Drug interactions
Itraconazole + Red yeast rice
Severity: Major
Itraconazole 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. Itraconazole greatly increases lovastatin exposure, which raises the risk of myopathy and rhabdomyolysis.
What this interaction means in plain words
Itraconazole 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.
Itraconazole belongs to Anti Fungals; Red yeast rice belongs to Gastrointestinal Tract.
Why it happens
Strong CYP3A4 inhibition by itraconazole reduces the metabolism of monacolin K (lovastatin).
What to do
Avoid the combination and stop red yeast rice during itraconazole therapy. Counsel the patient to report muscle pain or weakness and check creatine kinase if symptomatic.
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 Itraconazole
- Alfuzosin + Itraconazole Contraindicated
- Alprazolam + Itraconazole Contraindicated
- Avanafil + Itraconazole Contraindicated
- Conivaptan + Itraconazole Contraindicated
- Dihydroergotamine intranasal + Itraconazole Contraindicated
- Dihydroergotamine + Itraconazole Contraindicated
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 Itraconazole with Red yeast rice?
MediHelp rates the interaction as major. Itraconazole 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. Itraconazole greatly increases lovastatin exposure, which raises the risk of myopathy and rhabdomyolysis.
How serious is the interaction between Itraconazole 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 stop red yeast rice during itraconazole therapy. Counsel the patient to report muscle pain or weakness and check creatine kinase if symptomatic.
What other medicines interact with Itraconazole?
MediHelp also lists interactions of Itraconazole with, for example, Alfuzosin, Alprazolam, Avanafil. The full list is on the Itraconazole page.
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