over a thousand years; today, it is sold as a health food and supplement across the world .

Red yeast rice can be brewed into sake, vinegar, wine, and food pickling. In many East Asian countries, it is also used as a red food colorant .

This fascinating foodstuff may also reduce methane production by livestock. Methane, a potent greenhouse gas, might be the most dangerous byproduct of raising animals for food. When goats ate a diet containing 8.2% red yeast rice, the methane-producing bacteria in their guts was suppressed, and the goats released less methane .

Snapshot

Proponents:

  • Decreases cholesterol
  • Lowers blood pressure
  • Fights cancer
  • Improves metabolic syndrome
  • Prevents complications of obesity
  • Reduces inflammation
  • Improves bone health

Skeptics:

  • Amount of monacolin K not usually stated
  • Active ingredient controlled in the USA
  • May contain a kidney toxin
  • Potentially dangerous drug interactions
  • Some supplements may be spiked with lovastatin

Components

Red yeast rice contains, on average, 73.4% starch, 0.8% fiber, and 5.8% protein by weight. Its health effects are caused by a compound called monacolin K, the natural form of the cholesterol-lowering drug lovastatin .

Monacolin K

Monacolin K, which is chemically indistinguishable from lovastatin, is the main active component of red yeast rice. It is produced by Monascus purpureus, the red mold that ferments the rice and gives it its distinctive color .

The FDA regulates lovastatin, so commercial red yeast rice cannot be sold in the United States if it has more than a trace amount of monacolin K. However, many red yeast rice supplements do not have information about monacolin K on the label; multiple studies suggest that these supplements may contain significant amounts of this compound. It is currently impossible to know how much monacolin K a particular red yeast rice supplement contains without testing it in a lab .

Other Beneficial Compounds

Monascus purpureus produces several bioactive compounds which may be beneficial to our health. The most important of these are the monacolins and pigments. Red yeast rice contains at least 13 monacolins and several pigments .

Monascuspiloin (a yellow pigment) and rubropunctatin (a red pigment) may be used to boost the effectiveness of cancer treatments .

Citrinin

If red yeast rice is incorrectly fermented, it may contain a yeast toxin called citrinin. This poisonous compound causes kidney failure in animals and may cause mutations or damage in the DNA of cells .

In a red yeast rice supplement, citrinin has no known beneficial effect and should be avoided. Proper fermentation technique can prevent Monascus purpureus from producing citrinin .

Mechanism of Action

HMG-CoA reductase is an enzyme that converts a compound called HMG-CoA to mevalonate. Mevalonate is an essential building block for thousands of other molecules, including cholesterol. Monacolin K, like lovastatin, binds to HMG-CoA reductase and prevents the production of cholesterol .

Mevalonate can also be converted into important compounds like coenzyme Q10. Coenzyme Q10 is an antioxidant found in the mitochondria, the energy-making machinery of the cell. It may be responsible for the muscle-wasting side effects of lovastatin .

Red yeast rice doesn’t just contain monacolin K and its complete mechanism is more complex than lovastatin’s. According to some researchers, the other compounds in red yeast rice may, in fact, reduce the risk of side effects like muscle weakness .

Health Benefits (Likely Effective)

Multiple clinical trials have produced the following benefits of red yeast rice. Red yeast rice has not been approved by the FDA for any medical purpose or health claim; the FDA has further warned that monacolin K is an unapproved new drug. Talk to your doctor before supplementing with red yeast rice.

1) Cholesterol

High cholesterol is a serious health problem linked to obesity, insulin resistance, high blood pressure, heart attack, stroke, and diabetes. The most effective way to control cholesterol levels and prevent these conditions is to make healthy diet and lifestyle choices; however, some people are prone to high cholesterol regardless of these choices .

Red yeast rice lowers bad cholesterol (LDL) and triglycerides and raises good cholesterol (HDL) in the blood. It may also prevent weight gain and maintain normal levels of liver enzymes and leptin .

In multiple studies with almost 8,000 participants between them, people supplementing with red yeast rice had decreased LDL and total cholesterol, with no damage to liver or kidney function .

2) Heart Disease

Blood Triglycerides

Triglycerides, like cholesterol, are a type of fatty compound found in the blood. Recent studies have found that triglycerides are more likely than cholesterol to cause heart disease and stroke .

Red yeast rice lowers both cholesterol and triglycerides and measurably reduces the rate of heart attacks. In nearly 5,000 patients who had already suffered a heart attack, long-term red yeast rice supplementation lowered mortality rates by a third and cut the likelihood of a future heart attack in half, from 10.5% to 5.7% .

In combination with coenzyme Q10, red yeast rice also makes blood vessels more flexible. Stiff blood vessels, especially arteries, increase the risk of plaques forming in the vessels; these blockages can eventually lead to heart attack, stroke, and other complications .

