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Red Yeast Rice Side Effects & Safety

Evidence:Strong
·

This content is for informational purposes only and does not constitute medical advice. Statements about dietary supplements have not been evaluated by the FDA and are not intended to diagnose, treat, cure, or prevent any disease. Individual results may vary — consult your healthcare provider before starting any supplement. Full disclaimer

Safety Profile

Overall safety rating: Safe with Caution

Potential Side Effects

  • GI discomfort (bloating, gas, heartburn) in 5-10% of users
  • Muscle pain or weakness (myalgia) — same mechanism as statins
  • Elevated liver enzymes at high doses — periodic monitoring recommended
  • Headache and dizziness (uncommon)

Drug & Supplement Interactions

  • Statin drugs — do not combine, as monacolin K is identical to lovastatin and effects are additive
  • CYP3A4 inhibitors (grapefruit, ketoconazole, erythromycin) — may increase monacolin K levels
  • Fibrates and niacin — increased myopathy risk when combined
  • Cyclosporine — significantly increases monacolin K blood levels

Maximum Dose

Do not exceed: 4800mg/day (higher doses increase risk of statin-like side effects)

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References

  1. Meta-analysisLi Y, Jiang L, Jia Z, Xin W, Yang S, Yang Q, Wang L (2014). A meta-analysis of red yeast rice: an effective and relatively safe alternative approach for dyslipidemia. PLoS ONE. DOI PubMed
  2. RCTBecker DJ, Gordon RY, Halbert SC, French B, Morris PB, Rader DJ (2009). Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Annals of Internal Medicine. DOI PubMed
  3. Meta-analysisTrogkanis E, Karalexi MA, Sergentanis TN, Kornarou E, et al. (2024). Safety and Efficacy of the Consumption of the Nutraceutical "Red Yeast Rice Extract" for the Reduction of Hypercholesterolemia in Humans: A Systematic Review and Meta-Analysis.. Nutrients. DOI PubMed
  4. Ma ZY, Yang SP, Li Y, Xu TT, et al. (2024). Associations between the use of red yeast rice preparations and adverse health outcomes: An umbrella review of meta-analyses of randomized controlled trials.. Journal of integrative medicine. DOI PubMed
  5. Meta-analysisRahmani P, Melekoglu E, Tavakoli S, Malekpour Alamdari N, et al. (2023). Impact of red yeast rice supplementation on lipid profile: a systematic review and meta-analysis of randomized-controlled trials.. Expert review of clinical pharmacology. DOI PubMed
  6. Xu G, Lin M, Dai X, Hu J (2022). Comparing the effectiveness of Chinese patent medicines containing red yeast rice on hyperlipidaemia: A network meta-analysis of randomized controlled trials.. Endocrinology, diabetes & metabolism. DOI PubMed
  7. Wu B, Huang JF, He BJ, Huang CW, et al. (2020). Promotion of Bone Formation by Red Yeast Rice in Experimental Animals: A Systematic Review and Meta-Analysis.. BioMed research international. DOI PubMed
Show 4 more references
  1. Sungthong B, Yoothaekool C, Promphamorn S, Phimarn W (2020). Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials.. Scientific reports. DOI PubMed
  2. Meta-analysisFogacci F, Banach M, Mikhailidis DP, Bruckert E, et al. (2019). Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials.. Pharmacological research. DOI PubMed
  3. Peng D, Fong A, Pelt AV (2017). Original Research: The Effects of Red Yeast Rice Supplementation on Cholesterol Levels in Adults.. The American journal of nursing. DOI PubMed
  4. Millán J, Cicero AF, Torres F, Anguera A (2016). Effects of a nutraceutical combination containing berberine (BRB), policosanol, and red yeast rice (RYR), on lipid profile in hypercholesterolemic patients: A meta-analysis of randomised controlled trials.. Clinica e investigacion en arteriosclerosis : publicacion oficial de la Sociedad Espanola de Arteriosclerosis. DOI PubMed