Red Yeast Rice: Cholesterol Effects and the 2024 Kidney-Injury Reports

Table of Contents

1. What Red Yeast Rice Is
2. Traditional Use in Chinese Food and Medicine
3. Monacolin K Is the Same Molecule as Lovastatin
4. How Regulators Treat Red Yeast Rice
5. How Much Monacolin a Product Contains Varies Widely
6. Citrinin Contamination
7. What the Cholesterol Trials Found
8. The Chinese Heart-Attack Survivor Trial
9. Muscle and Liver Effects and the Statin-Intolerance Trials
10. The 2024 Kidney-Injury Reports in Japan
11. Interactions as Sources Describe Them
12. What Is Not Known
13. Key Research Papers
14. Connections
15. Featured Videos

What Red Yeast Rice Is

Red yeast rice is made by fermenting cooked rice kernels with a mold of the Monascus family, most often Monascus purpureus. A 2019 systematic review of its chemistry counted more than 101 compounds isolated from it, mainly monacolins, pigments, organic acids, sterols, decalin derivatives, flavonoids and polysaccharides (Zhu 2019). The red pigments are what give the rice its colour.

The name is slightly misleading. The United States National Center for Complementary and Integrative Health points out that Monascus purpureus is technically a mold, a fungus made of many-celled filaments, rather than a single-celled yeast. Supplement labels in the United States still use the name "red yeast rice" rather than "red mold rice." The same agency notes that red yeast rice is sold as a food, as a traditional Chinese medicine and as a dietary supplement, and that the amount of monacolin K it contains depends on the strain of mold and the conditions of fermentation (National Center for Complementary and Integrative Health, Red Yeast Rice fact sheet).

A laboratory analysis of authentic and commercial material describes the same dependence: depending on the Monascus strain and how it is fermented, red yeast rice may contain monacolins, pigments and the mold toxin citrinin as by-products of the mold's growth (Avula 2014). Not every red yeast rice is made with the same species. The tablets involved in the 2024 Japanese kidney-injury outbreak were made from red yeast rice produced with a related mold, Monascus pilosus (Yoshinari 2025).

Traditional Use in Chinese Food and Medicine

Red yeast rice has a long history in East Asia. Japanese kidney specialists describe it as traditionally used in Asian cooking (Shinzawa 2025). In Chinese folk medicine, according to a 2019 review of its traditional uses, it has long been used for what that tradition calls blood circulation stasis, for indigestion, for diarrhea and for limb weakness (Zhu 2019). These are descriptions of traditional practice, not trial results. The same review notes that the indigestion and diarrhea uses have never been tested in modern pharmacological trials and calls for such studies.

The modern interest is different from the traditional one. Supplements sold in Europe and North America are marketed almost entirely for cholesterol, because of the monacolin K content described in the next section. The Food and Drug Administration states in a 2020 warning letter that traditional red yeast rice does not contain more than trace amounts of lovastatin, if any. The National Center for Complementary and Integrative Health makes the same point: traditional red yeast rice may contain trace amounts of monacolin K, while some commercial products contain large amounts.

Red yeast rice is itself a fermented rice product. The evidence below concerns red yeast rice and its concentrated extracts sold as supplements, not traditional dishes coloured with it.

Monacolin K Is the Same Molecule as Lovastatin

Statin drugs lower cholesterol by blocking 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, the enzyme the liver uses to build cholesterol. Monacolin K blocks the same enzyme because it is the same molecule as the statin lovastatin. An Italian pharmacology group describes monacolin K as chemically identical to lovastatin (Rigillo 2025), and the Italian surveillance study discussed below describes it the same way (Mazzanti 2017).