Cardiac Inflammation

Chinese researchers have extensively studied xuezhikang, a red yeast rice extract, for its anti-inflammatory effects. In 50 patients with coronary heart disease, 1200 mg of xuezhikang per day produced decreased markers of inflammation and triglycerides .

In rats with high cholesterol, red yeast rice decreased the expression of genes that cause inflammation. The rats that ate the supplement had decreased levels of TNF-α and IL-6, two compounds that increase inflammation .

Monascustin, one of the active compounds of red yeast rice, may inhibit a gene called HDAC1. We do not yet fully understand how HDAC1 controls inflammation, but this relationship may be responsible for the anti-inflammatory effect of RYR .

Potential Benefits with Insufficient Evidence

At least one clinical trial has produced the following benefits of red yeast rice, but these studies have either not been repeated or produced contradictory results. Red yeast rice has not been approved by the FDA for any medical purpose or health claim; the FDA has further warned that monacolin K is an unapproved new drug. Talk to your doctor before supplementing with red yeast rice.

4) Metabolic Syndrome & Blood Sugar

Metabolic syndrome is a collection of conditions including obesity, high blood pressure, high blood sugar, insulin resistance, high levels of triglycerides, and low levels of good cholesterol (HDL). People with metabolic syndrome also have increased inflammation and are prone to inflammatory conditions .

Red yeast rice can lower cholesterol, blood pressure, and blood sugar; it also has anti-inflammatory and bone–strengthening effects. More research is required before doctors actively prescribe red yeast rice for metabolic syndrome; however, most of their hesitation has to do with citrinin toxicity and an inconsistent chemical profile. Red yeast rice is a useful nutraceutical for managing metabolic syndrome and obesity .

Animal Research (Lacking Evidence)

No clinical evidence supports the use of red yeast rice for any of the conditions listed in this section. Below is a summary of the existing animal and cell-based research, which should guide further investigational efforts. However, the studies listed below should not be interpreted as supportive of any health benefit.

5) Kidney Function

High cholesterol and triglycerides can cause serious kidney damage if left untreated. Through its effect on these fats, red yeast rice protected the kidneys from injury in a rat study .

The effect of red yeast rice on healthy kidneys is currently unknown. Furthermore, some red yeast rice may be contaminated with citrinin, which can cause kidney damage. We do not recommend red yeast rice as a supplement for kidney health .

6) Bone Health

In one rat study, red yeast rice reduced bone loss in rats with osteoporosis. Animals given red yeast rice supplements had higher bone mineral density and healthier bone cells than those without the supplement .

A study of white rabbits demonstrated a similar effect. In this study, however, the researchers added a red yeast rice extract to grafts and applied these grafts to a rabbit’s skull. The grafts that included red yeast rice extract showed improved bone growth compared to grafts without the extract .

Red yeast rice may increase the expression of the BMP2 gene, which is important for healing broken bones .

Cancer Research

Monascuspiloin, a yellow pigment in red yeast rice, can cause the death of prostate cancer cells by inhibiting mTOR and increasing AMPK. Through this same pathway, monascuspiloin makes cancer cells more sensitive to radiation and enhances the effectiveness of radiation therapies .

Another pair of compounds found in red yeast rice, rubropunctatin and monacolin L, are of interest to cancer researchers. Rubropunctatin may block telomerase, an enzyme that allows cancers to metastasize and move to different parts of the body. Meanwhile, monacolin L seems to increase the rate of apoptosis, or cell death, in the tumor .

These effects have not yet been studied in animal models, let alone in humans.

Supplement Combinations

Some research suggests that combining red yeast rice with other supplements could further improve its benefits and prevent adverse side effects. Talk to your doctor before adding any new supplements to your regimen, let alone combinations of supplements.

Coenzyme Q10

Red yeast rice, like lovastatin, decreases levels of a compound called coenzyme Q10, or CoQ10. CoQ10 is important for maintaining muscle mass and strength: this is why the most common side effect of statins is muscle disease. According to some practitioners, supplementing CoQ10 alongside red yeast rice may reduce the incidence of these side effects .

Healthy Fats

Healthy fats like rice bran oil (rather than coconut or sunflower) may further reduce cholesterol buildup while supplementing with red yeast rice. In one study, rats ate a very high cholesterol diet and supplemented with red yeast rice; the group of rats fed with rice bran oil had far lower cholesterol and oxidative stress when compared with rats fed other oils .

Berberine

Berberine is a compound found in several different medicinal plants. This compound has been a part of Chinese and Indian traditional medicine for thousands of years. Berberine is reported to increase LDL cholesterol receptors in the liver, thereby reducing LDL in the blood. In one human study, a combination of berberine and red yeast rice reduced LDL as much as statin therapy, with a much lower rate of muscle damage .

