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red yeast rice (Monascus purpureus, Xue Zhi Kang)

produced by fermenting rice with Monascus purpureus yeast. contains monacolin(s), natural HMG CoA reductase inhibitor(s) Uses: - hypercholesterolemia - coronary artery disease - diabetes mellitus - used in China to treat indigestion, diarrhea Dosage: 1800 mg PO BID [2] 1800 mg of red yeast rice contains monacolin K in an amount equipotent to 6 mg of lovastatin with respect to inhibition of HMG-CoA reductase Adverse effects: - nausea/vomiting [4] - GI upset - myalgia, myopathy, rhabdomyolysis - abnormal liver function tests [6] - case report of hepatitis Drug interactions: - other anti-hyperlipidemic agents (use caution) [4] - may interact with drugs metabolized by CYP3A4 [6] Mechanism of action: - contains lovastatin [2] - lowers total serum cholesterol & LDL cholesterol - lowers LDL-cholesterol 35-43 mg/dL within 12 weeks vs 11-15 mg/dL for placebo [2] - no change in HDL-cholesterol, serum triglycerides [2] - in combination with probiotic Bifidobacterium longum BB536 lowers serum LDL cholesterol 26% in 12 weeks in patients with mean LDL cholesterol of 183 mg/dL [7] Notes: - marked variation among commercial products [5] - some products may citrinin as a contaminant which may cause renal failure [6]

General

yeast pharmaceutical herb; medicinal herb; herbal supplement; botanical

References

  1. Prescriber's Letter 15(12): 2008 Safety of Red Yeast Rice Detail-Document#: 241203 (subscription needed) http://www.prescribersletter.com
  2. Becker DJ Red Yeast Rice for Dyslipidemia in Statin-Intolerant Patients A Randomized Trial Annals of Internal Medicine 2009, 150(12):830 PMID: 19528562 http://www.annals.org/cgi/content/abstract/150/12/830
  3. Mayo Clinic: Red yeast rice (Monascus purpureus) http://www.mayoclinic.com/health/red-yeast-rice/NS_patient-redyeast
  4. Geriatrics at your Fingertips, 13th edition, 2011 Reuben DB et al (eds) American Geriatric Society
  5. Gordon RY, Cooperman T, Obermeyer W, Becker DJ. Marked variability of monacolin levels in commercial red yeast rice products: buyer beware! Arch Intern Med. 2010 Oct 25;170(19):1722-7. PMID: 20975018
  6. Medical Knowledge Self Assessment Program (MKSAP) 17, 18, 19 American College of Physicians, Philadelphia 2015, 2018, 2022
  7. Wendling P Probiotic, Red Yeast Rice Extract Combo May Cut Cholesterol Medscape - May 05, 2017. http://www.medscape.com/viewarticle/879583

Component-of

red yeast rice/ubiquinone