A single red yeast rice product can contain several monacolins, not only monacolin K. One analysis of twelve commercial products describes fourteen active monacolins that inhibit cholesterol production in the liver (Gordon 2010). In laboratory tests, an Italian group compared red yeast rice samples with pure lovastatin. The red yeast rice mixtures blocked the cholesterol enzyme more strongly in a test tube than lovastatin alone, which the authors attribute to other monacolins and compounds acting together. In muscle cells grown in the laboratory, the red yeast rice samples had a smaller effect on cell survival and on muscle-damage genes than lovastatin (Rigillo 2025). These were cell and test-tube experiments; the authors state that the clinical effect in people still needs to be firmly established.

Because monacolin K is lovastatin, red yeast rice that contains meaningful amounts of it is, in effect, a low and unmeasured dose of a statin. The site's Cholesterol Management page explains how statins work and how the drugs are compared; the Goldstein and Brown page tells the story of the cholesterol pathway that statins act on.

How Regulators Treat Red Yeast Rice

United States

The Food and Drug Administration's position is set out in its warning letters to supplement sellers. A 2020 warning letter, sent after Food and Drug Administration laboratory analyses found lovastatin in a product sold as a dietary supplement, states that:

• the agency approved lovastatin as a new drug on August 31, 1987;
• neither lovastatin as a single ingredient, nor any red yeast rice product made and promoted for its lovastatin content, was marketed as a dietary supplement or food before that date;
• a red yeast rice product with enhanced or added lovastatin therefore cannot be marketed as a dietary supplement;
• the agency's conclusion that a lovastatin-enhanced red yeast rice product is not a dietary supplement was upheld in court;
• traditional red yeast rice does not contain more than trace amounts of lovastatin, if any.

The National Center for Complementary and Integrative Health summarises the same position: red yeast rice products with considerable amounts of monacolin K are considered by the Food and Drug Administration to be unapproved new drugs and are not sold legally in the United States, and the agency has sent warning letters on several occasions to companies selling products with enhanced or added lovastatin. The fact sheet also notes that monacolin K and lovastatin levels are not usually printed on labels, so buyers cannot know how much a product contains.

A 2017 study tested whether the Food and Drug Administration's manufacturing standards for dietary supplements had made the monacolin K content of red yeast rice predictable. It concluded that, despite those standards, the strength and composition of red yeast rice supplements sold at mainstream retail stores in the United States remained unpredictable (Cohen 2017).

Europe

In the European Union, a 2024 Belgian analysis reports that the European Commission prohibited red yeast rice supplements whose maximum daily serving exceeds 3 mg of total monacolins, citing safety concerns linked to statins, and lowered the permitted limit for the mold toxin citrinin to 100 micrograms per kilogram (Vanhee 2024). The National Center for Complementary and Integrative Health reports that a 2018 opinion of the European Food Safety Authority concluded that exposure to monacolin K from red yeast rice products could lead to severe side effects and that the panel could not identify a dietary level of monacolins that was guaranteed safe. An Italian analysis from 2021 refers to a European health claim tied to a daily intake of 10 mg of monacolin K (Righetti 2021).

How Much Monacolin a Product Contains Varies Widely

Every laboratory survey of commercial red yeast rice products has found large differences in monacolin content between products sold under the same name.

• United States, 12 products (Gordon 2010). All twelve were labelled as 600 mg of red yeast rice per capsule. Monacolin K ranged from 0.10 to 10.09 mg per capsule, and total monacolins from 0.31 to 11.15 mg per capsule.
• United States, 28 brands (Cohen 2017). Two brands contained no detectable monacolin K. In the other 26, monacolin K ranged more than 60-fold, from 0.09 to 5.48 mg per 1,200 mg of red yeast rice. Taken at the labelled daily serving, intake would range more than 120-fold, from 0.09 to 10.94 mg a day.
• Raw materials and supplements (Avula 2014). Three authentic red yeast rice samples contained 1.2 to 1.38 mg of monacolin K per 600 mg. Supplements labelled as 600 mg of red yeast rice ranged more than 40-fold, from 0.03 to 2.18 mg. Many products also had ratios of monacolins that differed significantly from authentic red yeast rice.
• European Union, 37 products (Righetti 2021). Nine products contained less monacolin K than their label stated (30 to 83 percent less) and 24 contained more (10 to 266 percent more). Three had negligible monacolin K. No product met the pharmaceutical standard of 95 to 105 percent of the labelled amount. Small amounts of the statin simvastatin, 0.1 to 7.5 micrograms per daily dose, were found in 30 samples.
• European online market, 35 products (Vanhee 2024). At least four products (about 11 percent) raised safety concerns, either because their total monacolin K exceeded the European limit or because of severe bacterial contamination. Three (about 9 percent) were likely adulterated, and six of the seventeen bought through one European online marketplace had labels that did not meet the rules, with the mandatory warning missing or incomplete or the monacolin amount not stated.

