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Red Yeast (Monascus purpureus) Be aware that the U.S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain red yeast. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with their pharmacists or health care providers before starting.
Scientists have studied red yeast for the following health problem: High cholesterol | Since the 1970s, there have been reports that red yeast lowers cholesterol and triglyceride levels, helping atherosclerosis or congenital heart disease. In March 2001, a U.S. District Court ruled that the red yeast rice extract product Cholestin contained the same chemical as the prescription cholesterol-lowering drug lovastatin (Mevacor) and therefore could not be sold without a prescription. This product is no longer available in the United States, but other products containing red yeast rice extract can still be purchased, mostly on the Internet.
According to the manufacturer's website (accessed August, 2001), new and improved Cholestin contains policosanol, a natural product from the wax of honey bees. It no longer contains any red yeast. Policosanols are potent inhibitors of cholesterol synthesis and have been well-studied in clinical trials in Cuba and South America. As of June 14, 2005, the manufacturer's website says that Cholestin recently has been reformulated with a unique proprietary blend of ingredients, including Lipidol.
For lowering cholesterol, there is better evidence for using prescription drugs such as lovastatin. | Coronary heart disease | Early 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. | Diabetes | Early human evidence suggests the potential for benefits in diabetics. Additional study is needed before a firm recommendation can be made. |
Red yeast has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care provider before using red yeast for any unproven use. Acetaminophen toxicity
Anthrax
Anti-inflammatory
Antimicrobial
Antioxidant
Atherosclerosis
Blood circulation problems
Bruised muscles
Bruises
Cancer
Colic in children
Cuts | Diarrhea
Dysentery (bloody diarrhea)
Exercise performance enhancement
Food additive (coloring)
Food preservative
Hangovers
High blood pressure
HIV (associated hyperlipidemia)
Immunosuppression
Indigestion
Liver disorders
Metabolic disorders
Obesity
Ovarian cancer
Postpartum problems
Spleen problems
Stomach problems
Weight loss
Wounds |
Red yeast is possibly unsafe when used in higher doses over longer periods than currently studied or in patients with hepatic or renal dysfunction. The presence of the mycotoxin citrinin, a secondary metabolite of the Monascus species, in fermentation products is a potential threat to public health. There is no established tolerance limit, so use caution when consuming products containing citrinin. Allergies There is one report of anaphylaxis (a severe allergic reaction) in a butcher who touched meat containing red yeast. Side Effects There is limited evidence about the side effects of red yeast. Mild headache and stomachache can occur. Side effects may be similar to those for the prescription drug lovastatin (Mevacor). Heartburn, gas, bloating, muscle pain or damage, dizziness, asthma, kidney problems, increased risk of bleeding, and liver problems are possible, but they are not well documented. People with liver disease should not use red yeast products. A metabolite of Monascus species called mycotoxin citrinin, used in fermentation products, may be harmful. Pregnancy And Breast-Feeding Prescription drugs with similar chemicals as red yeast cannot be used during pregnancy. Therefore, it is strongly recommended that red yeast not be taken by pregnant or breast-feeding women.
Interactions with drugs, herbs and other supplements have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with your health care provider or pharmacist before using herbs or dietary supplements. 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 with red yeast rice extract may increase the risk of muscle breakdown or kidney damage. Drugs broken down in the liver may be affected by red yeast rice extract. These include digoxin; certain antibiotics, such as azithromycin (Zithromax) and clarithromycin (Biaxin); ketoconazole; itraconazole; thyroid drugs; protease inhibitors, such as saquinavir (Fortovase); and some anticoagulants. 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 (Coumadinฎ) or heparin, anti-platelet drugs such as clopidogrel (Plavixฎ), and non-steroidal anti-inflammatory drugs such as ibuprofen (Motrinฎ, Advilฎ) or naproxen (Naprosynฎ, Aleveฎ). Red yeast may alter blood sugar levels in the blood, and 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. Red yeast may produce gamma-aminobutyric acid (GABA) and may therefore have additive effects when taken with GABA drugs, such as Neurontin (gabapentin). Interactions With Herbs And Dietary Supplements Herbs and supplements with anticoagulant activity may increase the risk of bleeding when taken with red yeast. Examples include Ginkgo biloba and garlic ( Allium sativum). Red yeast may interact with products that cause liver damage or are broken down in the liver. Grapefruit juice may increase the blood levels of red yeast. Milk thistle, St. John's wort, niacin and vitamin A may interact with red yeast rice extract. Coenzyme Q levels may be lowered by red yeast rice extract. Red yeast may produce GABA and may therefore have additive effects when taken with GABA herbs and supplements. Cholesterol-lowering herbs and supplements may have increased effects when taken with red rice yeast. Coenzyme Q10 levels may be lowered. 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.
