Drugs A - Z
Red yeast rice (Monascus purpureus)
Generic Name: red yeast rice
Brand Names: Cholestin
CategoryHerbs & Supplements
Alkaloids, angkak, anka, ankaflavin, Asian traditional fermentation foodstuff, astaxanthin, beni-koju, ben-koji, Chinese red yeast rice, citrinin, CRYR, dehydromonacolin K, dietary red yeast, dihydromeyinolin, dihydromonacolin K, dihydromonacolin L, DSM1379, DSM1603, ergosterol, flavonoids, GABA, glycosides, HMG-CoA reductase inhibitors, hon-chi, hong qu, hongqu, hung-chu, hydroxymethylglutaryl coenzyme A reductase, KCCM11832, koji, linoleic acid, lovastatin, M9011, mevinolin, monacolin hyroxyacid, monacolin J, monacolin K, monacolin K (hydroxyl acid form), monacolin L, monacolin M, monacolin X, Monascaceae (yeast family), monascopyridine A, monascopyridine B, monascopyridine C, monascopyridine D, monascorubramine, monascorubrin, Monascus, Monascus anka, Monascus purpureus fermentate, Monascus purpureus HM105, Monascus purpureus NTU568, Monascus purpureus Went rice, Monascus ruber, oleic acid, orange anka pigment, palmitoleic acid, Phaffia rhodozyma, red fermented rice, red koji, red leaven, red mould rice, red rice, red rice yeast, red yeast, red yeast rice extract, rice, RICE products, rubropunctamine, rubropunctatin, RYR, RYRE, saponins, statins, stearic acid, xuezhikang, Xue Zhi Kang, yellow anka pigment, zhitai, Zhi Tai.
Red yeast rice is the product of yeast (Monascus purpureus) grown on rice, and is served as a dietary staple in some Asian countries. It contains several compounds collectively known as monacolins, substances known to inhibit cholesterol synthesis. One of these, "monacolin K," is a potent inhibitor of HMG-CoA reductase, and is also known as mevinolin or lovastatin (Mevacor®, a drug produced by Merck & Co., Inc).
Red yeast rice extract has been sold as a natural cholesterol-lowering agent in over the counter supplements, such as CholestinTM (Pharmanex, Inc). However, there has been legal and industrial dispute as to whether red yeast rice is a drug or a dietary supplement, involving the manufacturer, the U.S. Food and Drug Administration (FDA), and the pharmaceutical industry (particularly producers of HMG-CoA reductase inhibitor prescription drugs or "statins").
The use of red yeast rice in China was first documented in the Tang Dynasty in 800 A.D. A detailed description of its manufacture is found in the ancient Chinese pharmacopoeia, Ben Cao Gang Mu-Dan Shi Bu Yi, published during the Ming Dynasty (1368-1644). In this text, red yeast rice is proposed to be a mild aid for gastric problems (indigestion, diarrhea), blood circulation, and spleen and stomach health. Red yeast rice in a dried, powdered form is called Zhi Tai. When extracted with alcohol it is called Xue Zhi Kang.
EvidenceDISCLAIMER: These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.
Since the 1970s, human studies have reported that red yeast lowers blood levels of total cholesterol, low-density lipoprotein/LDL ("bad cholesterol"), and triglyceride levels. Other products containing red yeast rice extract can still be purchased, mostly over the Internet. However, these products may not be standardized and effects are not predictable. For lowering cholesterol, there is better evidence for using prescription drugs such as lovastatin.
Coronary heart disease:
Preliminary evidence shows that taking Monascus purpureus by mouth may result in cardiovascular benefits and improve blood flow. Additional study is needed before a firm recommendation can be made.
Early human evidence suggests the potential for benefits in diabetics. Additional study is needed before a firm recommendation can be made.
TraditionWARNING: DISCLAIMER: The below uses are based on tradition, scientific theories, or limited research. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider. There may be other proposed uses that are not listed below.