The authors of the American survey call for better standardisation of products and labelling (Gordon 2010), and the 2017 survey describes product strength as unpredictable (Cohen 2017).

Citrinin Contamination

Citrinin is a toxin made by some molds, including Penicillium, Aspergillus and the Monascus molds used for red yeast rice. A Polish analysis describes it as having toxic effects on the kidney, the liver and the developing embryo and fetus (Twarużek 2021). The American product survey describes it as toxic to the kidneys in animals (Gordon 2010).

Results on how often citrinin turns up in supplements go both ways:

• In the American survey of twelve products, four had elevated citrinin levels, one third of those tested (Gordon 2010).
• In the European survey of 37 products, citrinin was found in every product, at 100 to 25,100 micrograms per kilogram. Only one product met the current European limit of 100 micrograms per kilogram, and four contaminated products were labelled "citrinin free" (Righetti 2021).
• In a Polish survey of fifteen supplements, none contained citrinin above the level the test could detect (Twarużek 2021).

Citrinin was not the cause of the 2024 Japanese kidney injuries. The nationwide Japanese study states that the mold strains used for the implicated tablets did not produce citrinin; the safety concern came from a different contaminant described below (Shinzawa 2025).

What the Cholesterol Trials Found

Red yeast rice lowers low-density lipoprotein (LDL) cholesterol in randomized trials. The size of the effect, and whether it extends to other blood fats, differs between analyses.

An early American trial

In a 12-week double-blind trial at a California university, 83 adults with high cholesterol who were not taking cholesterol drugs received 2.4 g a day of a Chinese red yeast rice supplement or a placebo, alongside a prescribed diet. In the red yeast rice group, total cholesterol fell from an average of 254 mg/dL to 208 mg/dL by week 8, significantly more than with placebo. Low-density lipoprotein cholesterol and triglycerides also fell; high-density lipoprotein cholesterol did not change significantly (Heber 1999).

Meta-analyses

• Trogkanis 2024. Fourteen double-blind trials published from 2012 to 2022, lasting 4 to 24 weeks. Red yeast rice extract lowered low-density lipoprotein cholesterol by an average of 35.82 mg/dL (95 percent confidence interval 28.29 to 43.36) and total cholesterol by 37.43 mg/dL. It did not significantly change high-density lipoprotein cholesterol, triglycerides, or apolipoproteins A-I and B, and was not associated with an increase in life-threatening side effects.
• Rahmani 2023. Randomized trials with 24 treatment arms. Low-density lipoprotein cholesterol fell by 28.94 mg/dL, total cholesterol by 33.16 mg/dL and triglycerides by 23.36 mg/dL, and high-density lipoprotein cholesterol rose by 2.49 mg/dL.
• Li 2022. Fifteen trials the authors rated high quality, 1,012 participants. Compared with statin drugs, red yeast rice lowered low-density lipoprotein cholesterol by a comparable amount, lowered total cholesterol less (by 12.24 mg/dL less) and lowered triglycerides more. Compared with other cholesterol supplements it lowered low-density lipoprotein cholesterol by a further 14.40 mg/dL. It did not increase the risk of adverse events. The trials gave 200 to 4,800 mg a day, and the authors call for longer trials.

The analyses disagree on triglycerides and high-density lipoprotein cholesterol: one found no significant effect on either (Trogkanis 2024), another found both improved (Rahmani 2023). All three agree on a reduction in low-density lipoprotein cholesterol.

