M. purpureus is a natural source of the drug lovastatin, used in the treatment of hyperlipidemia. The compound is usually referred to as "monacolin K" or "mevinolin" when discussing red yeast rice or other natural sources. Red yeast rice may have a role in managing dyslipidemia, especially when statin intolerance has resulted in poor concordance with pharmaceutical interventions. Traditional red yeast rice often contains very low levels of monacolin K, while more modern preparations may contain levels approaching prescription dosage levels; neither should be used without clinical oversight. Studies have been conducted to evaluate its antibacterial, antioxidant, and CNS effects, as well as its activity on glycemic metabolism, but quality clinical trials are lacking to recommend use for these indications.
Red yeast rice is available commercially, primarily in 600 mg capsules. Clinical trials evaluating the safety and efficacy of red yeast rice compared to statins or placebo for improvement of lipid profiles reported dosages of 1,200 to 3,600 mg/day for durations of 4 to 12 weeks.
Commercial red yeast rice products are often combination products containing other nutraceutical ingredients, and reports of adulteration with prescription lovastatin exist.
Use is contraindicated in individuals with hypersensitivity to any component of red yeast rice. Anaphylactic reactions in certain populations are documented. Red yeast rice may exacerbate statin-induced myopathy.
Avoid use during pregnancy and lactation. One ingredient in red yeast rice is monacolin K, also known as mevinolin or lovastatin; based on theoretical considerations and small case studies, statins are potential teratogens. CNS and limb defects have been reported in newborns exposed to statins in utero.
Limited evidence suggests that red yeast rice products may not affect the pharmacokinetic profile of concomitant medications despite the potential for interference with CYP-450 enzymes and P-gp. Caution is warranted, particularly with medications with a narrow therapeutic index. See Interactions section for more information.
Serious adverse reactions are rare. Commonly reported adverse reactions include dizziness, decreased appetite, nausea, stomachache, abdominal distension, and diarrhea. Reviews and meta-analyses report no differences between red yeast rice products and comparators for liver injury, kidney injury, or myopathy.
The nephrotoxic mycotoxin citrinin has been isolated from some strains of M. purpureus and Monascus ruber. No severe toxicities at high doses have been reported.
The US Food and Drug Administration (FDA) issued a warning to consumers and health care providers concerning some red yeast rice products. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm153116.htm. (Accessed May 21, 2014.) Information obtained from the FDA under the Freedom of Information Act suggests that red yeast rice products are not carefully regulated by the FDA. Patient safety issues include presence of undeclared drugs and potentially toxic substances in products being sold as dietary supplements.Childress 2013
Red yeast rice is made by cultivating and fermenting the fungal strain M. purpureus Went. (red mold species) on starch-containing substrates, such as white or sterile rice, for up to a week at room temperature.Erdoğrul 2004, Hong 2008, Ma 2000, Su 2007 The rice grains are red at the core and reddish purple on the outside; the cooked grain may be used as a paste or dried and powdered.Ma 2000 Total monacolin K content of dietary supplements is variable, while traditional red yeast rice usually contains very low amounts.FDA 2014