Safety Considerations

Labeling and Regulation

There is currently no way to tell how much monacolin K, citrinin, or any other active compound is in a given red yeast rice supplement. Some red yeast rice supplements have been found to contain pure lovastatin, probably added during production. Almost all commercial supplements have different chemical profiles than the standardized red yeast rice that is used in clinical studies .

Lack of regulation is perhaps the biggest safety concern associated with red yeast rice supplements. If you are not confident in the safety of your supplement, we recommend switching or discontinuing it.

Pregnancy

Pregnant women should not use red yeast rice. Lovastatin has been associated with birth defects after exposure in the womb. The data is not conclusive, but most researchers caution against using any statin during pregnancy; this includes monacolin K .

Citrinin Toxicity

Citrinin is produced by molds and fungi and is often found in poorly stored food. Long-term exposure to citrinin can cause damage to the heart, liver, kidney, and reproductive system. High-quality red yeast rice does not contain enough citrinin to be dangerous; however, supplement bottles are unlikely to admit to citrinin content. Use caution and always buy high-quality supplements to avoid this toxin .

Since monacolin K is the same chemical as lovastatin, people taking red yeast rice and lovastatin may have similar side effects. Known side effects of lovastatin include muscle pain and weakness, nausea, heartburn, headache, and memory loss .

Muscle problems are among the most commonly reported side effects of all statins, ranging from slight pain to severe muscle breakdown. People with existing muscular conditions like myasthenia gravis should avoid red yeast rice: monacolin K may worsen their symptoms .

Lovastatin is also known to suppress the immune system This property could be helpful for people with autoimmune diseases but it may also make it more difficult to fight off infection .

Other compounds found in red yeast rice may compensate for some of the negative side effects of monacolin K. People taking red yeast rice as a supplement usually have fewer side effects than those taking lovastatin .

Rare Allergy

Some people may have a very rare allergy to Monascus purpureus. In one case, a young and otherwise healthy butcher developed a severe anaphylactic reaction just from handling red yeast rice as an ingredient for sausage .

Limitations and Caveats

Most, but not all, of the above health effects and safety considerations refer to studies on red yeast rice: some refer to studies on lovastatin. The FDA considers lovastatin and monacolin K from red yeast rice to be chemically identical; the other bioactive compounds in red yeast rice may change the effect of monacolin K on the human body. The effects of lovastatin and red yeast rice will, therefore, be very similar, but not exactly the same.

Most red yeast rice supplements do not contain a standardized amount of monacolin K and other bioactive compounds. The effects of different supplements may vary, and researchers using different extracts may reach different conclusions.

Drug Interactions

Few drugs have been specifically tested for interactions with red yeast rice. However, because monacolin K is identical to lovastatin, drugs that interact with lovastatin should not be combined with red yeast rice.

Verapamil

Verapamil treats high blood pressure, angina, and irregular heartbeat. Red yeast rice and lovastatin both increase the availability and effect of verapamil. If you are taking verapamil for any reason, consult your doctor before supplementing with red yeast rice .

Lovastatin Interactions

Many drugs have demonstrated interactions with statins. These include:

Talk to your doctor before using red yeast rice supplements if you are currently taking any of these medications.

Grapefruit

Like some of the drugs above, grapefruit blocks an enzyme called CYP3A4 and prevents statins from being broken down. These statins can then build up to dangerously high levels and cause serious muscle problems. Even a single glass of grapefruit juice with lovastatin could be dangerous; we recommend avoiding grapefruit if you are supplementing with red yeast rice .

Other foods that increase or decrease CYP3A4 activity will also decrease or increase the effect of red yeast rice.

Genetics/Genetic Predispositions

Familial Hypercholesterolemia

Familial hypercholesterolemia is a genetic condition that causes very high levels of bad cholesterol (LDL) to build up and remain in the blood, regardless of diet and lifestyle. This condition is under-diagnosed and under-treated; genetic testing is not offered in all countries .

Familial hypercholesterolemia is often treated with statins such as lovastatin. Red yeast rice lowers LDL cholesterol and may be especially beneficial to people with this disease .

Mutations at any one of four genes cause familial hypercholesterolemia. These genes are :

  • LDLR, which normally produces the LDL receptor. A mutation here reduces the body’s ability to get rid of LDL. This type of mutation accounts for 85 – 90% of all cases of familial hypercholesterolemia.
  • ApoB, which normally allows LDL to bind to its receptor. This type of mutation accounts for 5 – 10% of all cases.
  • PCSK9, which normally degrades LDL receptors. When PCSK9 is too active, it has a similar effect to an LDLR mutation. This type of mutation is rare.
  • LDLRAP1, which normally allows LDL receptors to cross the cell membrane and enter the cell. This type of mutation is rare; two copies are required to cause familial hypercholesterolemia.

SNPs associated with hypercholesterolemia include: rs693, rs7575840, rs4420638, rs12654264, rs1529729, rs688, and rs11591147. Certain variations in these SNPs have been associated with heart disease; people who carry them may benefit the most from red yeast rice .