Red yeast rice is also tested in combination supplements alongside berberine and other ingredients. The site's Berberine for Cholesterol and Cardiovascular Health page covers those combination trials; the figures on this page refer to red yeast rice on its own unless stated.

The Chinese Heart-Attack Survivor Trial

The largest outcome trial of red yeast rice is the China Coronary Secondary Prevention Study. It tested a partially purified Chinese red yeast rice extract in people who had already had a heart attack. Nearly 5,000 patients with average low-density lipoprotein cholesterol levels were randomly assigned to the extract or a placebo daily for an average of 4.5 years (Lu 2008).

• Major coronary events, meaning a non-fatal heart attack or death from coronary heart disease, occurred in 10.4 percent of the placebo group and 5.7 percent of the extract group: an absolute reduction of 4.7 percentage points and a relative reduction of 45 percent.
• Deaths from cardiovascular disease fell by 30 percent and deaths from all causes by 33 percent.
• The need for procedures to reopen coronary arteries fell by one third.
• Total and low-density lipoprotein cholesterol and triglycerides fell, high-density lipoprotein cholesterol rose, and the authors report the extract as safe and well tolerated.

A 2020 meta-analysis of seven studies with 10,699 heart-attack patients whose cholesterol was borderline high found that red yeast rice extract at 1,200 mg a day was associated with fewer non-fatal heart attacks (risk ratio 0.42), fewer artery-reopening procedures (risk ratio 0.58) and fewer sudden deaths (risk ratio 0.71), with low-density lipoprotein cholesterol 20.70 mg/dL lower (Sungthong 2020). Follow-up in those studies ranged from 4 weeks to 4.5 years.

These outcome results come from one standardised extract tested in a Chinese population. The product surveys described earlier show that commercial red yeast rice products differ widely in their monacolin content (Gordon 2010; Cohen 2017).

Muscle and Liver Effects and the Statin-Intolerance Trials

Statin drugs can cause muscle pain and, rarely, serious muscle breakdown (rhabdomyolysis) and liver injury. Because red yeast rice contains a statin, researchers have asked whether it carries the same risks. Controlled trials and spontaneous-report databases give different pictures.

Randomized trials

• Safety meta-analysis (Fogacci 2019). Fifty-three randomized trials, 8,535 people. Red yeast rice was not associated with an increased risk of muscle and joint disorders (odds ratio 0.94, 95 percent confidence interval 0.53 to 1.65). Other adverse events (odds ratio 0.59) and serious adverse events (odds ratio 0.54) were less frequent than in the control groups.
• People who had stopped statins because of muscle pain (Becker 2009). Sixty-two such patients received 1,800 mg of red yeast rice twice daily or placebo for 24 weeks, with a lifestyle program for everyone. Low-density lipoprotein cholesterol fell by 43 mg/dL at week 12 and 35 mg/dL at week 24 with red yeast rice, against 11 and 15 mg/dL with placebo. Liver enzymes, creatine kinase (a marker of muscle damage) and pain scores did not differ between groups. The authors list the trial's small size, single site and short duration as limits.
• Red yeast rice against a statin (Halbert 2010). Forty-three adults who had stopped statins because of muscle pain received 2,400 mg of red yeast rice twice daily or the statin pravastatin 20 mg twice daily for 12 weeks. One of 21 people (5 percent) on red yeast rice and two of 22 (9 percent) on pravastatin stopped because of muscle pain, a difference that was not significant. Pain scores and muscle strength did not differ. Low-density lipoprotein cholesterol fell 30 percent with red yeast rice and 27 percent with pravastatin.

