Drug & supplement interaction

Red Yeast Rice + Lefamulin Acetate

Lefamulin Acetate brand name: Xenleta.

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

Red Yeast Rice has a moderate interaction with Lefamulin Acetate. Theoretically, drugs that inhibit the CYP3A4 enzymes might increase levels of lovastatin from red yeast rice.

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

Red Yeast Rice and Lefamulin Acetate

Here is the interaction we found between these two, with the evidence behind it.

Moderate

CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS

Why this applies to Lefamulin Acetate

Lefamulin Acetate falls under CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS — the group Red Yeast Rice interacts with.

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 this combo: red yeast rice contains lovastatin, a natural statin that your liver clears using an enzyme called CYP3A4. Lefamulin (Xenleta) can put the brakes on that same enzyme. So in theory, while you're getting lefamulin, the lovastatin from red yeast rice could build up higher than usual.

If statin levels climb too high, the main worry is muscle aches, weakness, or in rare cases more serious muscle breakdown, plus extra strain on the liver. The good news is that lefamulin is usually a short course for pneumonia, and this concern is theoretical, based on how the drugs work rather than real-world reports. Still, it's worth a quick chat with your pharmacist or doctor, who may suggest pausing the red yeast rice while you finish treatment.

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 Lefamulin Acetate one above is one of them. If you take anything else, check it against the full list below.

Moderate 476 No known interaction 2,354 (incl. Lefamulin Acetate)
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 Lefamulin Acetate

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 Lefamulin Acetate, 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 Lefamulin Acetate

This page covers Red Yeast Rice only. If you take other supplements — a multivitamin, a sleep aid, something for joints — the Lefamulin Acetate page lists 178 supplements it has a documented interaction with, worst first, each one explained.

The most serious there right now: Activated Charcoal (major), American Hellebore (major), Arsenic (major), Cesium (major) and Ephedra (major).

By severity: 8 major · 130 moderate · 40 minor.

From our pharmacist’s overview on the Lefamulin Acetate page

“Before adding any supplement to lefamulin acetate (Xenleta), a short-course antibiotic for pneumonia, look hard at the eight major-rated entries among its 178 documented interactions. They cluster around two dangers: ingredients that change how much lefamulin reaches your blood, and ingredients that can stretch the heart's rhythm on to…”

Reviewed by 2 · Jul 18, 2026

Open the Lefamulin Acetate 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 Lefamulin Acetate 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 Lefamulin Acetate 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%

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

29 days ago today
Medication Lefamulin Acetate
Steady interest

#2,371 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 Lefamulin Injection

What Is Lefamulin Injection Used For?

Brand name: Xenleta

Xenleta (lefamulin) injection is used to treat adults with community-acquired bacterial pneumonia (CABP) — a bacterial lung infection you can get in everyday life, outside of a hospital setting. It works against specific bacteria that commonly cause this type of pneumonia.

It should only be used when a bacterial infection is proven or strongly suspected. Using antibiotics when they aren't needed increases the risk of antibiotic-resistant bacteria.

See full Lefamulin Injection 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 Lefamulin Acetate, 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 Lefamulin Acetate supplement interactions › Every supplement checked against Lefamulin Acetate, ranked by severity Lefamulin Injection 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 Lefamulin Acetate Together: Common Questions

Can you take Red Yeast Rice with Lefamulin Acetate?
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.
How serious is the Red Yeast Rice and Lefamulin Acetate 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 Lefamulin Acetate 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.