Red Yeast Rice

What is Red Yeast Rice?
Latin name: Monascus purpureus
Other names: Hong Qu, red rice, red yeast
Red yeast rice is a substance made by fermenting a type of red yeast called Monascus purpureus over rice.
Red yeast rice has been used in China as a preservative, spice, and food coloring. It is used to give Peking duck its characteristic red color, and is also used for fish sauce, fish paste, and rice wine. Red yeast rice was also used in Chinese medicine for improving circulation and as a remedy for indigestion and diarrhea.
Red yeast rice was found to contain naturally-occurring substances called monacolins. Monocolins inhibit an enzyme in the body known to trigger cholesterol production, called HMG-CoA reductase.
A class of drugs called HMG-CoA reductase inhibitors (commonly called 'statin' drugs), such as Lipitor, Zocor, and Pravachol work in the same way. In fact, lovastatin (Altoprev™, Mevacor®) was originally derived from a type of red yeast called Monascus ruber.
Because of this action, red yeast rice products containing a higher concentration of monocolins have been developed and marketed as a natural product to lower cholesterol.
Red yeast rice is classified as a dietary supplement by the U.S. Food and Drug Administration (FDA). Because of its similarity to the statin drugs, there is an ongoing legal debate about whether red yeast rice should be reclassified as a prescription drug rather than a dietary supplement.
There have only been a few well-designed studies on red yeast rice in humans. A study conducted by the UCLA School of Medicine examined the use of red yeast rice in 83 people with high cholesterol.
Subjects were randomized to receive 2.4 grams a day red yeast rice or placebo, and they were told to consume a 30% fat diet (with no more than 10% of this from saturated fat and less than 300 mg cholesterol a day).
After the 12 week treatment period, there was a significant reduction in total cholesterol, LDL cholesterol, and triglyceride levels, compared with placebo. HDL cholesterol was not affected in this study.
The side effects of red yeast rice are not fully understood. Side effects may include:

Headache
Indigestion
Bloating and gas
Dizziness
Heartburn
Muscle pain
Joint pain
Liver inflammation
Damage to peripheral nerves
Red yeast rice, like the statin drugs, can cause myopathy. Signs and symptoms include muscle pain, weakness, and elevated levels of creatine kinase.
Rhabdomuolysis, a breakdown of muscle tissue that can lead to kidney failure, is a serious side effect that can occur rarely. People who notice muscle pain, weakness, or tenderness while using red yeast rice should see a doctor immediately.
In studies, red yeast rice has been found to interfere with the body's ability to produce Co q10, similar to statin drugs.
There is insufficient information about the long-term safety of red yeast rice.
Red yeast rice products have been found to contain citrinin, a toxic by-product of the fermentation process.
Pregnant or nursing women and children should not use red yeast rice.
People with liver disease or at risk for liver disease should not use red yeast rice, as red yeast rice may impair liver function.
People with acute infections, kidney disease, or who have had an organ transplant should not use red yeast rice.
People taking red yeast rice who develop muscle pain or tenderness should discontinue the product immediately and check with their doctor.
Drug Interactions:
HMG Co-A Reductase Inhibitors / Statin Drugs: e.g. atorvastatin (Lipitor®), lovastatin (Mevacor®), pravastatin (Pravachol®)
Statin cholesterol-lowering drugs should not be taken with red yeast rice because it may increase the effect of these medications and raise the risk of side effects such as liver damage.
Fibrate Drugs: e.g. fenofibrate ((Tricor®, Triglide™, Lofibra™), gemfibrozil (Lopid®), clofibrate (Atromid-S®)
Drugs in the fibrate family are used to lower cholesterol and triglyceride levels in blood. Using them with red yeast rice may increase the effect of these medications.
Cyclosporine: Cyclosporine (Sandimmune®, Neoral® Gengraf™) should not be taken with red yeast rice. Because red yeast rice works in a similar way to statin drugs, taking them with cyclosporine increases blood levels of red yeast rice and raises the risk of the serious condition rhabdomyolysis.
Macrolide Antibiotics: e.g. erythromycin, azithromycin (Zithromax®), clarithromycin (Biaxin®), dirithromycin (Dynabac®), roxithromycin (Rulid®, Surlid®)
Macrolides are a class of drugs used to treat infections such as respiratory tract infections and soft tissue infections. They are known to interact with statin drugs (and therefore red yeast rice) and increase the risk of rhabdomyolysis.
Antifungal Drugs: Antifungal agents, particularly the azole antifungals fluconazole (Diflucan®), itraconazole (Sporanox®), ketoconazole (Nizoral®) are known to interact with statin drugs (and therefore red yeast rice) and increase the risk of rhabdomyolysis.
High-Dose Niacin: Niacin supplements may increase the risk of myopathy if combined with red yeast rice.
Nefazodone : Nefazadone is primarily used to treat depression. If combined with red yeast rice nefazodone may increase the risk of red yeast rice.
Protease Inhibitors: Protease inhibitors, such as amprenavir, indinavir, nelfinavir, ritonavir, saquinavir, are used for HIV infection. Use of red yeast rice with a protease inhibitor may increase the risk of myopathy.
Warfarin (Coumadin®): Red yeast rice used with warfarin may increase the risk of bleeding.