Reports from everyday use

• Italian surveillance system (Mazzanti 2017). From 2002 to 2015, 52 reports described 55 suspected reactions to red yeast rice supplements: muscle pain or raised creatine kinase in 19, rhabdomyolysis in 1, liver injury in 10, digestive reactions in 12, skin reactions in 9 and other reactions in 4. Seventy percent of the people affected were women, 13 needed hospital care and 28 were taking other medicines. In 73 percent of reactions, symptoms went away after the supplement was stopped. The authors conclude that the signals of muscle and liver injury raise the hypothesis that red yeast rice has a safety profile similar to statins.
• United States reporting databases (Raschi 2018). In the Food and Drug Administration's drug adverse-event database, red yeast rice was reported disproportionately often with liver disorders (five cases); in the agency's food and supplement database, it was reported disproportionately often with rhabdomyolysis or muscle disease (27 cases). The authors call for monitoring of muscle and liver safety and for regulators to harmonise how red yeast rice is classified.

The National Center for Complementary and Integrative Health states that red yeast rice products containing significant amounts of monacolin K can have the same potential side effects as statin drugs, including muscle, kidney and liver damage, as well as digestive problems such as diarrhea, nausea and stomach pain. Spontaneous reports cannot show how often a reaction happens, only that it has been reported; the trials, by contrast, were short and enrolled selected volunteers.

The 2024 Kidney-Injury Reports in Japan

In late 2023 and early 2024, Japanese doctors began seeing kidney injury in people taking specific red yeast rice tablets marketed for lowering cholesterol (Shinzawa 2025). Reports of serious food poisoning linked to the tablets were made public from late March 2024 (Yoshinari 2025). A case series published in 2024 states that, following the first identified case, 76 possibly related deaths and 492 hospitalizations had been reported in Japan (Chikasue 2025). These problems were tied to particular contaminated production, not to red yeast rice as a whole; the contaminant is described below.

What the kidney damage looked like

The injury mainly hit the kidney tubules, the small channels that reclaim salts, sugar and other substances from urine. Many patients developed Fanconi syndrome, a tubule failure in which the body loses potassium, phosphate, uric acid and glucose into the urine and the blood turns acidic.

• Two cases (Uchiyama 2024). A woman with previously normal kidneys developed high blood pressure, then after six months of the tablets her estimated glomerular filtration rate (eGFR), the standard measure of kidney filtering, had fallen to 22.5. She had Fanconi syndrome, and a kidney biopsy showed tubule damage. Thirty-five days after she stopped the tablets, the protein in her urine cleared and her estimated glomerular filtration rate returned to its earlier level. A man with diabetes fell to an estimated glomerular filtration rate of 3.5 after four months, needed dialysis for more than two weeks, and recovered kidney function after stopping.
• Three cases (Chikasue 2025). Kidney injury with renal tubular acidosis and Fanconi syndrome developed after two weeks to seven months on the tablets. Kidney function and Fanconi syndrome improved after the tablets were stopped and the steroid prednisolone was given.
• Nationwide survey, 192 patients (Shinzawa 2025). A survey of Japanese kidney specialists found that 94.1 percent of patients had an estimated glomerular filtration rate below 60, the usual threshold for reduced kidney function. Blood and urine tests showed the pattern of Fanconi syndrome. Creatine kinase was not raised, which the authors read as showing the kidney damage was not caused by muscle breakdown. On biopsy, 50 percent showed tubulointerstitial nephritis and 32 percent tubular necrosis. The Fanconi-syndrome measures improved significantly after the tablets were stopped, but 87 percent still had an estimated glomerular filtration rate below 60 at the last check.
• Follow-up cohort, 190 adults (Doi 2026). Sixty-eight percent were women and the median age group was 50 to 59. Median estimated glomerular filtration rate at first presentation was 29.2. Kidney filtering improved quickly in the first 60 days and then levelled off below 60. Among people who started below 60, 33 percent had reached 60 or more by day 540. The salt and sugar losses of Fanconi syndrome resolved much faster, with at least 80 percent reaching target values by day 120. Six patients needed emergency dialysis, and one of them went on to permanent kidney replacement therapy.

