Supplements and Statins and Cholesterol Medicines

Safety box

Red yeast rice can contain a statin-like compound, so taking it with a statin could mean getting statin effects twice. NCCIH says red yeast rice products with significant monacolin K can cause muscle, kidney and liver damage like statin drugs. [1] Tell a clinician or pharmacist before combining any of these with a cholesterol medicine. For collapse, seizure or trouble breathing, call 911.

The question

Which herbs, foods and supplements are documented to affect statins (medicines that lower cholesterol), and what should a reader do about it? This page covers cholesterol medicines in general; the grapefruit page and the St. John's wort page go deeper on those two.

Red yeast rice

Red yeast rice is made by fermenting a fungus, usually Monascus purpureus (a mold, accepted name per GBIF), on rice. [2] NCCIH says the fungus can enrich the rice with monacolins, including monacolin K, which "is structurally identical to the medicine lovastatin," a statin. [1]

• Amount is unknowable from the label. NCCIH says it is "impossible for consumers to know" how much monacolin K is in a product; some products contain very little or none and others contain large amounts. [1]
• Same side effects and interactions as statins. Products with significant monacolin K can have the same potential side effects as statins, including muscle, kidney and liver damage, and the same types of drug interactions. [1]
• Contamination. NCCIH describes a kidney-toxic contaminant, citrinin, found in red yeast rice products. [1]
• Safe level unknown. The European Food Safety Authority panel (2018, as described by NCCIH) could not identify a guaranteed safe dietary level of monacolins from red yeast rice. [1]
• Legal status in the US. According to NCCIH, products with enhanced or added lovastatin cannot be marketed as a dietary supplement in the United States. [1]
• Pregnancy and breastfeeding. NCCIH says these products are not recommended. [1]

Label: documented by an NIH source. This page covers interactions only, not traditional use.

Grapefruit

The US Food and Drug Administration (FDA) lists some statins, such as simvastatin and atorvastatin, among medicines that grapefruit juice can interact with. [3] FDA explains that with some statins "too much of the drug may stay in your body," raising the risk of liver and muscle damage that can lead to kidney failure, and that grapefruit does not affect all drugs in a category. [3] See Grapefruit and Medicine Interactions.

St. John's wort

NCCIH lists certain statins, including simvastatin, among medicines St. John's wort (Hypericum perforatum) can affect. [4] The UK National Health Service (NHS) also names St John's wort and grapefruit on its list of things that can interfere with statins. [5] Details: St. John's Wort Interactions.

The general rule from the NHS

The NHS says taking statins with other medicines, herbal remedies, or some foods and drinks can stop the medicines working properly or raise the risk of side effects. [5]

What a reader can do

• Tell the prescriber and pharmacist about any red yeast rice, herb or supplement, and bring the bottle.
• Do not start red yeast rice as a "natural statin" while on a prescribed statin, and do not stop a prescribed statin, without asking the prescriber.
• Ask the pharmacist whether grapefruit matters for your specific medicine.
• Other pages: How Interactions Work, Vitamin and Medicine Interactions Reference, Coenzyme Q10 and Product Quality and Contamination.

Not covered

Interactions with other supplements and with non-statin cholesterol medicines are not described in the sources we read for this page. Proper evidence not found here; we searched NCCIH, NHS, MedlinePlus and FDA pages on statins, red yeast rice and grapefruit.