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.
NAPLEX Question of the Week: Herbal Remedies
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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!

Sincerely,

Dr. B 

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