CYP3A4

CYP3A4 is an enzyme that breaks down many drugs and other substances, including lovastatin. Variations in the CYP3A4 gene may cause different people to respond differently to red yeast rice .

Variations in some SNPs are associated with decreased CYP3A4 activity, including rs2740574, rs67666821, rs35599367, and rs4987161. People with certain variations in these SNPs may have a stronger response to red yeast rice because CYP3A4 will take longer to break down monacolin K .

Variations in other SNPs are associated with increased CYP3A4 activity, including rs4986910 and rs2737418. People with specific variations in these SNPs may have a weaker response to red yeast rice because CYP3A4 will clear monacolin K more quickly .

Women also have higher CYP3A4 activity than men and may have a weaker response to red yeast rice .

Supplementation

Red yeast rice can be eaten as is, ground up into a powder, or purified into an extract. Xuezhikang is a partially purified extract found primarily in China. Clinical studies should use standardized red yeast rice with known quantities of active compounds .

Some red yeast rice supplements are sold in combination with coenzyme Q10, ostensibly to prevent or reduce muscle damage .

If you choose to supplement with red yeast rice, keep in mind that there is currently no way to tell how much monacolin K, citrinin, or other compounds are in each supplement without lab testing. Companies are not required to give this information on the label .

Cholestin

Before it was outlawed by the FDA, red yeast rice extract was sold in the USA as a supplement called Cholestin. You or someone you know may have used Cholestin before the turn of the century. People who responded well to Cholestin may likewise respond well to red yeast rice; talk to your doctor to see whether this is an appropriate option for you .

Dosage

There is no safe and effective dose of red yeast rice because no sufficiently powered study has been conducted to find one.

Clinical studies use a purified extract of red yeast rice that is guaranteed to contain a certain percentage of monacolins. In one such study, 10 mg of monacolins per day, from purified extract, safely reduced cholesterol and prevented harmful changes to blood vessels. It also lowered hs-CRP, a protein that increases during inflammation .

In another study, 2.4 g of red yeast rice per day reduced cholesterol and blood triglycerides. The correct dosage depends on the purity and form of the supplement .

Takeaway

Red yeast rice is produced when the red mold Monascus purpureus grows on white rice. This health food is a staple of Chinese traditional medicine; it contains a group of bioactive compounds called monacolins and several pigments.

Monacolin K is chemically identical to lovastatin, a drug prescribed to lower cholesterol. As a result, the FDA controls red yeast rice supplements; it may be difficult to find a high-quality supplement that contains enough monacolins to be effective.

Monacolin K, like lovastatin, blocks the production mevalonate, which is later converted to cholesterol. This decreases total cholesterol and bad cholesterol (LDL), but it also decreases coenzyme Q10 and other important compounds.

Like many nutraceuticals, red yeast rice carries some risk. Lovastatin has been linked to birth defects; pregnant women should therefore not supplement with red yeast rice. Red yeast rice may also interact with several drugs; always consult your doctor before choosing to supplement. If you are taking red yeast rice, avoid eating grapefruit or drinking grapefruit juice.

Red Yeast Rice

Red yeast rice is a traditional Chinese culinary and medicinal product. In the United States, dietary supplements containing red yeast rice have been marketed to help lower blood levels of cholesterol and related lipids. Red yeast rice products may not be safe; some may have the same side effects as certain cholesterol-lowering drugs, and some may contain a potentially harmful contaminant. This fact sheet provides basic information about red yeast rice, summarizes scientific research on effectiveness and safety, discusses the legal status of red yeast rice, and suggests sources for additional information.

Key Facts

  • Some red yeast rice products contain substantial amounts of monacolin K, which is chemically identical to the active ingredient in the cholesterol-lowering drug lovastatin. These products may lower blood cholesterol levels and can cause the same types of side effects and drug interactions as lovastatin.
  • Other red yeast rice products contain little or no monacolin K. It is not known whether these products have any effect on blood cholesterol levels.
  • Consumers have no way of knowing how much monacolin K is present in most red yeast rice products. The labels on these products usually state only the amount of red yeast rice that they contain, not the amount of monacolin K.
  • The U.S. Food and Drug Administration (FDA) has determined that red yeast rice products that contain more than trace amounts of monacolin K are unapproved new drugs and cannot be sold legally as dietary supplements.
  • Some red yeast rice products contain a contaminant called citrinin, which can cause kidney failure.
  • Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Red Yeast Rice

Red yeast rice is made by culturing rice with various strains of the yeast Monascus purpureus. Some preparations of red yeast rice are used in food products in Chinese cuisine, including Peking duck. Others have been sold as dietary supplements to lower blood levels of cholesterol and related lipids.

Some red yeast rice products contain substances called monacolins, which are produced by the yeast. Monacolin K is chemically identical to the active ingredient in the cholesterol-lowering drug lovastatin, which is one of the drugs in the category known as statins. These drugs lower blood cholesterol levels by reducing the production of cholesterol by the liver.

