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Red yeast


What is it?

Red yeast is the product of rice fermented with Monascus purpureus yeast. Red yeast supplements are different from red yeast rice sold in Chinese grocery stores. People use red yeast as medicine.

Red yeast is used for maintaining desirable cholesterol levels in healthy people, reducing cholesterol in people with high cholesterol, for indigestion, diarrhea, improving blood circulation, and for spleen and stomach health.

In foods, red yeast is used as a food coloring for Peking duck.

The active ingredient in red yeast is the same as the active ingredient in prescription drugs called statins used for high cholesterol. That’s why red yeast has all the possible side effects, drug interactions, and precautions associated with this type of drug. The American Heart Association warns against using red yeast until the results of long-term studies are in. You should talk with your healthcare provider if you plan to take red yeast.

You may have come across a red yeast product called Cholestin, manufactured by Pharmanex. It was one of the most widely studied red yeast products. Originally, Cholestin contained the same active ingredient found in statin drugs. This caused the U.S. Food and Drug Administration (FDA) to call Cholestin an unapproved drug. Cholestin was reformulated so that its active ingredient is now something else.

How effective is it?

Natural Medicines Comprehensive Database rates effectiveness based on scientific evidence according to the following scale: Effective, Likely Effective, Possibly Effective, Possibly Ineffective, Likely Ineffective, Ineffective, and Insufficient Evidence to Rate.

The effectiveness ratings for RED YEAST are as follows:

Likely effective for...

  • High cholesterol. Some research shows that taking a specific red yeast product for up to 6 months can lower total cholesterol, low-density lipoprotein (LDL or “bad”) cholesterol levels and triglycerides. However, this specific product contains large amounts of a chemical similar to "statin" drugs, such as lovastatin. Statins are approved by the FDA to lower cholesterol. In the U.S., the Food and Drug Administration (FDA) now considers this product and other red yeast products that contain statins to be illegal unapproved drugs. However, outside the U.S., these specific red yeast products are still available. Some red yeast products available in the U.S. these days contain little or no statins. It is not known if these products do much to reduce cholesterol levels in people with high cholesterol. Some other products still contain significant amounts of statins. One analysis shows that that some of these products can contain up to 5 mg of statins per tablet.

Possibly effective for...

  • Heart disease. Taking 0.6-1.2 grams of red yeast rice daily for an average of 4.5 years decreases total cholesterol, low-density lipoprotein (LDL or “bad”) cholesterol, and triglycerides. It also decreases the risk of heart disease-related events, heart attacks, and death in people with a history of heart attack.
  • High cholesterol and triglyceride levels caused by human immunodeficiency virus (HIV) disease (AIDS). Taking red yeast rice by mouth seems to reduce cholesterol and triglyceride levels in people with abnormal levels associated with HIV infection.

Possibly ineffective for...

  • High blood pressure. Taking red yeast rice with blood pressure-lowering drugs does not seem to further reduce blood pressure in people with high blood pressure compared to the effects of the blood pressure-lowering drugs alone. However, red yeast rice might improve some heart-related outcomes in patients with high blood pressure.

Insufficient evidence to rate effectiveness for...

  • Diabetes. Some early research shows that taking 600 mg of red yeast daily for 8 weeks can lower total cholesterol, triglycerides, and blood sugar in people with diabetes. Other research shows that taking 1.2 grams of red yeast rice daily for 12 weeks reduces low-density lipoprotein (LDL or “bad”) cholesterol and triglycerides, as well as increases high-density lipoprotein (HDL or “good”) cholesterol in people with diabetes and liver disease.
  • Liver disease. Some research shows that taking 1.2 grams of red yeast rice daily for 12 weeks reduces levels of liver enzymes associated with liver damage and improves blood thickness in people with diabetes and a certain type of liver disease.
  • Indigestion.
  • Diarrhea.
  • Improving blood circulation.
  • Spleen and stomach problems.
  • Other conditions.
More evidence is needed to rate the effectiveness of red yeast for these uses.

How does it work?

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Red yeast supplements are manufactured by culturing Monascus purpureus yeast on rice at carefully controlled temperature and growing conditions to increase the concentrations of chemicals that lower blood cholesterol and triglycerides. These chemicals are similar to the prescription drugs known as "statins," including lovastatin (Mevacor) and others.

Are there safety concerns?

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Red yeast is POSSIBLY SAFE for most people when taken by mouth for up to 4.5 years.

Red yeast contains chemicals similar to the prescription drugs called "statins." Therefore, red yeast might also cause side effects similar to statin drugs, such as liver damage and severe muscle pain and muscle damage.

There is also concern about product quality. Many red yeast rice products have been found to contain varying amounts of the statin-like chemicals. Some products may contain none and others may contain high amounts, which are more likely to cause serious side effects.

Serious allergic reactions can occur after breathing in red yeast.

Red yeast that is not fermented correctly may contain citrinin. Citrinin is a poison that may cause kidney damage.

Special precautions & warnings:

Pregnancy and breast-feeding: Red yeast is LIKELY UNSAFE during pregnancy. It has caused birth defects in animals. Not enough is known about the safety of using red yeast during breast-feeding. Don’t use during pregnancy or breast-feeding.