The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with your health care provider before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas. Adults (Aged 18 Or Older) Capsules: A dose of 1,200 milligrams of concentrated red yeast powder two times per day has been taken by mouth with food. Food may enhance absorption.
The average consumption of naturally occurring red yeast rice in Asia has been reported as 14 to 55 grams per day. Children (Younger Than 18) There is not enough scientific evidence to recommend red yeast for children.
Red yeast rice is believed to lower cholesterol levels because it contains the same chemical as the cholesterol-lowering prescription drug lovastatin (Mevacor). People who drink alcohol or grapefruit juice and people who take other cholesterol-lowering drugs; anticoagulants; cyclosporine; drugs broken down by the liver; digoxin; certain antibiotics or antifungal drugs; thyroid drugs; protease inhibitors, such as saquinavir (Fortovase); coenzyme Q; milk thistle; niacin; or vitamin A should consult their health care provider and pharmacist before taking red yeast rice extract. Pregnant or breast-feeding women, children and people with liver disease should not take red yeast rice extract. Consult your health care provider immediately if you experience side effects. The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.
- Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
- National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research
Selected Scientific Studies: Red Yeast Natural Standard has reviewed all of the currently available medical literature to prepare the professional monograph from which this version was created. Some of the more recent studies are listed below: - Cicero AF, Rovati LC, Setnikar I. Eulipidemic effects of berberine administered alone or in combination with other natural cholesterol-lowering agents. A single-blind clinical investigation. Arzneimittelforschung. 2007;57(1):26-30.
- Gavagan T. Cardiovascular disease. Prim Care 2002;Jun, 29(2):323-338, vi.
- 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;Apr, 7(2):133-139.
- Hsieh PS, Tai YH. Aqueous extract of Monascus purpureus M9011 prevents and reverses fructose-induced hypertension in rats. J Agric Food Chem 2003;Jul 2;51(14):3945-3950.
- 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.
- Natural Standard Research Collaboration, Chief Editors: Ulbricht C, Basch E, Natural Standard Herb and Supplement Reference - Evidence-Based Clinical Reviews, USA: Elsevier/Mosby, 2005.
- 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;Feb, 352(1-2):217-224.
- Li F, Xu G, Li Y, Chen Y. [Study on the production of citrinin by Monascus strains used in food industry.] Wei Sheng Yan Jiu 2003;Nov, 32(6):602-605. In Chinese.
- Liu L, Zhao SP, Cheng YC, Li YL. Xuezhikang decreases serum lipoprotein(a) and C-reactive protein concentrations in patients with coronary heart disease. Clin Chem 2003;Aug, 49(8):1347-1352.
- Liu BH, Wu TS, Su MC, et al. Evaluation of citrinin occurrence and cytotoxicity in Monascus fermentation products. J Agric Food Chem 2005;Jan 12, 53(1):170-175.
- Patrick L, Uzick M. Cardiovascular disease: C-reactive protein and the inflammatory disease paradigm. HMG-CoA reductase inhibitors, alpha-tocopherol, red yeast rice, and olive oil polyphenols: a review of the literature. Altern Med Rev 2001;Jun, 6(3):248-271. Review.
- Prasad GV, Wong T, Meliton G, Bhaloo S. Rhabdomyolysis due to red yeast rice (Monascus purpureus) in a renal transplant recipient. Transplantation 2002;Oct 27, 74(8):1200-1201.
- Smith DJ, Olive KE. Chinese red rice-induced myopathy. South Med J 2003;Dec, 96(12):1265-1267.
- SoRelle R. Appeals court says Food and Drug Administration can regulate Cholestin. Circulation 2000;Aug 15, 102(7):E9012-E9013.
- Su YC, Wang JJ, Lin TT, Pan TM. Production of the secondary metabolites gamma-aminobutyric acid and monacolin K by Monascus. J Ind Microbiol Biotechnol 2003;Jan, 30(1):41-46. Epub 2003 Jan 03.
- Thompson Coon JS, Ernst E. Herbs for serum cholesterol reduction: a systematic view. J Fam Pract 2003;Jun, 52(6):468-478.
- 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;Jun, 14(6):314-318.
- Yang HT, Lin SH, Huang SY, Chou HJ. Acute administration of red yeast rice (Monascus purpureus) depletes tissue coenzyme Q(10) levels in ICR mice. Br J Nutr 2005;Jan, 93(1):131-135.
- Zhao SP, Liu L, Cheng YC, Li YL. Effect of xuezhikang, a cholestin extract, on reflecting postprandial triglyceridemia after a high-fat meal in patients with coronary heart disease. Atherosclerosis 2003;Jun, 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;Aug 24, 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.
Last updated
Last updated September 03, 2008
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