The composition of red yeast rice products varies depending on the yeast strains and culture conditions used to manufacture them. The strains and conditions used to produce culinary red yeast rice differ from those used to produce products that are intended to lower cholesterol. Tests performed by the FDA indicate that the red yeast rice sold as a food product contains only traces of monacolin K or none at all.

In both 2008 and 2009, the most recent years for which data are available, sales of red yeast rice dietary supplements were approximately $20 million per year. According to the 2007 National Health Interview Survey, which included a comprehensive survey of the use of complementary health approaches by Americans, 2.1 percent of respondents (an estimated 1.8 million Americans) had used complementary health approaches for cholesterol in the past year.

Safety

  • The same types of side effects that can occur in patients taking lovastatin as a drug can also occur in patients who take red yeast rice products that contain monacolin K. Potential side effects include myopathy (muscle symptoms such as pain and weakness), rhabdomyolysis (a condition in which muscle fibers break down, releasing substances into the bloodstream that can harm the kidneys), and liver toxicity. Each of these three side effects has been reported in people who were taking red yeast rice.
  • Red yeast rice supplements should not be used while pregnant or breastfeeding.
  • Lovastatin can interact with a variety of drugs to increase the risk of rhabdomyolysis; these drugs include other cholesterol-lowering agents, certain antibiotics, the antidepressant nefazodone, drugs used to treat fungal infections, and drugs used to treat HIV infection. Red yeast rice containing monacolin K could interact with drugs in the same way.
  • If the process of culturing red yeast rice is not carefully controlled, a substance called citrinin can form. Citrinin has been shown to cause kidney failure in experimental animals and genetic damage in human cells. In a 2011 analysis of red yeast rice products sold as dietary supplements, 4 of 11 products were found to contain this contaminant.

What the Science Says

Red yeast rice products that contain substantial amounts of monacolin K can lower blood cholesterol levels. Researchers have not reported results of any studies of red yeast rice products that contain little or no monacolin K, so whether these products have any effect on blood cholesterol is unknown.

Results of Clinical Trials

In clinical trials (studies in people) of red yeast rice products that contained substantial amounts of monacolin K, the products lowered blood levels of total cholesterol and low-density lipoprotein (LDL) cholesterol (the so-called bad cholesterol that is linked to increased heart disease risk). It is important to emphasize that all of these clinical trials used products that contained substantial amounts of monacolin K. A 2011 analysis showed that some of the red yeast rice products on the market contain very little monacolin K. These products may have little or no effect on blood cholesterol levels. Therefore, even though the participants in the clinical trials were able to lower their cholesterol levels by taking red yeast rice, you might not be able to achieve the same results.

In one of the clinical trials, the tested product produced a cholesterol-lowering effect greater than would be expected based on its monacolin K content. Further investigations, supported by the National Center for Complementary and Integrative Health (NCCIH), suggested that other monacolins or other substances present in the product may have contributed to its cholesterol-lowering effect.

Tolerability of Red Yeast Rice Products

Two studies supported by NCCIH have indicated that some people who had been unable to tolerate statin drugs because of side effects (muscle pain or weakness) were able to tolerate red yeast rice. It is uncertain whether the smaller amount of monacolin K in the red yeast rice products, as compared with the amounts of active ingredients in the drugs, accounted for the greater tolerability or whether other factors were responsible.

Legal Status of Red Yeast Rice

In 1998, the FDA determined that a red yeast rice product that contained a substantial amount of monacolin K was an unapproved new drug, not a dietary supplement. On several occasions since then, the FDA has taken action against companies selling red yeast rice products that contain more than trace amounts of monacolin K, warning them that it is against the law to market these products as dietary supplements.

Despite the FDA actions, some red yeast rice products currently on the market in the United States may contain monacolin K. (Some products tested as recently as 2011 have been found to contain it in substantial amounts.) Other products may contain little or none of this component. Consumers have no way of knowing how much monacolin K is present in most red yeast rice products, and therefore have no way of knowing whether a particular product is safe, effective, or legal. The labels on these products usually state only the amount of red yeast rice that they contain, not the amounts of monacolin K or other monacolins.