What the contamination was

Puberulic acid, a compound that was not expected in the product, was detected in tablets linked to the poisoning. Scientists from Japan's National Institute of Health Sciences inspected the factory that made the red yeast rice and found a Penicillium mold, Penicillium adametzioides, in wipe samples. In the laboratory this mold grew on rice already covered with the red yeast rice mold, Monascus pilosus, and produced puberulic acid. The authors conclude that the mold lived in the factory and accidentally contaminated the red yeast rice culture, so that contaminated tablets were made and caused the outbreak (Yoshinari 2025).

A separate analysis found two previously unknown compounds, possibly related to lovastatin, in product samples linked to adverse-event reports. Both were found in every sample that also contained puberulic acid. The authors describe their route into the product as under investigation (Tanaka 2024). The nationwide study states that further research is needed to establish definitive cause and long-term outcomes (Shinzawa 2025).

Japanese kidney specialists who reported the cases describe the main lesson as the need for long-term kidney follow-up of affected people and for rigorous safety evaluation of dietary supplements (Shinzawa 2025; Doi 2026). A 2025 review of red yeast rice case reports published between 2020 and 2025 found that Fanconi syndrome and kidney dysfunction were the main adverse events, mostly reported from Japan (Shaleha 2025). The site's Renal Tubular Acidosis page explains the acid-handling side of tubule failure.

Interactions as Sources Describe Them

The National Center for Complementary and Integrative Health states that red yeast rice products can have the same types of drug interactions as statin drugs, and so may interfere with certain medicines or increase the chance of side effects.

A case report from Italy describes a 70-year-old woman taking several medicines, including the antidepressant sertraline and the statin rosuvastatin, who developed rhabdomyolysis after she started a dietary supplement containing monacolin K. Using a standard drug-interaction scoring scale, the authors judged the reaction possibly related to an interaction between the three. Her symptoms and blood tests returned to normal after all three were stopped (Russo 2016). In the Italian surveillance data, more than half of the people with a suspected reaction (28 of 52) were taking other medicines at the time (Mazzanti 2017).

Taking red yeast rice together with a prescribed statin means taking two statins at once. The Italian product survey also found small amounts of a second statin, simvastatin, in most of the supplements it tested (Righetti 2021). The National Center for Complementary and Integrative Health states that there are no studies on the safety of red yeast rice during pregnancy or breastfeeding.

What Is Not Known

• What a given product contains. Surveys in the United States and Europe found monacolin K ranging from none to amounts above the European daily limit, often different from the label (Gordon 2010; Cohen 2017; Righetti 2021; Vanhee 2024).
• A safe intake level. The European Food Safety Authority panel could not identify a dietary level of monacolins guaranteed to be safe, as reported by the National Center for Complementary and Integrative Health. Trial meta-analyses report good tolerability (Fogacci 2019; Trogkanis 2024), while report databases show muscle and liver signals (Mazzanti 2017; Raschi 2018).
• Long-term outcomes outside one extract and one country. The large outcome trial used one standardised extract in Chinese heart-attack survivors (Lu 2008). The authors of the 2022 meta-analysis call for longer, high-quality trials (Li 2022).
• Long-term kidney outcomes in Japan. Many affected people still had reduced kidney function more than a year later (Doi 2026). Whether puberulic acid alone, the newly found lovastatin-like compounds, or both explain the injuries is still being studied (Tanaka 2024; Shinzawa 2025).
• Whether the other compounds matter in people. The idea that other monacolins and plant compounds add to monacolin K's effect, or soften its effect on muscle, rests on laboratory and cell experiments (Rigillo 2025).
• The traditional uses. The uses for indigestion and diarrhea in Chinese folk medicine have not been tested in modern trials (Zhu 2019).

