myopathy
22 interactions related to myopathy
niacin + red yeast rice
Red yeast rice contains monacolin K, which is chemically identical to the statin lovastatin, so it behaves as a low-dose statin. Lipid-modifying amounts of niacin can independently injure skeletal muscle, and combining a lovastatin-class agent with such niacin can add to the risk of muscle pain or damage (including, rarely, rhabdomyolysis). Because red yeast rice acts as a variable-strength statin, the same additive muscle-toxicity concern applies when it is taken alongside high-dose niacin.
seville orange + red yeast rice
Seville orange contains furanocoumarins that inhibit intestinal CYP3A4, the enzyme that clears the monacolin K in red yeast rice. Because monacolin K is chemically identical to the statin lovastatin and depends on CYP3A4 for its first-pass breakdown, blocking that enzyme raises systemic exposure to the active statin, increasing the risk of muscle-related side effects such as myopathy and, rarely, rhabdomyolysis.
rosuvastatin + red yeast rice
Red yeast rice contains monacolin K, a compound chemically identical to a statin, so taking it alongside rosuvastatin stacks a second statin-like HMG-CoA reductase inhibitor on top of the prescription statin. Because rosuvastatin is not broken down by the CYP3A4 enzyme, there is no enzyme-based (pharmacokinetic) interaction; the concern is purely additive statin-class exposure. This modestly raises the combined potential for statin-type muscle injury (myopathy, and rarely rhabdomyolysis) and liver injury beyond either agent alone. The added statin burden is usually small because red yeast rice's monacolin content is typically low, highly variable, and not shown on the label, but unregulated high-monacolin products can carry a more meaningful statin-like load.
pomelo + red yeast rice
Pomelo, like grapefruit, contains furanocoumarins that inhibit the intestinal CYP3A4 enzyme. Red yeast rice's active constituent, monacolin K, is chemically identical to the statin lovastatin, which depends on CYP3A4 for its breakdown. When pomelo blocks that enzyme, more of the monacolin K reaches the bloodstream, amplifying the dose-dependent statin-type risks of muscle injury and, rarely, liver enzyme elevation. Because furanocoumarin inhibition can persist for days, the effect is not reliably avoided by taking the two at different times of day.
clarithromycin + red yeast rice
Clarithromycin is a strong CYP3A4 inhibitor. Red yeast rice's active compound, monacolin K, is chemically identical to the statin lovastatin and is cleared mainly by CYP3A4. Combining them slows clearance of the statin-like compound and raises its blood levels, increasing the risk of muscle injury and, rarely, rhabdomyolysis.
lovastatin + red yeast rice
Red yeast rice contains monacolin K, which is chemically identical to the statin lovastatin. Taking red yeast rice together with prescription lovastatin means taking the same statin twice, adding to HMG-CoA reductase inhibition and raising the risk of muscle injury (including rhabdomyolysis) and liver harm. Because the amount of monacolin K in red yeast rice is variable and usually not stated on the label, the added statin exposure is unpredictable and stacks on top of an already-active prescription dose.
pravastatin + red yeast rice
Red yeast rice contains monacolin K, a compound chemically identical to the statin lovastatin. Taking it alongside pravastatin means two HMG-CoA reductase inhibitors are active at the same time, so their cholesterol-lowering statin effect and their potential for muscle injury (muscle pain, and rarely rhabdomyolysis) add together. Because pravastatin is water-soluble and is not broken down by the CYP3A4 enzyme, this is not a metabolic (drug-processing) interaction — it is simply the additive effect of stacking two statin-type ingredients, made harder to gauge by red yeast rice's variable, unlabeled monacolin content.
gemfibrozil + red yeast rice
Red yeast rice supplies monacolin K, a compound chemically identical to the statin lovastatin. Combining it with gemfibrozil, a fibrate, can add up to serious muscle injury. The fibrate is itself toxic to muscle and also raises circulating statin levels by interfering with how the statin is cleared, so the two effects stack toward myopathy and, in the worst case, rhabdomyolysis with kidney injury.
grapefruit + red yeast rice
Grapefruit inhibits intestinal CYP3A4, the enzyme that clears red yeast rice's active constituent monacolin K (the same molecule as the statin lovastatin). Blocking this enzyme lets more monacolin K reach the bloodstream, raising its cholesterol-enzyme-blocking activity and the associated risk of muscle-related side effects. This is a food-drug interaction driven by the grapefruit inhibitor, and because some unregulated red yeast rice products carry near-prescription statin content, the risk can be meaningful.
