Drug interactions
Levoketoconazole + Red yeast rice
Severity: Major
Levoketoconazole 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 levoketoconazole is a potent CYP3A4 inhibitor. Combined use can greatly raise statin exposure and the risk of myopathy and rhabdomyolysis.
What this interaction means in plain words
Levoketoconazole 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.
Levoketoconazole belongs to Endocrine; Red yeast rice belongs to Gastrointestinal Tract.
Why it happens
Levoketoconazole inhibits CYP3A4, decreasing the clearance of monacolin K.
What to do
Avoid the combination and stop red yeast rice during levoketoconazole therapy. If a statin is needed, choose one not dependent on CYP3A4 and monitor for muscle symptoms.
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
Other interactions of Levoketoconazole
- Alfuzosin + Levoketoconazole Contraindicated
- Alprazolam + Levoketoconazole Contraindicated
- Amiodarone + Levoketoconazole Contraindicated
- Avanafil + Levoketoconazole Contraindicated
- Cisapride + Levoketoconazole Contraindicated
- Clarithromycin + Levoketoconazole Contraindicated
Frequently asked questions
Can I take Levoketoconazole with Red yeast rice?
MediHelp rates the interaction as major. Levoketoconazole 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 levoketoconazole is a potent CYP3A4 inhibitor. Combined use can greatly raise statin exposure and the risk of myopathy and rhabdomyolysis.
How serious is the interaction between Levoketoconazole 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 levoketoconazole therapy. If a statin is needed, choose one not dependent on CYP3A4 and monitor for muscle symptoms.
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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