If You Are Considering Red Yeast Rice

  • Do not use red yeast rice to replace conventional care or to postpone seeing your health care provider about a health problem.
  • Do not use red yeast rice dietary supplements if you are pregnant, trying to become pregnant, or nursing a child. If you are considering giving a child a red yeast rice dietary supplement, it is especially important to consult the child’s health care provider.
  • Do not take red yeast rice in addition to prescription statin drugs.
  • Many Web sites, including sales sites, have information about red yeast rice. Be cautious when you evaluate information from the Web; not all of it is trustworthy. For more information, see the NCCIH fact sheet Evaluating Web-Based Health Resources.
  • Federal regulations for dietary supplements are very different from—and less strict than—those for drugs. For more information about dietary supplements, see NCCIH’s fact sheet Using Dietary Supplements Wisely.
  • Tell all your health care providers about any complementary health approaches you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

red yeast rice (Cholestin (obsolete), Red Yeast Rice)

Brand Names: Cholestin (obsolete), Red Yeast Rice

Generic Name: red yeast rice

  • What is red yeast rice (Cholestin (obsolete), Red Yeast Rice)?
  • What are the possible side effects of red yeast rice (Cholestin (obsolete), Red Yeast Rice)?
  • What is the most important information I should know about red yeast rice (Cholestin (obsolete), Red Yeast Rice)?
  • What should I discuss with my healthcare provider before taking red yeast rice (Cholestin (obsolete), Red Yeast Rice)?
  • How should I take red yeast rice (Cholestin (obsolete), Red Yeast Rice)?
  • What happens if I miss a dose (Cholestin (obsolete), Red Yeast Rice)?
  • What happens if I overdose (Cholestin (obsolete), Red Yeast Rice)?
  • What should I avoid while taking red yeast rice (Cholestin (obsolete), Red Yeast Rice)?
  • What other drugs will affect red yeast rice (Cholestin (obsolete), Red Yeast Rice)?
  • Where can I get more information (Cholestin (obsolete), Red Yeast Rice)?

What is red yeast rice (Cholestin (obsolete), Red Yeast Rice)?

Red yeast rice is a product that is made by fermenting red rice with a certain type of yeast. Red yeast rice is also known as Cholestin, Hypocol, Xuezhikang, or Zhitai.

Red yeast rice supplements are not the same as red yeast rice that is sold in Chinese grocery stores.

Red yeast rice has been used in alternative medicine as a likely effective aid in reducing levels of “bad” cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood.

Red yeast rice has been used as a possibly effective aid in reducing the risk of heart disease, heart attacks, or death in people with a history of heart attack.

Red yeast rice has also been used as a possibly effective aid in lowering cholesterol and triglyceride levels in people with human immunodeficiency virus (HIV).

Red yeast rice has been used to treat high blood pressure. However, research has shown that red yeast rice may not be effective in treating this condition.

Other uses not proven with research have included: lowering cholesterol levels in people with diabetes or liver disease; improving blood circulation; and treating diarrhea, indigestion, or other stomach problems.

It is not certain whether red yeast rice is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Red yeast rice should not be used in place of medication prescribed for you by your doctor.

Red yeast rice is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Red yeast rice may also be used for purposes not listed in this product guide.

What are the possible side effects of red yeast rice (Cholestin (obsolete), Red Yeast Rice)?

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Although not all side effects are known, red yeast rice is thought to be possibly safe when taken as directed for up to 4.5 years.

Stop using red yeast rice and call your healthcare provider at once if you have:

  • unexplained muscle pain, tenderness, or weakness;
  • fever, unusual tiredness; or
  • nausea, upper stomach pain, itching, tiredness, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • constipation; or
  • stomach discomfort.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What is the most important information I should know about red yeast rice (Cholestin (obsolete), Red Yeast Rice)?

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

What Are the Risks of Red Yeast Rice?

Studies have shown that side effects are mild, like headaches, heartburn, and upset stomach. Side effects from prescription lovastatin include elevation of liver enzymes and muscle enzymes, muscle problems, and liver problems.

But more research needs to be done before we can know about the long-term safety of red yeast rice extract. We do know that some types may be more dangerous than others because of high levels of other substances such as citrinic acid.

RYRE also shares some of the same risks as statins, the class of drugs containing lovastatin. Experts say that the risks of lovastatin would logically apply to RYRE — elevation of liver and muscle enzymes, muscle problems, and liver problems.

The extract may not be safe for everyone. You should not take it if you:

  • Have kidney disease
  • Have liver disease
  • Are pregnant
  • Are breastfeeding

In addition, anyone taking one of the following medicines should not use red yeast rice:

  • Statins to control cholesterol such as lovastatin (Mevacor), rosuvastatin (Crestor), fluvastatin (Lescol), atorvastatin (Lipitor), pravastatin (Pravachol), and simvastatin (Zocor)
  • Other cholesterol drugs such as gemfibrozil (Lopid) and fenofibrate (TriCor)
  • Drugs to suppress the immune system, like cyclosporine
  • Antifungal drugs such as fluconazole (Diflucan), ketoconazole (Nizoral), and itraconazole (Sporanox)
  • The antibiotics erythromycin and clarithromycin (Biaxin)
  • Serzone, an antidepressant
  • Protease inhibitors, used to treat HIV

People who have allergies to fungus or yeast should also be wary of using RYRE.

The extract may also interact with other drugs for blood pressure and thyroid problems and interact with other herbs and supplements you may be taking.