Liver problems: Red yeast contains chemicals that are the same as the statin drug lovastatin. Lovastatin can cause liver damage. Some research shows that red yeast might also cause liver damage. However, other research shows that red yeast might improve liver function in people with certain liver problems. Because of the mixed results, red yeast products should be used cautiously or avoided in people with liver problems.

Are there interactions with medications?

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Moderate

Be cautious with this combination.

Alcohol
Drinking alcohol might harm the liver. Red yeast might also harm the liver. Taking red yeast along with alcohol might increase the risk of liver damage. Do not drink alcohol if you are taking red yeast.

Cyclosporine (Neoral, Sandimmune)
Red yeast might affect the muscles. Cyclosporine (Neoral, Sandimmune) might also affect the muscles. Taking red yeast along with cyclosporine (Neoral, Sandimmune) might cause serious side effects.

Gemfibrozil (Lopid)
Gemfibrozil (Lopid) can affect the muscles. Red yeast can also affect the muscles. Taking gemfibrozil along with red yeast might increase the risk of muscle problems.

Medications that can harm the liver (Hepatotoxic drugs)
Red yeast contains the statin drug lovastatin. Lovastatin might harm the liver in some people. Taking red yeast along with other medications that might also harm the liver might increase the risk of liver damage.

Some medications that can harm the liver include acetaminophen (Tylenol and others), amiodarone (Cordarone), carbamazepine (Tegretol), isoniazid (INH), methotrexate (Rheumatrex), methyldopa (Aldomet), fluconazole (Diflucan), itraconazole (Sporanox), erythromycin (Erythrocin, Ilosone, others), phenytoin (Dilantin), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and many others.

Medications that decrease the break down of other medications in the liver (Cytochrome P450 3A4 (CYP3A4) inhibitors)
Some medications are changed and broken down by the liver. Some medications might decrease how quickly the liver breaks down red yeast. Taking red yeast along with some medications that decrease the breakdown of other medications in the liver can increase the effects and side effects of red yeast. Before taking red yeast, talk to your healthcare provider if you are taking any medications that are changed by the liver.

Some medications that might decrease how quickly the liver breaks down red yeast include amiodarone (Cordarone), clarithromycin (Biaxin), diltiazem (Cardizem), erythromycin (E-mycin, Erythrocin), indinavir (Crixivan), ritonavir (Norvir), saquinavir (Fortovase, Invirase), and many others.

Medications used for lowering cholesterol (Statins)
Red yeast contains the statin drug lovastatin.. Taking red yeast along with other statins, a type of medication used to lower cholesterol, might increase the risk of adverse effects. Do not take red yeast if you are already taking these medications.

Some medications used for high cholesterol include cerivastatin (Baycol), atorvastatin (Lipitor), lovastatin (Mevacor), pravastatin (Pravachol), simvastatin (Zocor), and others

Niacin
Niacin can affect the muscles. Red yeast can also affect the muscles. Taking niacin along with red yeast might increase the risk of muscle problems.

Are there interactions with herbs and supplements?

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Coenzyme Q-10 (CoQ10, Ubiquinone)
Red yeast can lower levels of coenzyme Q-10.

Grapefruit
Grapefruit can slow the rate at which the body uses up red yeast. This could increase the amount of the red yeast in the body and increase its effects and side effects.

Herbs and supplements that might harm the liver
Red yeast contains statin-like drugs. Statins can harm the liver. Taking red yeast along with other herbs and supplements that can harm the liver might increase the risk of liver damage. Some products that might harm the liver include androstenedione, chaparral, comfrey, DHEA, germander, kava, niacin, pennyroyal oil, and others.

St. John's wort
St. John's wort can lower serum levels of the statin drug lovastatin. Red yeast contains statin-like drugs such as lovastatin. So, St. John's wort might reduce the effects from using of red yeast.

Are there interactions with foods?

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Alcohol
Red yeast contains the statin drug lovastatin. Lovastatin can cause liver damage in some people. Theoretically, drinking alcohol along with red yeast might increase the risk of liver damage.

Food
Taking red yeast with food gets it into the system faster.

Grapefruit
Red yeast contains the statin drug lovastatin. Grapefruit can slow the rate at which the body uses up lovastatin. This could increase the amount of the lovastatin in the body and increase its effects and side effects.

What dose is used?

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The following doses have been studied in scientific research:

BY MOUTH:
  • High cholesterol: 1200 mg to 2400 mg of red yeast once or twice daily. Only products containing chemicals similar to the prescription “statin” cholesterol drugs have been shown to lower cholesterol levels. Many of these products provide approximately 5-10 mg of the statin drug called lovastatin.
  • High cholesterol related to HIV infection: 1200 mg twice daily.

Other names

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Arroz de Levadura Roja, Cholestin, Hong Qu, Koji Rouge, Levure de Riz Rouge, Monascus, Monascus purpureus, Monascus Purpureus Went, Red Rice, Red Rice Yeast, Red Yeast Rice, Red Yeast Rice Extract, Riz Rouge, Xue Zhi Kang, XueZhiKang, XZK, Zhibituo, Zhi Tai.

Methodology

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To learn more about how this article was written, please see the Natural Medicines Comprehensive Database methodology.methodology (http://www.nlm.nih.gov/medlineplus/druginfo/natural/methodology.html).

References

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To see all references for the Red yeast page, please go to http://www.nlm.nih.gov/medlineplus/druginfo/natural/925.html.

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Last reviewed - 10/27/2014




Page last updated: 10 December 2014