Drug & supplement interaction

Red Yeast Rice + Fluconazole

Fluconazole brand names: Diflucan, Diflucan Injection.

Moderate Interaction
Medically reviewed by · Updated September 2026
The bottom line Moderate

Fluconazole falls into 2 drug categories that Red Yeast Rice can interact with; the most serious is rated moderate. Theoretically, concomitant use might increase the risk of liver damage.

Read the full interaction report
SeverityModerate
LikelihoodPossible
Interactions2
EvidenceD
What do Severity, Likelihood & Evidence mean?
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Interaction report

Red Yeast Rice and Fluconazole

These two interact in 2 distinct ways. Each one is explained separately below.

Why Are There 2 Interactions?

Red Yeast Rice interacts with whole categories of medication. Fluconazole falls into 2 of those categories, so it can interact with Red Yeast Rice in 2 different ways. We’ve listed each one below — your overall risk is driven by the most serious of them (Moderate).

Moderate

HEPATOTOXIC DRUGS

1 of 2

Why this applies to Fluconazole

Fluconazole falls under HEPATOTOXIC DRUGS — the group Red Yeast Rice interacts with.

Theoretically, concomitant use might increase the risk of liver damage.
Red yeast rice contains varying levels of the drug lovastatin. Lovastatin can cause liver damage in some people. Some clinical research suggests that supplements containing red yeast rice might increase liver enzyme levels in some, but not all, participants. Cases of acute hepatitis have been associated with red yeast rice. Combining it with hepatotoxic drugs might further increase this risk.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the simple version: both of these can be tough on your liver, so taking them together may add up. Red yeast rice naturally contains lovastatin (a statin), and statins can occasionally bump up liver enzymes or, rarely, cause liver irritation. Fluconazole can also stress the liver in some people, especially with higher doses or longer courses. Stacking two liver-stressing products may raise the odds of a problem.

I want to be honest that this is a theoretical concern based on how these work, not a proven, common event, so don't panic. Watch for yellowing skin or eyes, dark urine, belly pain, or unusual tiredness, and check with your pharmacist or doctor before combining them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. 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. PubMed
  2. Huang, J., Frohlich, J., and Ignaszewski, A. P. The impact of dietary changes and dietary supplements on lipid profile. Can J Cardiol 2011;27(4):488-505. PubMed
  3. Grieco, A., Miele, L., Pompili, M., Biolato, M., Vecchio, F. M., Grattagliano, I., and Gasbarrini, G. Acute hepatitis caused by a natural lipid-lowering product: when "alternative" medicine is no "alternative" at all. J Hepatol 2009;50(6):1273-1277. PubMed
  4. Lin, C. C., Li, T. C., and Lai, M. M. Efficacy and safety of Monascus purpureus Went rice in subjects with hyperlipidemia. Eur J Endocrinol 2005;153(5):679-686. PubMed
  5. Prescribing Information. Mevacor (lovastatin). Whitehouse Station, NJ: Merck & Co., Inc., February 2012.
Moderate

CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS

2 of 2

Fluconazole also falls under CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS.

Theoretically, drugs that inhibit the CYP3A4 enzymes might increase levels of lovastatin from red yeast rice.
Red yeast rice contains varying levels of the statin drug lovastatin, which is metabolized by CYP3A4. Combining red yeast rice with CYP3A4 inhibitors might increase serum levels of lovastatin from red yeast rice.
Severity Moderate Likelihood Possible Evidence D

Interaction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.

Dr. Brian Staiger, PharmD, BCPS
Dr. Brian Staiger explains PharmD, Clinical Pharmacist

Here's the thing to know about pairing these two. The active part of red yeast rice is basically lovastatin, a statin, and your body clears that statin using a liver enzyme called CYP3A4. Fluconazole slows that same enzyme down, so the statin from your red yeast rice may not get broken down as quickly and can build up in your blood.

When statin levels run high, the main worry is muscle problems, things like unusual aches, weakness, or tenderness, and rarely a more serious muscle breakdown that can stress the kidneys. This concern is based on how the drugs work rather than hard studies, so it's not a sure thing, especially with short fluconazole courses. Still, since red yeast rice doses vary a lot, please check with your pharmacist or doctor before combining them.

