Drug interactions
Nelfinavir + Red yeast rice
Severity: Major
Nelfinavir 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 the same as lovastatin and is cleared mainly by CYP3A4. Nelfinavir inhibits CYP3A4 and can markedly raise monacolin K exposure, increasing the risk of myopathy and rhabdomyolysis.
What this interaction means in plain words
Nelfinavir 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.
Nelfinavir belongs to Anti Virals; Red yeast rice belongs to Gastrointestinal Tract.
Why it happens
Nelfinavir inhibits CYP3A4-mediated metabolism of monacolin K (lovastatin), raising its systemic exposure.
What to do
Avoid the combination; lovastatin is contraindicated with HIV protease inhibitors. If lipid lowering is needed, use a statin with less CYP3A4 dependence, such as pravastatin or rosuvastatin at an appropriate dose, and counsel on 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 Nelfinavir
- Alfuzosin + Nelfinavir Contraindicated
- Avanafil + Nelfinavir Contraindicated
- Dronedarone + Nelfinavir Contraindicated
- Eletriptan + Nelfinavir Contraindicated
- Ergotamine + Nelfinavir Contraindicated
- Flibanserin + Nelfinavir Contraindicated
Frequently asked questions
Can I take Nelfinavir with Red yeast rice?
MediHelp rates the interaction as major. Nelfinavir 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 the same as lovastatin and is cleared mainly by CYP3A4. Nelfinavir inhibits CYP3A4 and can markedly raise monacolin K exposure, increasing the risk of myopathy and rhabdomyolysis.
How serious is the interaction between Nelfinavir 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; lovastatin is contraindicated with HIV protease inhibitors. If lipid lowering is needed, use a statin with less CYP3A4 dependence, such as pravastatin or rosuvastatin at an appropriate dose, and counsel on 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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