Drug interactions
Atazanavir + Red yeast rice
Severity: Major
Atazanavir and Red yeast rice: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Red yeast rice contains monacolin K, which is chemically identical to lovastatin, a CYP3A4 substrate. Atazanavir, boosted or not, is a strong CYP3A4 inhibitor and can greatly increase monacolin K exposure, raising the risk of myopathy and rhabdomyolysis.
What this interaction means in plain words
Atazanavir and Red yeast rice can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Atazanavir belongs to Anti Virals; Red yeast rice belongs to Gastrointestinal Tract.
Why it happens
Atazanavir inhibits CYP3A4, reducing first-pass and systemic clearance of monacolin K (lovastatin).
What to do
Avoid the combination and use a statin with a lower CYP3A4 dependence, such as pravastatin or rosuvastatin, at a suitable dose. Counsel the patient to report muscle pain or dark urine.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Red yeast rice
- Red yeast rice + Ritonavir Contraindicated
- Red yeast rice + Saquinavir Contraindicated
- Red yeast rice + Tipranavir Contraindicated
- Atorvastatin + Red yeast rice Major
- Conivaptan + Red yeast rice Major
- Cyclosporine + Red yeast rice Major
Other interactions of Atazanavir
- Alfuzosin + Atazanavir Contraindicated
- Atazanavir + Avanafil Contraindicated
- Atazanavir + Dronedarone Contraindicated
- Atazanavir + Eletriptan Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Atazanavir + Ergotamine Contraindicated
Frequently asked questions
Can I take Atazanavir with Red yeast rice?
MediHelp rates the interaction as major. Atazanavir and Red yeast rice can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Red yeast rice contains monacolin K, which is chemically identical to lovastatin, a CYP3A4 substrate. Atazanavir, boosted or not, is a strong CYP3A4 inhibitor and can greatly increase monacolin K exposure, raising the risk of myopathy and rhabdomyolysis.
How serious is the interaction between Atazanavir and Red yeast rice?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination and use a statin with a lower CYP3A4 dependence, such as pravastatin or rosuvastatin, at a suitable dose. Counsel the patient to report muscle pain or dark urine.
What other medicines interact with Red yeast rice?
MediHelp also lists interactions of Red yeast rice with, for example, Ritonavir, Saquinavir, Tipranavir. The full list is on the Red yeast rice page.
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