Red Yeast Rice and medications.
Red Yeast Rice is not in the Distil recommendation database. We surface it here deliberately, because why a compound is left out is as useful as what we recommend.
Red yeast rice is a statin sold as a supplement. It naturally contains monacolin K, which is the exact same molecule as the prescription statin lovastatin, and that single fact is why it sits outside the Distil database. Taken on top of a prescribed statin it is two statins at once, which raises the risk of muscle injury, including the serious form called rhabdomyolysis, with no added benefit. On its own it carries the same muscle and liver risks as any statin.
The bigger problem is that the monacolin content is unregulated and varies widely between products, so the statin dose you are actually taking is unknown. A medicine this consequential belongs under prescription with monitoring, not bought blind off a shelf. The documented pairs below are the statin-on-statin combinations to avoid. For lipids, the options below have a cleaner profile, though none replaces a statin where one is genuinely needed.
What to consider instead. Every option below is in the Distil database, so you can check each against your own medications:
- Bergamot Extract (BPF / Bergavit40): standardised bergamot has trial evidence for LDL and triglycerides
- Berberine: lowers LDL and fasting glucose; watch for additive effects with diabetes medicines
- Omega-3 EPA: mainly a triglyceride lever
We still hold the documented interactions for Red Yeast Rice, which is why it stays in the interactions checker even though we do not recommend it. Below are the 4 documented pairs we have explicitly assessed: 4 red. Every call is cited to a clinical reference (PMID) or the British National Formulary.
Documented interactions
Last reviewed 9 June 2026. Each interaction below is assessed against PubMed-indexed evidence.
Additive muscle toxicity
Red Does interact with Atorvastatin?
Taking red yeast rice on top of atorvastatin means taking two statins at once, which may raise the risk of muscle damage including a serious form called rhabdomyolysis, so do not combine them without your GP's guidance. Red yeast rice naturally contains monacolin K, the same molecule as the prescription statin lovastatin.
Evidence: Well established across multiple human studies or interaction references.
Red Does interact with Simvastatin?
Taking red yeast rice alongside simvastatin means two statins at once, and simvastatin is one of the more muscle-prone statins, so the combination may raise the risk of muscle damage including the serious form called rhabdomyolysis; do not combine them without your GP's guidance. Red yeast rice naturally contains monacolin K, the same molecule as the prescription statin lovastatin.
Evidence: Well established across multiple human studies or interaction references.
CYP3A4 inhibition
Red Does interact with Clarithromycin?
Taking red yeast rice with clarithromycin can push the statin it contains to much higher levels than intended and raise the risk of muscle damage including the serious form called rhabdomyolysis, so do not combine them. Red yeast rice naturally contains monacolin K (the same molecule as the statin lovastatin), which is cleared by a liver enzyme called CYP3A4 that clarithromycin strongly blocks; if you need clarithromycin, stop the red yeast rice for the course and speak to your GP or pharmacist.
Evidence: Supported by human study data.
Red Does interact with Erythromycin?
Taking red yeast rice with erythromycin can push the statin it contains to much higher levels than intended and raise the risk of muscle damage including the serious form called rhabdomyolysis, so do not combine them. Red yeast rice naturally contains monacolin K (the same molecule as the statin lovastatin), which is cleared by a liver enzyme called CYP3A4 that erythromycin blocks; if you need erythromycin, stop the red yeast rice for the course and speak to your GP or pharmacist.
Evidence: Supported by human study data.
What this page does not say. Leaving a compound out of our recommendations is not a verdict that it is useless for everyone. It is a statement about safety, evidence, or interaction load in the context Distil screens for. Discuss any supplement decision with whoever manages your prescriptions.
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How we grade severity, choose what's in scope, and what we exclude.
Every call on this page is reasoned. We publish the full rubric for severity tiers, the medication inclusion logic, the evidence grades we accept, and what we deliberately leave out. About three thousand words. Worth reading once if you use this tool more than occasionally.
Read the full methodologyWant this checked across everything you take?
This page checks the pairs you enter. The personalised Distil report goes further:
- the same graded, cited interaction check across your whole stack, not just the pairs you thought to type in
- where your current routine may be leaving you short of your goals
- the evidence-graded compounds worth adding, and the ones worth dropping
It's a paid report: £79, or £49 founder pricing while we earn our first reviews. The interactions check is one section of it, and you can read a real one in full before you decide.
See a real sample reportSomething missing?
If a supplement or medication you take isn't in our autocomplete, tell us. We go through what people flag every week and add what's missing.