Drug interactions
Isoniazid + Red yeast rice
Severity: Moderate
Isoniazid and Red yeast rice: moderate 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 and is cleared mainly by CYP3A4. Isoniazid has weak to moderate CYP3A4 inhibitory activity, so it may raise monacolin exposure and add to the risk of myopathy or rhabdomyolysis. Isoniazid itself can also cause liver injury, which complicates the picture.
What this interaction means in plain words
Isoniazid and Red yeast rice can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Isoniazid belongs to Anti Bacterial; Red yeast rice belongs to Gastrointestinal Tract.
Why it happens
Isoniazid inhibits CYP3A4 and may reduce first-pass metabolism of monacolin K (lovastatin).
What to do
Counsel the patient to report muscle pain, weakness or dark urine, and consider checking creatine kinase if symptoms occur. Consider stopping red yeast rice during isoniazid therapy, and monitor liver enzymes.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Isoniazid
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 Isoniazid with Red yeast rice?
MediHelp rates the interaction as moderate. Isoniazid and Red yeast rice can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Red yeast rice contains monacolin K, which is chemically identical to lovastatin and is cleared mainly by CYP3A4. Isoniazid has weak to moderate CYP3A4 inhibitory activity, so it may raise monacolin exposure and add to the risk of myopathy or rhabdomyolysis. Isoniazid itself can also cause liver injury, which complicates the picture.
How serious is the interaction between Isoniazid and Red yeast rice?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Counsel the patient to report muscle pain, weakness or dark urine, and consider checking creatine kinase if symptoms occur. Consider stopping red yeast rice during isoniazid therapy, and monitor liver enzymes.
What other medicines interact with Isoniazid?
MediHelp also lists interactions of Isoniazid with, for example, Bacillus calmette-guerin substrain tice, Benzhydrocodone / acetaminophen, Carbamazepine. The full list is on the Isoniazid page.
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