Drug interactions
Quinupristin / dalfopristin + Red yeast rice
Severity: Major
Quinupristin / dalfopristin 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 supplies monacolin K, identical to lovastatin, which depends on CYP3A4 for clearance. Quinupristin/dalfopristin inhibits CYP3A4 and may raise monacolin K levels, increasing the risk of myopathy and rhabdomyolysis.
What this interaction means in plain words
Quinupristin / dalfopristin 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.
Why it happens
Quinupristin/dalfopristin inhibits CYP3A4, reducing metabolism of monacolin K (lovastatin).
What to do
Hold red yeast rice during quinupristin/dalfopristin therapy. Monitor for muscle pain, weakness and dark urine, and check creatine kinase if symptoms occur.
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
Frequently asked questions
Can I take Quinupristin / dalfopristin with Red yeast rice?
MediHelp rates the interaction as major. Quinupristin / dalfopristin 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 supplies monacolin K, identical to lovastatin, which depends on CYP3A4 for clearance. Quinupristin/dalfopristin inhibits CYP3A4 and may raise monacolin K levels, increasing the risk of myopathy and rhabdomyolysis.
How serious is the interaction between Quinupristin / dalfopristin 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: Hold red yeast rice during quinupristin/dalfopristin therapy. Monitor for muscle pain, weakness and dark urine, and check creatine kinase if symptoms occur.
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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