Whatever the state of your health, always talk to your doctor before you start using red yeast rice or any other supplement. Remember that not all brands are equal, and that RYRE isn’t safe for everyone. Though red yeast rice extract looks like a promising treatment, more research needs to be done. For now, you should be cautious.

Red Yeast Rice

Red yeast rice is a traditional Chinese culinary and medicinal product that’s used to treat cholesterol levels and other ailments.

It’s made by fermenting various strains of Monascus purpureus yeast on rice.

Red yeast rice (sometimes called RYR) typically contains compounds that are similar to the active ingredients in prescription drugs called statins, which are used to treat high cholesterol.

In particular, RYR may contain monacolin K, a compound that’s chemically identical to the cholesterol-lowering drug lovastatin (Mevacor).

Because of its monacolin K content, RYR has all of the possible side effects, drug interactions, and precautions as lovastatin.

Some research suggests RYR is effective at reducing LDL cholesterol and triglyceride levels, possibly because of monacolin K.

Red yeast rice is also used to help with other health conditions, although its effectiveness is unknown. These conditions include:

  • High cholesterol related to HIV
  • High blood pressure (hypertension)
  • Diabetes
  • Heart disease
  • Liver disease
  • Digestive problems, including diarrhea and indigestion
  • Poor blood circulation

In 1998, the Food and Drug Administration (FDA) banned the sale of the RYR product Cholestin until it reformulated.

The FDA considered Cholestin an unapproved drug (rather than a supplement, which the FDA does not regulate) because it had an active amount of monacolin K.

Since then, RYR manufacturers are supposed to remove from the U.S. market any products that have more than trace amounts of monacolin K.

However, as long as they don’t claim their products lower cholesterol or contain monacolin K, they aren’t subject to FDA action, and consumers have no way of knowing just how much of it they’re consuming.

In 2010, there were at least 31 products with RYR available to U.S. consumers, according to a study published that year in the journal Archives of Internal Medicine.

The researchers tested 12 products sold online and at U.S. stores and found that the amount of monacolin (including monacolin K) varied widely.

In 2014, the company Doctor’s Best recalled more than 7,000 bottles of its RYR dietary supplement because it contained undeclared amounts of monacolin K.

Red Yeast Rice Warnings

Some RYR products contain a poison called citrinin (if the yeast isn’t fermented correctly), which can cause kidney failure.

One-third of the RYR products tested in the 2010 U.S. study contained citrinin.

A 2014 study in the journal Food Control also found that 35.1 percent of RYR dietary supplements in Taiwan contained citrinin.

If you have any health issues, be sure to tell your doctor if you are taking or have taken RYR.

Because it contains chemicals similar to statins, RYR supplements may cause liver damage, muscle damage, and severe muscle pain.

You shouldn’t take RYR if you have:

  • Liver disease or a high risk of liver disease
  • Kidney disease
  • Thyroid problems
  • Musculoskeletal disorders
  • A serious infection or physical condition
  • An organ transplant

Breathing in red yeast may cause serious allergic reactions.

If you think you might be having any serious reaction to RYR, call your doctor or get medical help right away.

Pregnancy and Red Yeast Rice

Do not take RYR if you are pregnant — red yeast has caused birth defects in animals.

You also should not take RYR if you are breastfeeding because it may be unsafe to your infant.

Generic Name: red yeast rice (RED YEAST RICE)
Brand Name: Cholestin (obsolete)

Medically reviewed by Drugs.com on Oct 21, 2019 – Written by Cerner Multum

  • Overview
  • Side Effects
  • Professional
  • Interactions
  • Reviews
  • More

What is red yeast rice?

Red yeast rice is a product that is made by fermenting red rice with a certain type of yeast. Red yeast rice is also known as Cholestin, Hypocol, Xuezhikang, or Zhitai.

Red yeast rice supplements are not the same as red yeast rice that is sold in Chinese grocery stores.

Red yeast rice has been used in alternative medicine as a likely effective aid in reducing levels of “bad” cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood.

Red yeast rice has been used as a possibly effective aid in reducing the risk of heart disease, heart attacks, or death in people with a history of heart attack.

Red yeast rice has also been used as a possibly effective aid in lowering cholesterol and triglyceride levels in people with human immunodeficiency virus (HIV).

Red yeast rice has been used to treat high blood pressure. However, research has shown that red yeast rice may not be effective in treating this condition.

Other uses not proven with research have included: lowering cholesterol and blood sugar levels in people with diabetes, improving blood circulation, lowering liver enzymes associated with liver damage, and treating diarrhea, indigestion, or other stomach problems.

It is not certain whether red yeast rice is effective in treating any medical condition. Medicinal use of this product has not been approved by the FDA. Red yeast rice should not be used in place of medication prescribed for you by your doctor.