Red yeast rice has been used in traditional Chinese medicine to strengthen the spleen, promote or improve digestion, eliminate dampness and phlegm, promote or improve blood circulation, and remove blood stasis. During the Ming Dynasty, red yeast rice was described as "sweet in flavor and warm in property."Huang 2008, Ma 2000 The genus Monascus has been used for centuries in Asia as a source of pigment for coloring traditional foods, such as Peking duck. The medicinal properties of red yeast rice are valued throughout Asia, and the species is also used to make rice wine and as a food preservative for maintaining the color and taste of fish and meat.Huang 2008 Commercial food applications include coloration of sausage, hams, surimi, and tomato ketchup. One study documents the registration of numerous patents obtaining the use of Monascus as a food pigment in Japan, the United States, France, and Germany.Silveira 2008 Additionally, Monascus-fermented rice has been used to enhance the flavor of food in Asian countries.Shi 2012
Red yeast rice forms naturally occurring hydroxymethylglutaryl-CoA reductase (HMG-CoA) inhibitors,Li 2005 a family of natural substances known as monacolins. The major ingredient in red yeast rice is monacolin K, also known as mevinolin or lovastatin. Monacolin K is found in some commercial red yeast–related products. Using high-performance liquid chromatography with photodiode array detection, one chemical study documented a total of 14 monacolin compounds, including monacolin K, J, L, M, and X with their corresponding hydroxyl acid forms, as well as dihydromonacolin K, dihydromonacolin L, compactin, and 3-hydroxy-3,5-dihydromonacolin L. Starch is the most abundant ingredient, accounting for 73% of the bulk, while crude protein accounts for 15%. Trace elements, magnesium and sodium, are the most abundant metal elements. The total monacolin content is usually 0.4% w/w rice.Ma 2000 Red yeast rice also contains sterols, such as beta-sitosterol and campesterol, that may block cholesterol absorption in the intestines, and absorption is also decreased via enhanced bile acid excretion.Ma 2009 Unsaturated fatty acids (eg, oleic, linoleic, linolenic acids) and B complex vitamins (eg, niacin) have been isolated and may further help to reduce cholesterol.Hsieh 2003
Monascus produces several secondary metabolites, such as pigments, monacolins, gamma-aminobutyric acid (GABA), and dimerumic acid.Huang 2008, Knecht 2006, Li 2005, Ma 2000, Silveira 2008 A total of 8 pigments called azaphilones are produced by Monascus and include yellow (monascin, ankaflavin, yellow II, and xanthomonascin A), orange (monascorubrin and rubropunctatin), and reddish purple (monascorubramine and rubropunctamine), each of which may have biological activity.Hamano 2005, Kim 2006, Silveira 2008, Su 2007 Commercial utilization of agro-industrial residues for pigment and enzyme production from M. purpureus has been documented.Daroit 2007, Silveira 2008 The natural pigment of Monascus also improves the organoleptic characteristics of various cheeses.Baranová 2004
Monascidin A, another constituent of Monascus, has been characterized as citrinin by qualitative methods, mass spectra, and nuclear magnetic resonance.Blanc 1995 Citrinin is a myotoxin that is especially toxic to liver and kidney tissues, and is suspected of being a renal carcinogen leading to renal tumors.Lee 2007 Monacolin K and citrinin are both polyketide derivatives. Chemical methods are available to remove citrinin and retain monacolin K in red yeast rice.Lee 2007
Studies using combinations of red yeast rice with coenzyme Q10 and other substances (including polyunsaturated fatty acids, phytosterols, curcumin, berberine, folic acid, artichoke, Lactobacillus casei, and resveratrol) largely report results in favor of the nutraceuticals. However, such studies are inconsistent regarding the combinations used, and effects cannot be attributed to an individual ingredient. These studies are excluded from this analysis.
Adulteration of commercial red yeast rice products with pharmaceutical lovastatin has been reported.(Song 2019) Traditional red yeast rice may not contain more than trace amounts of the active compound monacolin K, while modern products may be produced by methods that concentrate the naturally occurring monacolin K.(FDA 2014) Most studies do not undertake, or report on, chemical analysis of the red yeast rice product or test substance used.