Contact Dr. Brian directly if you have additional questions on this interaction
References
  1. Prescribing Information. Mevacor (lovastatin). Whitehouse Station, NJ: Merck & Co., Inc., February 2012.

What These Ratings Mean

Every interaction above is graded three ways — here’s the key to each label.

Severity how clinically significant the interaction is
Major

Clinically significant. Avoid the combination, or use only under close professional supervision.

Moderate

Usually worth avoiding or managing — may need monitoring, a dose change, or timing apart.

Minor

Generally not serious. Be aware of it and mention it to your pharmacist.

Likelihood how strong the evidence is that the interaction actually happens in people
  • LikelyWell-controlled human studies have demonstrated the likely existence of this interaction.
  • ProbableInteraction has not been documented in well-controlled studies, however, the interaction has been demonstrated in some small human studies or in controlled animal studies in conjunction with multiple case reports.
  • PossibleInteraction has been documented in animal or in lab research, or the interaction has been documented in humans but is limited to case reports or conflicting clinical research exists.
  • UnlikelyInteraction has been demonstrated in animal or in lab research but has been shown not to occur in humans.
Evidence the quality of the studies behind the rating (graded A–D)
  • AHigh-quality meta-analysis (quantitative systematic review).
  • BCase-control study.
  • CConsensus.
  • DAnecdotal evidence.

These ratings are for information only. Never start, stop, or otherwise change your therapy before speaking with your provider.

Keep it in perspective

Red Yeast Rice Also Interacts With Other Medications

Red Yeast Rice has 476 moderate known drug interactions in our database — the Fluconazole one above is among them. If you take anything else, check it against the full list below.

Moderate 476 No known interaction 2,354 (incl. Fluconazole)
Taking anything else?

Check Another of Your Medications Against Red Yeast Rice

Covers the 2,830 medications we’ve checked against Red Yeast Rice. Pick one to open its full report.

From our Q&A

Questions About Red Yeast Rice or Fluconazole

These are real questions from readers, answered by the pharmacists at HelloPharmacist — written by a person, not generated from a database. Each one covers Red Yeast Rice or Fluconazole, not necessarily both, but if one is close to what you were about to ask it will usually go further than a database entry can:

Not quite your question? Ask our pharmacists directly — it is free, there is no account required, and answers usually come back within 24 hours.

Everything else you take

See Every Supplement That Interacts With Fluconazole

This page covers Red Yeast Rice only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Fluconazole page lists 81 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), Beer (major), Siberian Cocklebur (major), Wine (major) and Adrafinil (moderate).

By severity: 4 major · 54 moderate · 23 minor.

From our pharmacist’s overview on the Fluconazole page

“Fluconazole (Diflucan) treats fungal infections, and I would pair it with supplements carefully. Nearly half of the 81 ingredients with an interaction on file, 38 of them, put extra strain on the liver, which is already busy processing the antifungal.”

Reviewed by 2 · Jul 18, 2026

Open the Fluconazole interaction page

One more smart check

Taking Red Yeast Rice as Part of a Dietary Supplement Product? Check It for Interactions

We hold 593 real supplement products containing Red Yeast Rice, each one broken down to its full ingredient list — and combination products often carry several ingredients besides Red Yeast Rice. Your product may carry other ingredients that interact with Fluconazole too, on top of Red Yeast Rice — and those would not show on this page. Find your product and we’ll check every ingredient on its label:

How much people look this up

Where Red Yeast Rice and Fluconazole Sit Against Everything Else

Out of every supplement and medication people look up on HelloPharmacist, here is where these two land this week — and which way each has been moving.

Supplement Red Yeast Rice
Top 25%

#350 of 1,452 supplements looked up here in the last 7 days

29 days ago today
Medication Fluconazole
Top 25%

#370 of 2,830 medications looked up here in the last 7 days

29 days ago today

Position among everything looked up on this site, not a measure of how commonly either one is used or how important it is. A supplement can climb this list because of a news story. It counts every request to the page, automated ones included, and nothing here identifies anyone.

Supplement

About Red Yeast Rice

What is Red Yeast Rice?

