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Clinician’s Corner: Red Yeast Rice

Red yeast rice (RYR)  (Monascus purpureus) is a natural product that lowers LDL-C (bad cholesterol) levels by 20 to 30 percent.  Red yeast rice is a fermented rice product that has been used in Chinese cuisine (like Peking duck) and medicinally to promote “blood circulation”.  Because it is a “natural product “patients assume it is a safer alternative to the prescription statins.  Red yeast rice may also induce muscle complaints because of its statin-like content. The LDL-C lowering effect of red yeast rice is due to the presence of monacolin K, a compound like lovastatin (Mevacor®) the first prescription statin drug.

Some studies show benefit of Red Yeast Rice:

  • lower LDL-C (bad cholesterol)by 19-62 mg/dL
  • increase HDL (good cholesterol) by 3mg/dL
  • lowers triglycerides by 23mg/dL

When we directly compare it to lovastatin the prescription drug, the daily lovastatin content of red yeast rice translates into a daily lovastatin dose of 4.8 mg.  Lovastatin (Mevacor®) that we have available in the pharmacy is available in 20mg and 40mg tablets.  The capsules are available as 600mg and can be dosed as two capsules twice daily and equals about 4.8mg.

My concerns:

  • Some preparations had elevated levels (1.6mcg/day) of citrinin, a potentially kidney damaging mycotoxin.
  • Although red yeast rice lowers LDL-C like a mild potency statin, and may be tolerated by some patients who have discontinued statin therapy for muscle side effects, this therapy is not recommended due to lack of clinical outcomes data, variable drug levels in the body, and possible toxic effects from contaminants.
  • Your Thompson pharmacists are concerned about these products, as the labels state only the amount of red yeast rice that they contain, not the amounts of monacolin K or other monacolins.
  • Lack of standardization, potential for kidney damage, as well as the costs of these products make it difficult to recommend this product. Most products are well over $18.00/month. Your Thompson Pharmacist can help your doctor choose a safer and cheaper alternative.

Your Thompson Pharmacist can help you get your cholesterol levels under control, by recommending diet, exercise and appropriate prescription therapy that your doctor can monitor.  We can select reasonable priced drugs that are effective, minimal drug interactions and will be of great benefit to you and your heart!  At Thompson Pharmacy …it’s all for YOU!