Inspired by the @CPSolvers #RLR episode released earlier this week, I wanted to share a bit about myopathy associated with statins and with red yeast rice.
Functioning as hmg-coa reductase inhibitors, statins are effective in reducing serum cholesterol levels but are proposed to be associated with myalgias and myopathies by various mechanisms as a direct result of decreased synthesis of mevalonate pubmed.ncbi.nlm.nih.gov/22001973/
Including--reduction in membrane fluidity due to decreased synthesis of membrane cholesterols, impaired mitochondrial function due to decreased synthesis of coenzyme Q, 
And impaired calcium homeostasis due to disinhibition of L-type calcium channels in the sarcoplasmic reticulum, leading to increased contractility and induction of apoptosis nature.com/articles/nrm11…
Per nccih.nih.gov/health/red-yea…, the active ingredient in red yeast rice is monacolin K, identical to the active ingredient in lovastatin, so red yeast rice may lead to myalgias and myopathy by many of the same mechanisms as statins
Including anti-hmg-coa reductase-associated autoimmune myopathy ncbi.nlm.nih.gov/pmc/articles/P…
However, not all red yeast rice supplements are created equal. Their concentrations of monacolin K can be highly variable, and they may contain other toxic compounds including citrinin, ncbi.nlm.nih.gov/pmc/articles/P…
And monacolin K is metabolized by CYP3A4, so co-ingestion of amiodarone, cyclosporine, erythromycin, fluoxetine, isoniazid, grapefruit, and many HIV medications may perpetuate its effects nature.com/articles/srep0…
@rabihmgeha @DxRxEdu @RosenelliEM @TheRealDSrini @medrants @UnremarkableLab @AnnKumfer @k_vaishnani @Gurleen_Kaur96
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