Red Yeast Rice
  • High cholesterol
  • Heart health
  • Metabolic syndrome
  • Statin alternative

Red yeast rice contains monacolin K, which is chemically identical to the prescription statin lovastatin, and it can lower LDL ('bad') cholesterol. Because of this, it carries the same risks as statin drugs, and the amount of active ingredient varies widely between products. Always talk to your pharmacist or doctor before using it, especially if you have liver problems or take other medicines.

Read the full Red Yeast Rice monograph & all interactions
Medication

About Fluconazole

What Is Fluconazole Used For?

Brand names: Diflucan, Diflucan Injection

Fluconazole treats infections caused by Candida and Cryptococcus fungi. Diflucan tablets and oral fluconazole tablets and suspension are approved to treat vaginal yeast infections (vaginal candidiasis), thrush in the mouth or throat (oropharyngeal candidiasis), and yeast infections of the esophagus. All forms — tablets, oral suspension, and injection — are used for cryptococcal meningitis (a serious fungal brain infection). In smaller studies, fluconazole has also shown effectiveness against Candida urinary tract infections, peritonitis (infection in the abdomen), and serious systemic (bloodstream and organ) Candida infections.

Fluconazole is also used to prevent candidiasis in people undergoing bone marrow transplants who receive chemotherapy or radiation therapy. Note that vaginal candidiasis is an approved use for the tablets and Diflucan oral products, but not for the injection or oral suspension alone.

See full Fluconazole drug information
Keep checking

Other Drugs & Red Yeast Rice

Browse every other medication we’ve checked against Red Yeast Rice — both the ones with a known interaction and the ones without. Select any drug for the full detail.

0Major
476Moderate
0Minor
2,353No known interaction
476 Moderate 2,353 No interaction
Moderate

476 interactions

Showing 60 of 476 moderate interactions — see all 476 on the Red Yeast Rice page.

No interaction 2,353 drugs checked — show the list

We also checked Red Yeast Rice against these medications and found no known interaction in our sources. Open any page to confirm.

Showing the 60 most looked-up of 2,353 medications checked with no known interaction — see the full Red Yeast Rice list.

See the full Red Yeast Rice interactions page
See every supplement checked against Fluconazole, ranked by severity
Sources

Sources & How We Checked

Interaction details are evidence-graded and sourced from the Natural Medicines database. The medication overview comes from MedlinePlus.

Content is written and reviewed by licensed HelloPharmacist pharmacists. See our data sources and editorial standards for how this information is built and checked.

Parts of this content are provided by the Therapeutic Research Center, LLC.

DISCLAIMER: Currently this does not check for drug-drug interactions. This is not an all-inclusive comprehensive list of potential interactions and is for informational purposes only. Not all interactions are known or well-reported in the scientific literature, and new interactions are continually being reported. Input is needed from a qualified healthcare provider including a pharmacist before starting any therapy. Application of clinical judgment is necessary.

© 2021 Therapeutic Research Center, LLC

Keep exploring
Red Yeast Rice monograph › Uses, safety, and every drug interaction in one place Fluconazole supplement interactions › Every supplement checked against Fluconazole, ranked by severity Fluconazole drug information › The full plain-English guide to this medication Supplement interaction checker › Check any supplement or product against your medications Browse medications A–Z › Every drug we've checked against herbs & supplements Ask a pharmacist › Free, personal answer from our licensed team
Pharmacist Counseling Corner

Taking Red Yeast Rice and Fluconazole Together: Common Questions

Can you take Red Yeast Rice with Fluconazole?
There is a moderate interaction, so it may be acceptable with monitoring or timing changes — but check with your pharmacist first. Read the full details on this page and confirm with your pharmacist before combining them.
Why are there 2 interactions listed for Red Yeast Rice and Fluconazole?
Fluconazole belongs to more than one drug category, and Red Yeast Rice interacts with each of those categories a little differently. We list every one so nothing is missed — your overall risk is driven by the most serious of them.
How serious is the Red Yeast Rice and Fluconazole interaction?
We rate it Moderate. This combination may require monitoring, a dose adjustment, or separating the times you take each one. Consult your pharmacist before using them together.

Written and reviewed by the HelloPharmacist editorial staff. Our editorial policy

Still Have a Question About Fluconazole and Red Yeast Rice?

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This information is for education only and is not a substitute for professional medical advice. Always check with your pharmacist or doctor before starting, stopping, or combining supplements and medications.