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Rice fermented with Monascus purpureus

Red yeast rice

Red yeast rice does lower LDL cholesterol, by about 0.9 mmol/L against placebo in trials, but only because it contains monacolin K, which is chemically identical to the prescription statin lovastatin, so it brings statin risks without a prescription's dose control: the EU food safety regulator could not identify any safe daily intake and notes serious muscle and liver reactions at doses as low as 3 mg a day.

The monacolin K in shop products varies widely and is rarely on the label, some products contain citrinin, a kidney toxin, and in 2024 contaminated red yeast rice supplements in Japan caused kidney injury that sent hundreds of people to hospital, with deaths reported. It should not be combined with a statin or other cholesterol medicine, and it is not recommended in pregnancy or breastfeeding.

Updated
10 October 2026
Dark red fermented rice grains in a small bowl
At a glance
Last reviewed 10 October 2026
Evidence
Strong
Best for
Lowering LDL cholesterol
Typical form & use
Capsule, 2–11 mg monacolin K in trials
Onset
4+ weeks
Safety
Contains a statin; muscle, liver and kidney harm reported. 2 known interactions, most serious with immunosuppressants.
Check with your medications →

What it's used for

Evidence is rated per use. The same ingredient can be strong for one thing and traditional for another.

UseEvidenceWhat the research shows
Lowering LDL cholesterolCompare remedies for heart health →Strong

A 2014 meta-analysis of 13 placebo-controlled trials (804 people, 4 weeks to 12 months) found red yeast rice lowered LDL cholesterol by 0.87 mmol/L and triglycerides by 0.23 mmol/L, with no clear change in HDL; the products supplied 2 to 11.4 mg monacolin K a day where reported, some contained other ingredients, and results varied a lot between trials. The effect comes from monacolin K, so products low in it have unknown effectiveness.6,1

Fewer heart attacks after a first one (Xuezhikang extract)Moderate

In a Chinese trial of nearly 5,000 people who had already had a heart attack, a partly purified red yeast rice extract (Xuezhikang) taken for an average of 4.5 years cut major coronary events from 10.4% to 5.7% against placebo, and lowered cardiovascular and total deaths by 30% and 33%. It is one trial, in one population, of one standardised extract, not of typical shop supplements.7

How much

Ranges below are what studies used and what supplements commonly contain. They are not a recommendation for you. Start at the low end.

Studied range
2–11.4 mg monacolin K a day6
From 200 mg to 3,600 mg of red yeast rice a day across the placebo-controlled trials in the 2014 meta-analysis. The monacolin K figure, not the weight of red yeast rice, is what matters.
EU limit
Under 3 mg monacolins a day4,3
EU law since 2022 limits a daily portion to under 3 mg of monacolins and keeps them under review. EFSA's 2025 opinion found the data still do not show that intakes below 3 mg a day are safe.
Safe intake
None identified2,3
EFSA judged 10 mg a day of significant safety concern and found reports of serious reactions at 3 mg a day; it could not identify any intake that raises no concern, for the general population or vulnerable groups.
Label reliability (US)
0.09–5.48 mg per 1,200 mg1,5
In a test of 28 US brands, none listed monacolin K on the label, two had none detectable, and the rest varied more than 60-fold. The FDA found one product that could supply 85.8 mg lovastatin a day, above the maximum dose of prescription lovastatin.
Timing · Our sources give no best time of day. EU labels must say not to reach 3 mg monacolins a day and not to take it alongside other red yeast rice products.With food? · Avoid grapefruit juice: EFSA notes it blocks CYP3A4, the liver enzyme that breaks down lovastatin, so it can raise levels in the blood.How long to trial · The trials measured cholesterol after 4 weeks to 12 months, so a blood test after a month or more is the only way to know whether a product is doing anything. Products high in monacolin K can cause the same muscle, liver and kidney side effects as statins.

How people take it

Capsule or tablet (supplement)Monacolin K often not statedIn the US, labels rarely state monacolin K and content ranges from none to statin-like doses; products with added or enhanced lovastatin cannot legally be sold as dietary supplements there.
EU-labelled supplementUnder 3 mg monacolins a dayEU labels must give the monacolin content per portion and carry warnings for pregnancy, breastfeeding, under-18s, over-70s and people on cholesterol medicine.
Partly purified extract (Xuezhikang)As in the Chinese trialThe standardised extract behind the heart-attack trial. Its results do not transfer to other red yeast rice products.