Acetaminophen toxicity, anthrax, anti-inflammatory, antimicrobial, antioxidant, blood circulation problems, bruised muscles, bruises, cancer, colic in children, cuts, diarrhea, digestion, dysentery (bloody diarrhea), exercise performance enhancement, food additive (coloring), food preservative, hangover, high blood pressure, HIV (associated hyperlipidemia), immunosuppression, indigestion, liver disorders, metabolic disorders, obesity, ovarian cancer, postpartum problems, spleen problems, stomach problems, weight loss, wounds.
Adults (18 years and older)
1,200 milligrams of concentrated red yeast powder capsules have been taken two times per day by mouth with food.
The average consumption of naturally occurring red yeast rice in Asia has been reported as 14-55 grams per day.
Children (younger than 18 years)
There is not enough scientific evidence to recommend red yeast for children.
SafetyDISCLAIMER: Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.
Side Effects and Warnings
There is limited evidence on the side effects of red yeast. Mild headache and abdominal discomfort can occur. Side effects may be similar to those for the prescription drug lovastatin (Mevacor®). Heartburn, gas, bloating, muscle pain or damage, dizziness, asthma, and kidney problems are possible. People with liver disease should not use red yeast products.
In theory, red yeast may increase the risk of bleeding. Caution is advised in patients with bleeding disorders or taking drugs that may increase the risk of bleeding. Dosing adjustments may be necessary. A metabolite of Monascus called mycotoxin citrinin may be harmful.
Pregnancy and Breastfeeding
Interactions with Drugs
There are not many studies of the interactions of red yeast rice extract with drugs. However, because red yeast rice extract contains the same chemicals as the prescription drug lovastatin, the interactions may be the same. Fibrate drugs or other cholesterol-lowering medications may cause additive effects or side effects when taken with red yeast. Alcohol and other drugs that may be toxic to the liver should be avoided with red yeast rice extract. Taking cyclosporine, ranitidine (Zantac®), and certain antibiotics with red yeast rice extract may increase the risk of muscle breakdown or kidney damage.
Certain drugs may interfere with the way the body processes red yeast using the liver's "cytochrome P450" enzyme system. Inhibitors of cytochrome P450 may increase the chance of muscle and kidney damage if taken with red yeast.
In theory, red yeast may increase the risk of bleeding when taken with drugs that increase the risk of bleeding. Some examples include aspirin, anticoagulants ("blood thinners") such as warfarin (Coumadin®) or heparin, anti-platelet drugs such as clopidogrel (Plavix®), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrin®, Advil®) or naproxen (Naprosyn®, Aleve®).
Red yeast may produce gamma-aminobutyric acid (GABA) and therefore can have additive effects when taken with drugs that affect GABA such as neurontin (Gabapentin®).
Red yeast may alter blood sugar levels; patients with diabetes or taking insulin or blood sugar-lowering medications by mouth should consult with a qualified healthcare professional, including a pharmacist. Dosing adjustments may be necessary.
Interactions with Herbs and Dietary Supplements
Red yeast may interact with products that cause liver damage or are broken down in the liver. Grapefruit juice may increase blood levels of red yeast. Milk thistle, St. John's wort, niacin, and vitamin A may interact with red yeast rice extract. Coenzyme Q10 levels may be lowered by red yeast rice extract. Cholesterol-lowering herbs and supplements such as guggul or fish oils may have increased effects when taken with red rice yeast. Although not well studied, red yeast may also interact with astaxanthin and zinc. Caution is advised.
Certain herbs and supplements may interfere with the way the body processes red yeast using the liver's "cytochrome P450" enzyme system. Inhibitors of cytochrome P450 may increase the chance of muscle and kidney damage if taken with red yeast.
