Drug interactions
Lopinavir + Red yeast rice
Severity: Major
Lopinavir 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 delivers monacolin K, identical to lovastatin, a sensitive CYP3A4 substrate. Lopinavir, coformulated with ritonavir, strongly inhibits CYP3A4 and can markedly increase exposure, raising the risk of myopathy and rhabdomyolysis.
What this interaction means in plain words
Lopinavir 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.
Lopinavir belongs to Anti Virals; Red yeast rice belongs to Gastrointestinal Tract.
Why it happens
Ritonavir-boosted lopinavir inhibits CYP3A4, reducing monacolin K metabolism.
What to do
Avoid the combination and use pravastatin or rosuvastatin at an appropriate dose if lipid lowering is required. Advise reporting of muscle pain or weakness.
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 Lopinavir
- Alfuzosin + Lopinavir Contraindicated
- Avanafil + Lopinavir Contraindicated
- Cisapride + Lopinavir Contraindicated
- Dronedarone + Lopinavir Contraindicated
- Eletriptan + Lopinavir Contraindicated
- Eplerenone + Lopinavir Contraindicated
Frequently asked questions
Can I take Lopinavir with Red yeast rice?
MediHelp rates the interaction as major. Lopinavir 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 delivers monacolin K, identical to lovastatin, a sensitive CYP3A4 substrate. Lopinavir, coformulated with ritonavir, strongly inhibits CYP3A4 and can markedly increase exposure, raising the risk of myopathy and rhabdomyolysis.
How serious is the interaction between Lopinavir 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 pravastatin or rosuvastatin at an appropriate dose if lipid lowering is required. Advise reporting of muscle pain or weakness.
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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