Safety

Who should avoid
  • Taking a statin or other cholesterol medicine — EU labels say do not take it
  • Pregnancy and breastfeeding — not recommended; no safety studies
  • Under 18 or over 70 — EU labels say it should not be taken
  • Liver, kidney or muscle disorders — named as higher-risk groups in EFSA's review
  • Drinking grapefruit juice — it slows the breakdown of lovastatin
  • Taking another red yeast rice product — EU labels say use only one
Known interactions
AvoidImmunosuppressants — Ciclosporin interferes with the breakdown of monacolins; EFSA's review describes this in a kidney transplant patient and cites a report of rhabdomyolysis (severe muscle breakdown) in a transplant recipient taking red yeast rice.
AvoidStatins (cholesterol medication) — Monacolin K is lovastatin, so taking it with a statin doubles up the same drug action; EFSA notes higher statin levels and a possible higher risk of toxic effects (gemfibrozil also raised lovastatin acid levels), and EU labels say not to take it with cholesterol-lowering medicine.

Questions people ask

Is red yeast rice the same as a statin?

In effect, yes. Its main active compound, monacolin K, is chemically identical to lovastatin, a prescription statin, and the FDA treats products with added or enhanced lovastatin as unapproved drugs rather than dietary supplements. The difference is that a supplement's dose is uncontrolled and usually not on the label.

Is red yeast rice safe?

The EU's food safety regulator could not identify a safe daily intake: it found reports of serious muscle and liver reactions, including rhabdomyolysis, at doses as low as 3 mg monacolins a day, and its 2025 review did not change that.

Some products also contain citrinin, which damages the kidneys; in a 2021 test of 37 products only one met the EU limit, and four labelled citrinin-free were contaminated.

What happened with red yeast rice supplements in Japan?

In March 2024 Kobayashi Pharmaceutical recalled its beni-koji (red yeast rice) supplements, including Beni-koji Choleste-Help, after reports of kidney damage and deaths.

Japan's health ministry concluded the cause was puberulic acid, made by a blue mould (Penicillium adametzioides) that contaminated the factory's fermentation, not monacolin K; by November 2024, 2,628 people had seen a doctor and many still have reduced kidney function.

Can I take red yeast rice instead of a statin?

That is a decision to make with your prescriber, not on your own. It works through the same drug as a statin, so it carries the same side effects, but you cannot know how much you are getting, and EU labels say it should not be taken with any cholesterol-lowering medicine.

Sources (10)

  1. Regulator monograph National Center for Complementary and Integrative Health (NCCIH). Red Yeast Rice: What You Need To Know. Updated November 2022.
  2. Regulator opinion EFSA Panel on Food Additives and Nutrient Sources added to Food (ANS), Younes M, et al. Scientific opinion on the safety of monacolins in red yeast rice. EFSA Journal. 2018.
  3. Regulator opinion EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA). Scientific Opinion on additional scientific data related to the safety of monacolins from red yeast rice submitted pursuant to Article 8(4) of Regulation (EC) No 1925/2006. EFSA Journal. 2025.
  4. Regulation European Commission. Commission Regulation (EU) 2022/860 of 1 June 2022 amending Annex III to Regulation (EC) No 1925/2006 as regards monacolins from red yeast rice. 2022.
  5. Regulator warning letter US Food and Drug Administration. Warning Letter 608729: Dr. Sam Robbins, Inc. dba HFL Solutions, LLC (CholesLo, red yeast rice with lovastatin). 28 August 2020.
  6. Systematic review and meta-analysis Li Y, Jiang L, Jia Z, Xin W, Yang S, Yang Q, Wang L. A meta-analysis of red yeast rice: an effective and relatively safe alternative approach for dyslipidemia. PLoS One. 2014.
  7. Randomised controlled trial Lu Z, Kou W, Du B, et al. Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol. 2008.
  8. Laboratory and clinical study Sekiguchi Y, Mori M, Maruyama H, et al. The Pathophysiological Mechanism of Beni-koji Choleste-Help or Puberulic Acid-Induced Kidney Injury. Kidney Int Rep. 2026.
  9. Regulator notice Ministry of Health, Labour and Welfare, Japan. Information for Adverse Events (beni-koji related products, Kobayashi Pharmaceutical).
  10. Review Sato K, Kodama K, Sengoku S. The Co-Evolution of Markets and Regulation in the Japanese Functional Food Industry: Balancing Risk and Benefit. Foods. 2025.

Reader notes

Experiences and questions from readers, read by an editor before they appear. They are personal accounts, not evidence, and are not medical advice.

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Last reviewed 10 October 2026 · Next review April 2027 · How we rate evidence