Symptomatic Myopathy due to Red Yeast Rice

Background: Red yeast rice is a dietary supplement that contains 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors and is used for self-treatment of hyperlipidemia.

Objective: To report a case of symptomatic myopathy associated with use of red yeast rice.

Case Report: In January 2005, a 61-year-old woman presented for a general health assessment. She reported a history of hyperlipidemia but had no symptoms at rest or with activities. Her medications included an estradiol transdermal patch (0.05 mg/wk), aspirin (81 mg/d), and a multivitamin (once daily). Her vital signs were normal, weight was 70.9 kg, and body mass index was 29.2 kg/m². Results of thyroid, chest, heart, abdomen, vascular, musculoskeletal, and neurologic examinations were normal. Laboratory studies showed hyperlipidemia (Table), for which the hepatic HMG-CoA reductase inhibitor simvastatin (20 mg/d) …