In theory, red yeast may increase the risk of bleeding when taken with herbs and supplements that are believed to increase the risk of bleeding. Multiple cases of bleeding have been reported with the use of Ginkgo biloba, and fewer cases with garlic and saw palmetto. Numerous other agents may theoretically increase the risk of bleeding, although this has not been proven in most cases.
Red yeast may also interact with digitalis (foxglove), or herbs and supplements that affect the thyroid or blood pressure. It may also have anti-inflammatory effects and should be used cautiously with other herbs or supplements that may have anti-inflammatory effects.
Red yeast may alter blood sugar levels in the blood, and patients with diabetes or taking herbs and supplement to control blood sugar should use with caution.
This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Tracee Rae Abrams, PharmD (University of Rhode Island); Ethan Basch, MD (Harvard Medical School); Julie Conquer, PhD (RGB Consulting); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Cathi Dennehey, PharmD (University of California, San Francisco); Nicole Giese, MS (Natural Standard Research Collaboration); Peter Glickman, MD (Harvard Medical School); Paul Hammerness MD (Harvard Medical School); Jenna Hollenstein, MS, RD (Natural Standard Research Collaboration); Richard Liebowitz, MD (Duke University); Michael Smith, MRPharmS, ND (Canadian College of Naturopathic Medicine); David Sollars, MAc, HMC (New England School of Acupuncture); Philippe Szapary, MD (University of Pennsylvania); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Kirstin Wadewitz, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration).
BibliographyDISCLAIMER: Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.
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Heber D, Lembertas A, Lu QY, et al. An analysis of nine proprietary Chinese red yeast rice dietary supplements: implications of variability in chemical profile and contents. J Altern Complement Med 2001;7(2):133-139.
Huang CF, Li TC, Lin CC, et al. Efficacy of Monascus purpureus Went rice on lowering lipid ratios in hypercholesterolemic patients. Eur J Cardiovasc Prev Rehabil 2007 Jun;14(3):438-40.
Li JJ, Hu SS, Fang CH, et al. Effects of xuezhikang, an extract of cholestin, on lipid profile and C-reactive protein: a short-term time course study in patients with stable angina. Clin Chim Acta 2005;352(1-2):217-224.
Liu BH, Wu TS, Su MC, et al. Evaluation of citrinin occurrence and cytotoxicity in Monascus fermentation products. J Agric Food Chem 2005;53(1):170-175.
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Man RY, Lynn EG, Cheung F, et al. Cholestin inhibits cholesterol synthesis and secretion in hepatic cells (HepG2). Mol Cell Biochem 2002;233(1-2):153-158.
Prasad GV, Wong T, Meliton G, et al. Rhabdomyolysis due to red yeast rice (Monascus purpureus) in a renal transplant recipient. Transplantation 2002;74(8):1200-1201.
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Wei W, Li C, Wang Y, et al. Hypolipidemic and anti-atherogenic effects of long-term Cholestin (Monascus purpureus-fermented rice, red yeast rice) in cholesterol fed rabbits. J Nutr Biochem 2003;14(6):314-318.
Yang HT, Lin SH, Huang SY, et al. Acute administration of red yeast rice (Monascus purpureus) depletes tissue coenzyme Q(10) levels in ICR mice. Br J Nutr 2005;93(1):131-135.
Zhao SP, Liu L, Cheng YC, et al. Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease. Atherosclerosis 2003;168(2):375-380.
Zhao SP, Liu L, Cheng YC, et al. Xuezhikang, an extract of cholestin, protects endothelial function through antiinflammatory and lipid-lowering mechanisms in patients with coronary heart disease. Circulation 2004;110(8):915-920.
Zhao SP, Lu ZL, Du BM, et al. Xuezhikang, an extract of cholestin, reduces cardiovascular events in type 2 diabetes patients with coronary heart disease: subgroup analysis of patients with type 2 diabetes from China coronary secondary prevention study (CCSPS). J Cardiovasc Pharmacol. 2007 Feb;49(2):81-4.
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.