NAPLEX Question of the Week: Herbal Remedies

Herbal remedies should be treated like medications with many drug interactions present. Today's question focuses on recognizing camouflaged herbal products.

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A 59 year old female presents to her community pharmacy to receive her COVID-19 vaccination. Her PMH is significant for hypertension, hyperlipidemia, and GERD for which she takes rabeprazole 20mg daily, fosinopril 20mg daily, chlorthalidone 25mg daily, and atorvastatin 80mg daily. After receiving her vaccine, she asks her pharmacist their opinion regarding red yeast rice. She recently ordered some online after speaking with her neighbor which encouraged her to take for "general health".  Which of the following may interact significantly with red yeast rice?

A. Rabeprazole

B. Fosinopril

C. Atorvastatin

D. Chlorthalidone

Answer with rationale:

The correct answer is C. Red yeast rice is a dietary staple in Asia and is often used in traditional Chinese medicine. Some red yeast rice can contain various compounds including monacolin K, a chemical that is identical to lovastatin (Mevacor). Therefore taking red yeast rice with our patient's atorastatin would essentially be duplicate statin therapy and result in increased risk of musculoskeletal toxicity with a worst case scenario of rhabdomyolysis. The other medications would not be expected to interact with the red yeast rice however it is important to remember that herbal remedies often do not undergo scrutiny and evaluation similar to OTC and prescription medicines.

Can you believe we are almost in April? Have you developed a plan yet? Time to get rolling!


Dr. B 

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.