Key Research Papers

1. Zhu B, Qi F, Wu J, Yin G, Hua J, Zhang Q, et al. Red Yeast Rice: A Systematic Review of the Traditional Uses, Chemistry, Pharmacology, and Quality Control of an Important Chinese Folk Medicine. Front Pharmacol. 2019;10:1449. PubMed PMID: 31849687
2. Shaleha RR, Yuliana A, Amin S, Levita J, Sumiwi SA. Monascus purpureus Red Yeast Rice: A Review of the in vitro and in vivo Pharmacological Activities, Studies in Humans, and Case Reports. Clin Pharmacol. 2025;17:269-289. PubMed PMID: 40927271
3. Heber D, Yip I, Ashley JM, Elashoff DA, Elashoff RM, Go VL. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69(2):231-6. PubMed PMID: 9989685
4. Rigillo G, Baini G, Bruni R, Puja G, Miraldi E, Pani L, et al. Red Yeast Rice or Lovastatin? A Comparative Evaluation of Safety and Efficacy Through a Multifaceted Approach. Phytother Res. 2025;39(1):264-281. PubMed PMID: 39511729
5. Avula B, Cohen PA, Wang YH, Sagi S, Feng W, Wang M, et al. Chemical profiling and quantification of monacolins and citrinin in red yeast rice commercial raw materials and dietary supplements using liquid chromatography-accurate QToF mass spectrometry: Chemometrics application. J Pharm Biomed Anal. 2014;100:243-253. PubMed PMID: 25168220
6. Gordon RY, Cooperman T, Obermeyer W, Becker DJ. Marked variability of monacolin levels in commercial red yeast rice products: buyer beware! Arch Intern Med. 2010;170(19):1722-7. PubMed PMID: 20975018
7. Cohen PA, Avula B, Khan IA. Variability in strength of red yeast rice supplements purchased from mainstream retailers. Eur J Prev Cardiol. 2017;24(13):1431-1434. PubMed PMID: 28641460
8. Righetti L, Dall'Asta C, Bruni R. Risk Assessment of RYR Food Supplements: Perception vs. Reality. Front Nutr. 2021;8:792529. PubMed PMID: 34950692
9. Twarużek M, Ałtyn I, Kosicki R. Dietary Supplements Based on Red Yeast Rice-A Source of Citrinin? Toxins (Basel). 2021;13(7):497. PubMed PMID: 34357969
10. Vanhee C, Jacobs B, Canfyn M, Malysheva SV, Willocx M, Masquelier J, et al. Quality Control and Safety Assessment of Online-Purchased Food Supplements Containing Red Yeast Rice (RYR). Foods. 2024;13(12):1919. PubMed PMID: 38928859
11. Lu Z, Kou W, Du B, Wu Y, Zhao S, Brusco OA, 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;101(12):1689-93. PubMed PMID: 18549841
12. Sungthong B, Yoothaekool C, Promphamorn S, Phimarn W. Efficacy of red yeast rice extract on myocardial infarction patients with borderline hypercholesterolemia: A meta-analysis of randomized controlled trials. Sci Rep. 2020;10(1):2769. PubMed PMID: 32066811
13. Trogkanis E, Karalexi MA, Sergentanis TN, Kornarou E, Vassilakou T. Safety and Efficacy of the Consumption of the Nutraceutical "Red Yeast Rice Extract" for the Reduction of Hypercholesterolemia in Humans: A Systematic Review and Meta-Analysis. Nutrients. 2024;16(10):1453. PubMed PMID: 38794691
14. Rahmani P, Melekoglu E, Tavakoli S, Malekpour Alamdari N, Rohani P, Sohouli MH. Impact of red yeast rice supplementation on lipid profile: a systematic review and meta-analysis of randomized-controlled trials. Expert Rev Clin Pharmacol. 2023;16(1):73-81. PubMed PMID: 36259545
15. Li P, Wang Q, Chen K, Zou S, Shu S, Lu C, et al. Red Yeast Rice for Hyperlipidemia: A Meta-Analysis of 15 High-Quality Randomized Controlled Trials. Front Pharmacol. 2021;12:819482. PubMed PMID: 35111069