simvastatin + coq10
Simvastatin blocks HMG-CoA reductase, the enzyme upstream of both cholesterol and coenzyme Q10 (CoQ10) synthesis, so it lowers circulating CoQ10 alongside cholesterol. This depletion is a plausible contributor to statin-associated muscle symptoms, and some randomized trials suggest CoQ10 supplements modestly ease those symptoms — though the evidence is mixed.
simvastatin + red yeast rice
Red yeast rice contains monacolin K, which is chemically identical to the prescription statin lovastatin. Adding it to simvastatin stacks two statins with the same mechanism and metabolism, adding to the risk of muscle injury, rhabdomyolysis, and liver problems.
atorvastatin + niacin
Adding cholesterol-dose niacin to atorvastatin raises the risk of muscle injury (myopathy, rarely rhabdomyolysis) without improving cardiovascular outcomes in patients already well treated with a statin.
rosuvastatin + coq10
Rosuvastatin blocks HMG-CoA reductase, the enzyme that makes both cholesterol and coenzyme Q10, so it modestly lowers circulating CoQ10. The depletion is generally smaller than with fat-soluble statins, and mitochondrial impairment is only one proposed mechanism for statin-associated muscle symptoms. This is a possible-benefit pairing, not a dangerous one.
rosuvastatin + berberine
Rosuvastatin is carried into liver cells by the OATP1B1 transporter. In a laboratory study using human liver-cell cultures, berberine increased OATP1B1 activity and pushed more rosuvastatin into the cells. This is an early, test-tube signal only: there is no human or animal data showing it changes blood levels, cholesterol response, or side-effect risk in real life.
lovastatin + grapefruit
Grapefruit blocks the intestinal enzyme CYP3A4 that normally limits how much lovastatin reaches your bloodstream. With that enzyme suppressed, lovastatin levels can rise sharply, raising the risk of muscle injury and, rarely, rhabdomyolysis. Spacing the timing does not help because the effect lasts for days.
atorvastatin + coq10
Atorvastatin inhibits HMG-CoA reductase, the upstream enzyme also needed to make coenzyme Q10 (ubiquinone), so statin therapy lowers blood CoQ10 levels. Mitochondrial CoQ10 depletion is one proposed mechanism for statin-associated muscle symptoms, but evidence that taking CoQ10 reverses those symptoms is modest and mixed. This is a supplement-may-help question, not a harmful interaction.
simvastatin + berberine
Simvastatin is activated and cleared by the CYP3A4 enzyme. A human study found that repeated berberine inhibits CYP3A4, which could raise simvastatin levels and increase the risk of muscle-related side effects. Some animal data suggest berberine can also induce CYP3A4 over time, so the net effect on statin exposure is hard to predict. There are no published human case reports of myopathy from this specific combination, so the concern is mechanistic and moderate.
atorvastatin + red yeast rice
Red yeast rice naturally contains monacolin K, the same compound as the prescription statin lovastatin. Taking it alongside atorvastatin effectively stacks two statins working through the same liver pathway, raising the risk of statin-associated muscle symptoms, rhabdomyolysis, and liver injury.
seville orange + atorvastatin
Seville (bitter) orange contains the same furanocoumarins as grapefruit, including bergamottin and 6',7'-dihydroxybergamottin, which inactivate intestinal CYP3A4. A randomized crossover study showed Seville orange juice raised levels of the CYP3A4 drug felodipine to a degree comparable with grapefruit juice, while ordinary sweet orange juice had no effect. Because atorvastatin is metabolised by the same CYP3A4 pathway, Seville orange can raise atorvastatin levels and increase the risk of statin-related muscle injury.
cbd + simvastatin
Simvastatin is cleared mainly by the liver enzyme CYP3A4, and CBD inhibits that same enzyme. Combining them is expected to raise simvastatin exposure, which could increase the risk of muscle pain and, rarely, more serious muscle injury. This is a predicted, mechanism-based interaction rather than one confirmed by a direct human study.
pomelo + simvastatin
Pomelo (Citrus maxima) contains furanocoumarins that inhibit intestinal CYP3A4, the enzyme that breaks down simvastatin during first-pass absorption. With that enzyme suppressed, more simvastatin reaches the bloodstream, raising the risk of muscle-related side effects. This is the same mechanism behind the well-established grapefruit-simvastatin interaction, since pomelo is the parent species of grapefruit and shares its furanocoumarins.
atorvastatin + berberine
In human trials, adding berberine to a statin did not raise muscle or liver side effects, and the two are sometimes studied together for cholesterol. The earlier claim that berberine meaningfully raises atorvastatin levels and risk is not supported by human evidence.