The antibacterial activity of Monascus derivatives depends on the hydrophobicity of pigment derivatives and on the amount of pigment absorbed to the cell surface.(Kim 2006)
Antibacterial activity has been demonstrated against gram-positive and gram-negative species.(Hsieh 2003, Kim 2006, Wong 1977) Orange Monascus pigments have been reported to have weak antibacterial activity, while the red pigment has little to no activity.(Kim 2006) Orange pigments showed antimicrobial activities against Bacillus subtilis, Escherichia coli, some filamentous fungi, and yeasts.(Kim 2006) Monascidin A inhibited bacteria from the genera Bacillus, Streptococcus, and Pseudomonas. Two yellow pigments had bacteriostatic activity against B. subtilis and inhibitory activity against Staphylococcus aureus.(Hsieh 2003)
Orange pigment derivatives of Monascus have exerted in vitro activity against hepatitis C.(Sun 2012)
In an in vitro study, polysaccharides derived from red mold rice and red mold dioscorea fermented with M. purpureus exhibited antioxidant activities such as scavenging of radicals, chelating, and inhibiting linoleic acid peroxidation. Additionally, these polysaccharides possessed immunomodulatory effects such as enhanced cell proliferation, phagocytosis, and production of cytokines and nitric oxide.(Tseng 2012)
Monascus daily supplementation given to rats decreased cigarette smoke–induced lung injuries by reducing oxidative stress and maintaining antioxidant mechanisms.(Li 2013) A murine study of alcoholic liver disease found that treatment with Monascus-fermented red mold rice attenuated elevations in liver function tests (AST/ALT), exerted antioxidant effects, and reduced cytokine levels.(Cheng 2011)
Statins may reduce the risk of bone fractures and increase bone formation and bone mass.
Red yeast rice stimulated bone formation in in vitro and in vivo studies in rats.(Gutierrez 2006)
In human cancer cell lines, red yeast rice inhibited proliferation and stimulated apoptosis, possibly via activity of caspases or polymerase cleavage.(Hong 2008, Hsu 2012, Lee 2013, Li 2005, Silveira 2008, Zheng 2010) In vitro studies found monacolin K inhibited cell proliferation through multiple protein expressions (a total of 20 proteins), including peroxiredoxins, cytoskeleton proteins, chaperone proteins, and energy-producing enzymes. Monacolin K may also alter the expression of some redox-related enzymes.(Lin 2006, Lin 2007) Three active components of Monascus-fermented red yeast rice (monacolin K, monascorubrin, and ankaflavin) have documented antiproliferative effects against tumor cells.(Lin 2007)
Studies in rodents have reported reductions in the number of tumors, mean tumor volume, and tumor burden.(Hong 2008, Hong 2011, Hsu 2012, Yasukawa 1994, Yasukawa 1996) However, it should be noted that red yeast rice may contain the toxic, carcinogenic, and mutagenic compound citrinin, which is a secondary metabolite of the fermentation process.(Song 2019, Steffen 2017)
The effect of red yeast rice on cardiovascular outcomes was assessed in a meta-analysis that included 7 randomized, controlled trials (N=10,699) conducted in China in patients with borderline dyslipidemia. Red yeast rice was administered as adjunctive treatment at a dose of 1,200 mg/day in all studies for a duration ranging from 4 weeks to 4.5 years. Most of the studies were of high quality. Although no significant difference was found between groups in the risk of fatal myocardial infarction (MI), statistically significant reductions were observed for red yeast rice in nonfatal MI (relative risk [RR]=0.42; 95% CI, 0.34 to 0.52; P<0.00001), revascularization (RR=0.58; 95% CI, 0.48 to 0.71; P<0.00001), and sudden death (RR=0.71; 95% CI. 0.53 to 0.94; P=0.02) compared to controls with little to no heterogeneity among studies. Red yeast rice was well tolerated with no serious adverse effects.(Sungthong 2020)
Red mold rice and its metabolites may be beneficial in Alzheimer disease by inhibiting amyloid beta–induced neurocytotoxicity, amyloid beta deposition in the brain, and amyloid beta synthesis, as well as by promoting the neuroprotective factor, soluble amyloid precursor protein alpha.(Lee 2011)
An open-label pilot study in schizophrenic adults stabilized on antipsychotics (N=35) assessed the effect of red yeast rice (200 mg/day for 12 weeks) on cognitive function. Of the 8 total cognitive measures, 3 improved with supplementation of red yeast rice, with no adverse effects reported.(Bruno 2019)
Based on limited animal studies, a postulated mechanism of action for red yeast rice involves the release of acetylcholine from nerve terminals, which in turn stimulates muscarinic receptors in pancreatic cells, increasing insulin release and resulting in lower plasma glucose.(Chen 2006) Additionally, monascin has been found to act as a peroxisome proliferator–activated receptor–gamma agonist to improve insulin sensitivity.(Chang 2006, Shi 2012) Red mold dioscorea improved glycemic control, exerted antioxidant and anti-inflammatory effects, and protected beta cells in the pancreas of streptozotocin-induced diabetic rats.(Shi 2011)
In the late 1970s, it was discovered in vitro that Monascus metabolites inhibit HMG-CoA reductase, the rate-limiting step in cholesterol biosynthesis.(Endo 1979) Animal studies report reductions in serum cholesterol levels, suppression of aortic atherosclerotic plaque formation, and reduced lipid accumulation in animal livers, similar to effects of pharmaceutical statins.(Gurr 1997, Xie 2012, Zhu 1995) Animal studies evaluating effects in hyperlipidemia have now largely been surpassed by clinical studies.
