Can NAOMI Italian Citrus Bergamot (resveratrol and olive oil) be taken with durable red yeast rice (lovastatin)?

Taking NAOMI Italian Citrus Bergamot with Red Yeast Rice: Safety Considerations

Red yeast rice should not be taken with citrus bergamot supplements due to potential increased risk of myopathy and rhabdomyolysis from combined statin-like effects. 1, 2

Understanding the Components and Their Interactions

Red Yeast Rice

• Contains monacolin K, which is chemically identical to lovastatin, a prescription statin medication 3
• Acts as a 3-hydroxy-3-methylglutaryl-CoA reductase inhibitor (same mechanism as statins) 1
• FDA has reported that red yeast rice products may contain significant amounts of lovastatin despite regulatory attempts 1
• Associated with risk of myopathy and rhabdomyolysis similar to prescription statins 2

Citrus Bergamot and Resveratrol

• Resveratrol may have antiplatelet effects via inhibition of COX pathways or by inhibiting cellular calcium channels 1
• Bergamot contains polyphenols that may have lipid-lowering effects 4
• Guidelines recommend holding resveratrol for 2 weeks before surgical procedures due to potential bleeding risk 1

Safety Concerns with Combination Use

The primary concern with combining these supplements is the increased risk of:

1. Myopathy/Rhabdomyolysis:

   • Red yeast rice contains lovastatin, which is known to cause muscle-related side effects 1, 2
   • Combining multiple agents that affect lipid metabolism can increase risk of muscle damage 1
   • The American Heart Association warns about combining statins with other lipid-lowering agents 1

2. Unpredictable Potency and Interactions:

   • Red yeast rice products have large variability in monacolin K content 3
   • This makes predicting dose-related efficacy and side-effect risks practically impossible 3
   • No standardization exists for these supplements, creating uncertainty about actual dosages 5

3. Potential for Additive Effects:

   • Both products may have lipid-lowering effects through different mechanisms 4, 6
   • This could lead to unpredictable cumulative effects on cholesterol levels

Evidence-Based Recommendation

Based on the perioperative management guidelines and drug interaction data:

• Avoid combining red yeast rice with citrus bergamot/resveratrol supplements 1
• If cholesterol management is needed, consider using a single agent rather than combination therapy
• For patients requiring lipid management who cannot take statins, consult with a healthcare provider about monitored use of a single supplement 7

Alternative Approaches

If lipid management is needed:

• Consider using only one supplement (either red yeast rice OR bergamot) rather than combining them
• Red yeast rice alone has shown significant reductions in LDL and total cholesterol in multiple trials 8
• Bergamot with olive extract has also shown lipid-lowering effects as a standalone therapy 6

Important Monitoring if Combined Use is Pursued

If a patient insists on using both supplements despite recommendations:

• Monitor for muscle pain, tenderness, or weakness (early signs of myopathy) 2
• Consider periodic creatine kinase (CK) determinations 2
• Be aware of symptoms like unexplained muscle pain, especially if accompanied by malaise or fever 2
• Discontinue immediately if myopathy is suspected 2

Remember that these supplements are not FDA-regulated medications, and their quality, potency, and safety profiles vary considerably between manufacturers and batches.