16. Fogacci F, Banach M, Mikhailidis DP, Bruckert E, Toth PP, Watts GF, et al. Safety of red yeast rice supplementation: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res. 2019;143:1-16. PubMed PMID: 30844537
17. Becker DJ, Gordon RY, Halbert SC, French B, Morris PB, Rader DJ. Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial. Ann Intern Med. 2009;150(12):830-9, W147-9. PubMed PMID: 19528562
18. Halbert SC, French B, Gordon RY, Farrar JT, Schmitz K, Morris PB, et al. Tolerability of red yeast rice (2,400 mg twice daily) versus pravastatin (20 mg twice daily) in patients with previous statin intolerance. Am J Cardiol. 2010;105(2):198-204. PubMed PMID: 20102918
19. Mazzanti G, Moro PA, Raschi E, Da Cas R, Menniti-Ippolito F. Adverse reactions to dietary supplements containing red yeast rice: assessment of cases from the Italian surveillance system. Br J Clin Pharmacol. 2017;83(4):894-908. PubMed PMID: 28093797
20. Raschi E, Girardi A, Poluzzi E, Forcesi E, Menniti-Ippolito F, Mazzanti G, et al. Adverse Events to Food Supplements Containing Red Yeast Rice: Comparative Analysis of FAERS and CAERS Reporting Systems. Drug Saf. 2018;41(8):745-752. PubMed PMID: 29582393
21. Russo R, Gallelli L, Cannataro R, Perri M, Calignano A, Citraro R, et al. When Nutraceuticals Reinforce Drugs Side Effects: A Case Report. Curr Drug Saf. 2016;11(3):264-6. PubMed PMID: 26830519
22. Uchiyama K, Otani M, Chigusa N, Sugita K, Matsuoka R, Hosoya K, et al. Acute Kidney Injury Associated With Red Yeast Rice (Beni-kōji) Supplement: A Report of Two Cases. Kidney Med. 2024;6(11):100908. PubMed PMID: 39507393
23. Chikasue A, Taguchi K, Iwatani R, Kimura K, Okuda S, Uesugi N, et al. Three Cases of Red Yeast Rice-Containing Supplement-Induced Acute Kidney Injury and Fanconi Syndrome. Am J Kidney Dis. 2025;85(4):522-526. PubMed PMID: 39424254
24. Shinzawa M, Matsui I, Doi Y, Matsumoto A, Takahashi A, Nangaku M, et al. A nationwide questionnaire study evaluated kidney injury associated with Beni-koji tablets in Japan. Kidney Int. 2025;107(3):530-540. PubMed PMID: 39708997
25. Doi Y, Shinzawa M, Matsui I, Nangaku M, Isaka Y; Collaborators. Clinical Course of Kidney Injury Associated With Specific Red Yeast Rice-Containing Supplements. Kidney Int Rep. 2026;11(12):107107. PubMed PMID: 42985088
26. Yoshinari T, Watanabe M, Aoki W, Tanaka S, Masumoto N, Ito M, et al. Mechanism of puberulic acid contamination in red yeast rice tablets that caused a serious food poisoning outbreak in Japan. Proc Jpn Acad Ser B Phys Biol Sci. 2025;101(5):302-316. PubMed PMID: 40159186
27. Tanaka S, Masumoto N, Makino T, Matsushima Y, Morikawa T, Ito M. Novel compounds isolated from health food products containing beni-koji (red yeast rice) with adverse event reports. J Nat Med. 2024;78(4):845-848. PubMed PMID: 38834898

PubMed Topic Searches

1. PubMed: red yeast rice meta-analysis cholesterol
2. PubMed: red yeast rice puberulic acid
3. PubMed: red yeast rice kidney injury Fanconi syndrome
4. PubMed: red yeast rice citrinin
5. PubMed: red yeast rice monacolin K content
6. PubMed: red yeast rice statin intolerance

Connections

• Medicines and Oils
• Berberine for Cholesterol and Cardiovascular Health
• Cholesterol Management
• Goldstein and Brown: The Low-Density Lipoprotein Receptor
• Niacin and Cholesterol Management
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• Mold and Mycotoxins
• Renal Tubular Acidosis

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