A role for red yeast rice preparations in statin intolerance has been suggested, based on observed lipid-lowering efficacy, potential effect on endothelial dysfunction arterial stiffness, and low levels of reported adverse effects.(Banach 2018, Burke 2015)
The 2018 American College of Cardiology/American Heart Association guideline on the management of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults does not mention red yeast rice.(Grundy 2019)
The 2017 joint position statement of the Italian Society of Diabetology and the Italian Society for the Study of Arteriosclerosis on nutraceuticals for the treatment of hypercholesterolemia states use of red yeast rice can be advised to reduce low-density lipoprotein (LDL) and other cardiovascular risk factors in patients with mild to moderate hypercholesterolemia and low to moderate cardiovascular risk.(Pirro 2017)
A meta-analysis of 20 studies published up to 2014 (N=6,663) compared red yeast rice (1,200 to 4,800 mg/day for varying durations [at least 4 weeks]) with placebo or active control to determine the safety and efficacy of using red yeast rice as an alternative to statins to improve lipid profile (ie, LDL). Only studies in which monacolin K content was known were included, and combination preparations were excluded. Results showed decreases in LDL (−1.02 mmol/L [95% CI, −1.2 to −0.83]), total cholesterol (−1 mmol/L [95% CI, −1.23 to −0.77]), and triglycerides (−0.26 mmol/L [95% CI, −0.35 to −0.17]). High-density lipoprotein (HDL) increased by 0.07 mmol/L (95% CI, 0.03 to 0.11).(Gerards 2015)
A meta-analysis of 10 studies (published up to May 2015) compared single-preparation red yeast rice with simvastatin in Chinese subjects with dyslipidemia (N=905). Results suggest similar lipid-lowering effects with no difference found between groups regarding changes in triglycerides, total cholesterol, or LDL or HDL cholesterol; total daily red yeast rice dosage ranged from 1,200 to 3,600 mg (duration of 4 to 12 weeks).(Ong 2016) Another meta-analysis of clinical trials investigating cardiovascular outcomes conducted in patients with borderline dyslipidemia also reported significant improvements with red yeast rice in all lipid parameters as a secondary outcome (P<0.00001 for each). LDL (weighted mean difference [WMD], −20.7 mg/dL), total cholesterol (WMD, −26.61 mg/dL), triglycerides (WMD, −24.69 mg/dL), and HDL (+2.71 mg/dL).(Sungthong 2020) Red yeast rice has also been reported to induce significantly less muscle fatigue than simvastatin (P<0.01) in dyslipidemic patients with low to moderate CV risk in a single-blind, randomized, controlled trial (N=60). Physical activity levels were also better in the red yeast rice group (P<0.001).(Xue 2017)
Reviews of the literature on red yeast rice use in dyslipidemia have been published.(Burke 2015, Dujovne 2017, Peng 2017) Further clinical studies continue to be conducted and reported,(Minamizuka 2021, Wang 2019) with varying comparators and methodological limitations. An English-language abstract reports on a large Chinese clinical study (N=4,870) achieving relative risk reduction of 45% in nonfatal myocardial infarctions and death from coronary artery disease with supplemental red yeast rice over 4 years. Secondary outcome measures were similarly reported to exhibit large treatment effects.(Lu 2005)
An aqueous extract of M. purpureus prevented and reversed fructose-induced hypertension in rats and did not affect blood pressure levels in normotensive rats fed a regular diet. This effect is believed to be associated with the GABA content of M. purpureus.(Hsieh 2003) In another study of hypertensive rats, a single dose of red mold dioscorea 150 mg/kg reduced systolic and diastolic blood pressure values 8 hours after administration. This effect was not noted with red mold rice administration. Higher amounts of GABA, yellow pigments, and higher angiotensin I−converting enzyme activity were noted with red mold dioscorea compared with red mold rice.(Wu 2009)
A meta-analysis of 21 clinical studies (N=4,558 hypertensive participants) conducted up to April 2014 found no effect of red yeast rice supplementation on systolic or diastolic blood pressure.(Patel 2016, Xiong 2017)
In a murine study, Monascus cursory extraction suppressed baldness in male mice, decreased prostate-specific antigen levels, reduced tumor volume and tumor incidence in testosterone-induced prostate cancer, and decreased dihydrotestosterone but not testosterone levels. Further studies are warranted to determine the role of Monascus in alopecia, benign prostatic hyperplasia, and prostate cancer.(Chiu 2013)
Red yeast rice is available commercially, primarily in 600 mg capsules. Most manufacturers suggest an oral dosage of 2 capsules twice a day, for a total dose of 2,400 mg/day. Clinical trials evaluating the safety and efficacy of red yeast rice compared to statins or placebo for improvement of lipid profiles reported dosages of 1,200 to 3,600 mg/day for durations of 4 to 12 weeks.Gerards 2015, Heber 1999, Keithley 2002, Ong 2016 These products have contained variable, or unknown, amounts of monacolin K.
Traditional red yeast rice preparations often contain only trace amounts of monacolin K, while modern preparations many contain widely varying amounts.FDA 2014 Commercial over-the-counter (OTC) products are often combination products containing other nutraceutical ingredients, and reports of adulteration of red yeast rice products with prescription lovastatin exist.Song 2019 A lack of regulation over the manufacture of red yeast rice products has reportedly resulted in a lack of quality control and wide variability in active ingredients.Burke 2015, Dujovne 2017, Gordon 2010, Peng 2017
Avoid use during pregnancy and lactation. The major ingredient in red yeast rice is monacolin K, also known as mevinolin or lovastatin; based on theoretical considerations and small case studies, statins have been identified as potential teratogens.Kazmin 2007 CNS and limb defects have been reported in newborns exposed to statins in utero.Statins 2006
The clinical importance of the following interactions has not been determined, but caution is warranted. Many potential interactions are theoretical; due to limited information, most proposed drug–red yeast rice product interactions are inferred from known drug-statin interactions despite the fact that red yeast rice is not only a lovastatin-containing product. Limited evidence suggests that red yeast rice products may not affect the pharmacokinetic profile of concomitant medications despite the potential for interference with CYP-450 enzymes and P-gp.(Chen 2012)
Acipimox: May enhance the myopathic (rhabdomyolysis) effect of HMG-CoA reductase inhibitors. Monitor therapy.(Olbetam March 2014)
Asunaprevir: May increase the serum concentration of HMG-CoA reductase inhibitors. Monitor therapy.(Sunvepra March 2016)
Bosentan: May increase the metabolism of HMG-CoA reductase inhibitors. Monitor therapy.(Dingemanse 2003, Tracleer 1999)
Dronedarone: Dronedarone may increase the serum concentration of red yeast rice. In particular, concentrations of the lovastatin-like components may be increased. Consider therapy modification.(Altoprev February 2018, Mevacor February 2014, Multaq March 2014)
Elbasvir and grazoprevir: Elbasvir and grazoprevir may increase the serum concentration of red yeast rice. Monitor therapy.(Caro 2021, Zepatier December 2019)
Etravirine: May decrease the serum concentration of HMG-CoA reductase inhibitors. This applies to atorvastatin, lovastatin, and simvastatin. Monitor therapy.(Intelence July 2019)
Exenatide: Exenatide may decrease the serum concentration of red yeast rice. No action needed.(Byetta October 2011, Kothare 2007)
