Meta Information
ID:red-yeast-rice
Name:
Schema Version:2.4_uniform_evidence_2026_06_18
Created
2026-05-25T18:50:05.062584+00:00
Model
claude-sonnet-4.6-wave15-stub-rebuild
Interactions
Target id:
/class/statins
Target name:
Statin Therapy (Monacolin K = Lovastatin)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Red yeast rice contains monacolin K (chemically identical to lovastatin); avoid combining with prescription statins.
Actionable advice:
This combination should be avoided; if unavoidable, it should be managed under specialist supervision with intensive monitoring.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
In Germany, red yeast rice products with a daily monacolin K (lovastatin) dose greater than 5 mg are classified as drugs (98822).
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
avoid
Target id:
/class/cyp3a4-inhibitors
Target name:
CYP3A4 Inhibitors
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
CYP3A4 inhibitors may increase monacolin K exposure and statin-like adverse effects.
Actionable advice:
This is best used with caution, and it is a good idea to monitor for clinical effect; dose adjustment or monitoring may be required.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
less CYTOCHROME P450 3A4 (CYP3A4) INHIBITORS Interaction Rating Moderate Be cautious with this combination.
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
adjust_with_prescriber
Target id:
/intervention/niacin
Target name:
Niacin
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combination with niacin may increase myopathy risk as with prescription statins.
Actionable advice:
This is best used with caution, and it is a good idea to monitor for clinical effect; dose adjustment or monitoring may be required.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
less NIACIN Interaction Rating Moderate Be cautious with this combination.
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
adjust_with_prescriber
Target id:
/intervention/gemfibrozil
Target name:
Fibrates/Gemfibrozil
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Combination with fibrates may increase myopathy risk similar to lovastatin.
Actionable advice:
This is best used with caution, and it is a good idea to monitor for clinical effect; dose adjustment or monitoring may be required.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
less GEMFIBROZIL (Lopid) Interaction Rating Moderate Be cautious with this combination.
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
adjust_with_prescriber
Target id:
/intervention/cyclosporine
Target name:
Cyclosporine
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Cyclosporine increases monacolin K exposure and myopathy risk.
Actionable advice:
This combination should be avoided; if unavoidable, it should be managed under specialist supervision with intensive monitoring.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
| CYCLOSPORINE (Neoral, Sandimmune) Interaction Rating Moderate Be cautious with this combination.
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
avoid
Target id:
/condition/hepatic-disease
Target name:
Hepatic Disease
Severity:
major
Interaction type:
contraindication
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Use with caution in liver disease; case reports of hepatotoxicity.
Actionable advice:
This combination should be avoided; if unavoidable, it should be managed under specialist supervision with intensive monitoring.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
uents, including lovastatin, it has the potential to cause similar side effects, including elevated liver enzymes.
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
avoid
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
contraindication
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Contraindicated in pregnancy as with all statin-like agents.
Actionable advice:
Use should be avoided during pregnancy unless the benefit clearly outweighs the risk, and it is worth discussing with a prescriber.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
PREGNANCY: Likely Unsafe when used orally.
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
avoid
Target id:
/condition/lactation
Target name:
Lactation
Severity:
major
Interaction type:
contraindication
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Avoid during breastfeeding.
Actionable advice:
Not recommended while breastfeeding. If you are nursing, do not start red yeast rice (contains a statin) without your prescriber arranging an alternative or advising you to stop nursing.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
LACTATION: Insufficient reliable information available; avoid using.
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
avoid
Target id:
/adverse/myopathy-rhabdomyolysis
Target name:
Myopathy / Rhabdomyolysis
Severity:
major
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Case reports of myopathy and rhabdomyolysis with red yeast rice products.
Actionable advice:
Unexplained muscle pain, tenderness, weakness, or dark urine should be reported immediately; this may require CK measurement and drug discontinuation.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
The risk of myopathy seems to depend on the specific red yeast rice formulation and dose used (95903).
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
monitor
Target id:
/adverse/citrinin-contamination
Target name:
Citrinin Contamination Risk
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Some red yeast rice products are contaminated with citrinin, a nephrotoxic mycotoxin.
Actionable advice:
This is best used with caution, and it is a good idea to monitor for clinical effect; dose adjustment or monitoring may be required.
Validation status:
validated_via_monograph
Evidence tier:
tier_c
Evidence basis:
non_natmed_monograph_verbatim
Evidence anchors:
Exact phrase from label:
In vitro and in animal research, citrinin has been reported to cause kidney damage (70482, 70540, 70542).
Label source:
NatMed Professional Monograph: Red Yeast Rice
Action type:
adjust_with_prescriber
Target id:
/class/cns-depressants
Target name:
CNS Depressants
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Temporal spacing:
null
Description:
General caution when combined with other active therapeutic agents.
Actionable advice:
It is important to talk to a physician before combining this with other medications.
Validation status:
unvalidatable
Evidence tier:
tier_e
Evidence basis:
unvalidatable
Evidence anchors:
Source url:
Scientific literature support not found
Exact phrase from label:
Label source:
Generic placeholder row: the text is non-specific ('general caution') and there is no established CNS-depressant interaction for this agent. No validatable interaction claim - marked unvalidatable (candidate for removal).
Action type:
informational_none