Herb & supplement monograph

Red Yeast Rice Drug Interactions, Uses, Effectiveness, Safety & More

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS ·Updated July 2026

What is this page for?

First and foremost: how Red Yeast Rice interacts with medications. The heart of this page is the interaction list — every drug Red Yeast Rice is known to interact with, and how serious each one is.

But these pages have grown well beyond that into a full monograph — what Red Yeast Rice is, what people use it for and how strong the evidence is, its safety and side effects, and answers to the questions we’re asked most — written and reviewed by the clinical staff at HelloPharmacist. It’s educational information from our licensed clinical databases, not medical advice, and we don’t sell or endorse products. Our editorial policy

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Red Yeast Rice Drug Interactions: The Bottom Line

From the HelloPharmacist Editorial Team · Updated July 2026

Based on the available evidence, the risk of a clinically significant Red Yeast Rice drug interaction is moderate for many people, because this supplement naturally contains lovastatin, the same active compound found in a prescription statin. Every interaction on record is rated moderate, and none rise to the major level, but several are reasonably well documented in humans.

Interactions deserving the most attention

The combinations that deserve the most care involve muscle injury. Taking red yeast rice with cyclosporine is a real concern, since cyclosporine can raise lovastatin levels dramatically and has been tied to serious muscle breakdown. Combining it with other statins, gemfibrozil, or high-dose niacin may also raise the chance of muscle damage. Because red yeast rice can stress the liver in some people, pairing it with other medications known to affect the liver warrants extra awareness.

What the rest of the list means

The long list of interacting medications looks daunting, but most entries share one explanation: drugs that slow the enzyme the body uses to clear lovastatin could, in theory, raise its levels. Many of these pairings are theoretical and have not been shown to cause meaningful problems in people.

Check your medications against Red Yeast Rice

Based on HelloPharmacist’s Red Yeast Rice interaction data and reviewed under our editorial standards.

Interaction report

Drugs that interact with Red Yeast Rice

478 medications have a known interaction with Red Yeast Rice, graded by severity. Select any drug for the full evidence-based detail.

Don’t want to scroll the list? Just ask.

Tell us the medications you take and we’ll check each one against Red Yeast Rice using our pharmacist-reviewed interaction data.

AI summaries are generated from our Red Yeast Rice interaction data for education only — always confirm with your pharmacist. How we use AI

2,830 drugs

Read The List Like a Pharmacist

What Severity, Likelihood & Evidence Mean

Severity — How Serious It Can Be

Major. Clinically significant; generally best avoided, or used only under direct professional supervision.
Moderate. May need monitoring, a dose adjustment, or separating the times you take each one.
Minor. Generally not clinically significant, but still worth noting and mentioning to your pharmacist.
No known interaction. Checked against our sources with nothing documented — not the same as proven safety.

Likelihood — How Well It’s Documented

Likely. Well-controlled human studies have demonstrated the likely existence of this interaction
Probable. Interaction 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.
Possible. 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
Unlikely. Interaction has been demonstrated in animal or in lab research but has been shown not to occur in humans.

Where This Data Comes From

Interaction records are evidence-graded and sourced from the Natural Medicines database (TRC Healthcare), the same reference used by pharmacists and hospitals.
Each drug listed above links to the full report for that exact Red Yeast Rice combination — clinical detail, likelihood, evidence level, and citations.
Content is reviewed by licensed HelloPharmacist pharmacists — see our data sources and editorial standards.

The big picture

The kinds of drugs Red Yeast Rice affects

Every type of medication (drug category) Red Yeast Rice is known to interact with. Open any category for the detail — or search your exact drug in the checker above.

All 6 drug categories Red Yeast Rice interacts with

Cyclosporine (neoral, Sandimmune)Cytochrome P450 3a4 (cyp3a4) InhibitorsGemfibrozil (lopid)Hepatotoxic DrugsHmg-coa Reductase Inhibitors ("statins")Niacin

Cyclosporine (Neoral, Sandimmune)

Theoretically, taking red yeast rice in combination with cyclosporine might increase the risk of myopathy.
Red yeast rice contains varying levels of the statin drug lovastatin. Cyclosporine has been reported to increase plasma levels of lovastatin by 5- to 20-fold, resulting in reports of myopathy and rhabdomyolysis.

Likelihood Probable Evidence D

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.