Red yeast rice is often sold as an herbal supplement. There are no regulated manufacturing standards in place for many herbal compounds and some marketed supplements have been found to be contaminated with toxic metals or other drugs. Herbal/health supplements should be purchased from a reliable source to minimize the risk of contamination.

Red yeast rice may also be used for purposes not listed in this product guide.

Important Information

Follow all directions on the product label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use red yeast rice if you are allergic to it, or:

  • if you already take a cholesterol-lowering medication, such as lovastatin, simvastatin, atorvastatin, rosuvastatin, Zocor, Lipitor, Pravachol, Crestor, Vytorin, and many others.

Talk with your healthcare provider before using red yeast rice to lower your cholesterol. You should not use red yeast rice in place of any medication that has been prescribed by your doctor.

Ask a doctor, pharmacist, or other healthcare provider if it is safe for you to use this product if you have ever had:

  • liver disease; or

  • kidney disease.

Red yeast rice has caused birth defects in animals and is considered likely unsafe to use during pregnancy. Do not use this product without medical advice if you are pregnant.

It is not known whether red yeast rice passes into breast milk or if it could harm a nursing baby. Do not use this product without medical advice if you are breast-feeding a baby.

Do not give any herbal/health supplement to a child without medical advice.

How should I take red yeast rice?

Red yeast rice contains an active ingredient called monacolin K, which has the same chemical structure as the active drug in the “statin” cholesterol medicine lovastatin (Advicor, Altoprev, Mevacor). For this reason, red yeast rice supplements may produce the same side effects and drug interactions as statin cholesterol medications produce.

The US Food and Drug Administration (FDA) considers red yeast products that contain more than trace amounts of this statin-identical ingredient to be illegal and unapproved drugs. Red yeast rice products sold within the United States are formulated not to contain high levels of monacolin K. However, red yeast rice with higher levels of monacolin K are still available in other countries.

When considering the use of herbal supplements, seek the advice of your doctor. You may also consider consulting a practitioner who is trained in the use of herbal/health supplements.

If you choose to use red yeast rice, use it as directed on the package or as directed by your doctor, pharmacist, or other healthcare provider. Do not use more of this product than is recommended on the label.

Red yeast rice works best if you take it with food.

Do not inhale the powder from a red yeast rice capsule. It may cause an allergic reaction.

Call your doctor if the condition you are treating with red yeast rice does not improve, or if it gets worse while using this product.

Store at room temperature away from moisture and heat.

What happens if I miss a dose?

Skip the missed dose and use your next dose at the regular time. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking red yeast rice?

Avoid drinking alcohol. It may increase your risk of liver damage while you are taking red yeast rice.

Avoid using red yeast rice together with other herbal/health supplements that can harm your liver, such androstenedione, chaparral, comfrey, DHEA, germander, kava, niacin, pennyroyal oil, and others.

Grapefruit may interact with red yeast rice and lead to unwanted side effects. Avoid the use of grapefruit products.

Avoid taking an herbal supplement containing St. John’s wort at the same time you are taking red yeast rice.

Avoid using red yeast rice together with another herbal/health supplement that contains coenzyme Q10 (CoQ10, ubiquinone).

Red yeast rice side effects

Get emergency medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Although not all side effects are known, red yeast rice is thought to be possibly safe when taken as directed for up to 4.5 years.

Stop using red yeast rice and call your healthcare provider at once if you have:

  • unexplained muscle pain, tenderness, or weakness;

  • fever, unusual tiredness; or

  • nausea, upper stomach pain, itching, tiredness, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Common side effects may include:

  • constipation; or

  • stomach discomfort.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

What other drugs will affect red yeast rice?

Do not take red yeast rice without medical advice if you are using a medication to treat any of the following conditions:

  • any type of infection (viral, bacterial, or fungal), including HIV or tuberculosis;

  • arthritis, including gold injections;

  • cancer;

  • depression or a psychiatric disorder;

  • high blood pressure, high cholesterol, or a heart condition;

  • pain or headaches, especially if you take an NSAID (nonsteroidal anti-inflammatory drugs) aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, meloxicam, and others);

  • prevention of organ transplant rejection; or

  • seizures.

This list is not complete. Other drugs may affect red yeast rice, including prescription and over-the-counter medicines, vitamins, and herbal products. Not all possible drug interactions are listed here.

  • Consult with a licensed healthcare professional before using any herbal/health supplement. Whether you are treated by a medical doctor or a practitioner trained in the use of natural medicines/supplements, make sure all your healthcare providers know about all of your medical conditions and treatments.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Copyright 1996-2018 Cerner Multum, Inc. Version: 8.01.

Medical Disclaimer

  • Side Effects
  • Drug Interactions
  • Support Group
  • En Español
  • 6 Reviews
  • Drug class: nutraceutical products
  • FDA Alerts (1)

Professional resources

  • Red Yeast Rice (Advanced Reading)
  • High Cholesterol

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *