Drug interactions
Cyclosporine + Red yeast rice
Severity: Major
Cyclosporine 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
Monacolin K in red yeast rice is lovastatin, and cyclosporine markedly raises lovastatin exposure through CYP3A4 and OATP1B1 inhibition. This increases the risk of myopathy and rhabdomyolysis, particularly in transplant recipients.
What this interaction means in plain words
Cyclosporine 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.
Why it happens
Cyclosporine inhibits CYP3A4 and hepatic OATP uptake, increasing monacolin K (lovastatin) exposure.
What to do
Avoid red yeast rice in patients on cyclosporine and treat dyslipidemia with a statin and dose appropriate for use with cyclosporine. Monitor for muscle symptoms and creatine kinase.
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
- Atazanavir + Red yeast rice Major
- Atorvastatin + Red yeast rice Major
- Conivaptan + Red yeast rice Major
Frequently asked questions
Can I take Cyclosporine with Red yeast rice?
MediHelp rates the interaction as major. Cyclosporine 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. Monacolin K in red yeast rice is lovastatin, and cyclosporine markedly raises lovastatin exposure through CYP3A4 and OATP1B1 inhibition. This increases the risk of myopathy and rhabdomyolysis, particularly in transplant recipients.
How serious is the interaction between Cyclosporine 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 red yeast rice in patients on cyclosporine and treat dyslipidemia with a statin and dose appropriate for use with cyclosporine. Monitor for muscle symptoms and creatine kinase.
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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