Likelihood Possible Evidence D

Gemfibrozil (Lopid)

Theoretically, taking red yeast rice in combination with gemfibrozil might increase the risk of rhabdomyolysis.
Red yeast rice contains varying levels of the statin drug lovastatin. Gemfibrozil has been reported to increase the risk of rhabdomyolysis when used in combination with lovastatin.

Likelihood Probable Evidence D

Hepatotoxic Drugs

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.

Likelihood Possible Evidence D

Hmg-Coa Reductase Inhibitors ("Statins")

Theoretically, taking red yeast rice with other statins might increase the risk of potential adverse effects.
Red yeast rice contains varying levels of the statin drug lovastatin and might result in supratherapeutic levels when used with other statins. Based on evaluation of data from the US Food and Drug Administration's adverse event reporting system (FAERS), it is recommended that red yeast rice products be avoided in people taking prescription statins.

Likelihood Probable Evidence D

Niacin

Theoretically, taking red yeast rice in combination with high-dose niacin might increase the risk of rhabdomyolysis.
Red yeast rice contains varying levels of the statin drug lovastatin and has been linked to reports of myopathy. Niacin has been reported to increase the risk of rhabdomyolysis when used in combination with lovastatin.

Likelihood Probable Evidence D

Monograph

Red Yeast Rice: Uses, Safety & Side Effects

Medically reviewed by Dr. Brian Staiger, PharmD, BCPS · Reviewed July 2026 ·

The bottom line

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.

Scientific name: Monascus purpureus
Part used: Rice fermented with Monascus purpureus yeast
Common forms: Capsules, tablets, powder

People commonly use it for

High cholesterol
Heart health
Metabolic syndrome
Statin alternative

Popular and traditional uses — not proof it works. See “Uses & effectiveness” below for the evidence.

Safety at a glance

OverallUse caution

It works like a statin drug and can carry similar risks, plus product quality varies.

PregnancyLikely Unsafe

When used orally. The red yeast rice constituent, lovastatin, has induced fetal skeletal malformations in animals. The US Food and Drug Administration...

Read the full pregnancy detail

BreastfeedingInsufficient reliable information

Insufficient reliable information available; avoid using. The US FDA recommends against breastfeeding while taking statins.

Read the full breastfeeding detail

Pregnancy & breastfeeding ratings are from Natural Medicines (Therapeutic Research Center). Safety guidance is general; always confirm with your pharmacist or doctor for your situation.

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Overview

Red yeast rice is a traditional food and medicine made by fermenting white rice with a yeast called Monascus purpureus. The fermentation turns the rice a deep red color and creates several active compounds. It has been used for centuries in China and other parts of Asia, both as a food coloring and flavoring and as a folk remedy.

In traditional medicine, red yeast rice has been used to support digestion and blood circulation. Today, it is most popular as a dietary supplement for lowering cholesterol. It is sold mainly as capsules and tablets.

How it works

Red yeast rice contains a group of compounds called monacolins. The most important is monacolin K, which is chemically identical to the statin drug lovastatin (sometimes also called mevinolin).

Monacolin K blocks an enzyme in the liver called HMG-CoA reductase, which the body uses to make cholesterol. By slowing this enzyme, red yeast rice can reduce how much cholesterol the body produces. This is the same way prescription statin medicines work.

Red yeast rice also contains other natural substances, including plant sterols and pigments, but the cholesterol-lowering effect is mainly credited to the monacolins.

Effectiveness

Does Red Yeast Rice work?

Here’s what the research actually shows for each use — graded by Natural Medicines and reviewed by Dr. Brian Staiger, PharmD.

Evidence overview · 13 uses evaluated

2 Possibly effective 1 Leans ineffective 10 Insufficient evidence

How to read these evidence grades

Natural Medicines’ 7-point scale. We show each rating’s label word-for-word.

1EffectiveStrong, consistent evidence it works.

2Likely EffectiveGood evidence, though not yet conclusive.

3Possibly EffectiveSome evidence suggests a benefit.

4Possibly IneffectiveSome evidence it may not help.

5Likely IneffectiveFairly strong evidence it doesn’t help.

6IneffectiveStrong evidence it doesn’t work.

7Insufficient Reliable Evidence to RateToo little research to say either way.

Possibly Effective HIV/AIDS-related dyslipidemia