title: Rhabdomyolysis due to red yeast rice (Monascus purpureus) in a renal transplant recipient.
abstract: Rhabdomyolysis is a known complication of hepatic 3-methylglutaryl coenzyme A reductase (HMG-CoA) inhibitor (statin) therapy for posttransplant hyperlipidemia, and thus monitoring for this effect is indicated. We report a case of an herbal preparation-induced rhabdomyolysis in a stable renal-transplant recipient, attributed to the presence of red yeast rice (Monascus purpureus) within the mixture. The condition resolved when consumption of the product ceased. Rice fermented with red yeast contains several types of mevinic acids, including monacolin K, which is identical to lovastatin. We postulate that the interaction of cyclosporine and these compounds through the cytochrome P450 system resulted in the adverse effect seen in this patient. Transplant recipients must be cautioned against using herbal preparations to lower their lipid levels to prevent such complications from occurring.
authors.affiliation: Division of Nephrology, Department of Medicine, St. Michael's Hospital, University of Toronto, 61 Queen Street East, 9th Floor, Toronto, Ontario M5C 2T2 Canada. prasadr@smh.toronto.on.ca
authors.forename: G V Ramesh
authors.initials: GV
authors.lastname: Prasad
authors.forename: Timothy
authors.initials: T
authors.lastname: Wong
authors.forename: Galo
authors.initials: G
authors.lastname: Meliton
authors.forename: Salma
authors.initials: S
authors.lastname: Bhaloo
mesh_terms: D000328:Adult; D001688:Biological Products / Q000009:adverse effects*; D016572:Cyclosporine / Q000008:administration & dosage; D003577:Cytochrome P-450 Enzyme System / Q000378:metabolism; D019587:Dietary Supplements / Q000009:adverse effects*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000188:drug therapy; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation; D008517:Phytotherapy / Q000009:adverse effects; D012206:Rhabdomyolysis / Q000139:chemically induced*
chemical_list: D001688:Biological Products; D007166:Immunosuppressive Agents; C117343:red yeast rice; D016572:Cyclosporine; D003577:Cytochrome P-450 Enzyme System