Fosphenytoin-phenytoin: May decrease the serum concentration of HMG-CoA reductase inhibitors. Consider therapy modification.(Cooper 2003, Murphy 1999)
Glecaprevir and pibrentasvir: Glecaprevir and pibrentasvir may increase the serum concentration of red yeast rice. Avoid combination.(Mavyret August 2017)
Lanthanum: HMG-CoA reductase inhibitors may decrease the serum concentration of lanthanum. Consider therapy modification.(Fosrenol April 2011, Martin 2008, Yang 1996)
Letermovir: May increase the serum concentration of HMG-CoA reductase inhibitors. Monitor therapy.(Prevymis August 2019)
Lomitapide: Lomitapide may increase the serum concentration of red yeast rice. Consider therapy modification.(Juxtapid July 2017, Tuteja 2014)
Pazopanib: HMG-CoA reductase inhibitors may enhance the hepatotoxic effect of pazopanib. Specifically, the risk for increased serum transaminase concentrations may be increased. Monitor therapy.(Votrient March 2012)
Ranolazine: Ranolazine may increase the serum concentration of red yeast rice. Ranolazine may also enhance the distribution of lovastatin, a component of red yeast rice, to specific cells/tissues/organs where P-glycoprotein is present in large amounts (eg, brain, T-lymphocytes, testes, etc.). Consider therapy modification.(Altoprev April 2017, Hylton 2010, Ranexa January 2016, Rifkin 2008, Wiggins 2016)
Repaglinide: HMG-CoA reductase inhibitors may increase the serum concentration of repaglinide. Monitor therapy.(Hatorp 2003, Kalliokoski 2008, Zhu 2013)
Rifampin: Rifampin may decrease the serum concentration of red yeast rice. Monitor therapy.(Kyrklund 2000)
Rifamycin derivatives: May decrease the serum concentration of HMG-CoA reductase inhibitors. Consider therapy modification.(Backman 2005, Cooper 2003, Kyrklund 2000)
Rupatadine: May enhance the adverse/toxic effect of HMG-CoA reductase inhibitors. Specifically, the risk for increased creatinine phosphokinase and/or other muscle toxicities may be increased. Monitor therapy.(Rupafin June 2014, Rupafin October 2015, Rupatadine August 2016)
Sildenafil: May decrease the metabolism of HMG-CoA reductase inhibitors. Consider therapy modification.(Gutierrez 2001, Omar 2001)
Simeprevir: Simeprevir may increase the serum concentration of red yeast rice. Monitor therapy.(Olysio November 2013)
St. John's wort: May increase the metabolism of HMG-CoA reductase inhibitors. Consider therapy modification.(Sugimoto 2001)
Voxilaprevir: May increase the serum concentration of HMG-CoA reductase inhibitors. Consider therapy modification.(Vosevi July 2017)
Red yeast rice should be avoided in individuals with hypersensitivity to any of its components. Anaphylactic reactions have been reported.Hipler 2002, Wigger-Alberti 1999
Studies in rodents and limited case reports have raised concerns regarding decreases in coenzyme Q10 and development of myopathy due to red yeast rice.Vercelli 2006, Yang 2005 However, a meta-analysis of 53 clinical trials (N=8,535) published up to February 2019 found no increased risk of musculoskeletal adverse effects for red yeast rice versus comparator; this result was similar to that of an earlier meta-analysis of 20 clinical trials conducted up to 2014.Fogacci 2019, Gerards 2015 Reports of adulteration with prescription lovastatin exist,Song 2019 which may account for some observed adverse effects. Evidence regarding supplementation with oral coenzyme Q10 to increase mitochondrial levels is equivocal.Taylor 2018
A 2006 meta-analysis of 93 studies (N=9,625) documented no serious adverse reactions. The most common adverse reactions included dizziness, decreased appetite, nausea, stomachache, abdominal distension, and diarrhea. A small number of patients experienced increased serum urea nitrogen and ALT levels.Liu 2006
Another meta-analysis showed that incidence of liver injury, kidney injury, and muscle symptoms with red yeast rice products was not different compared with control; however, the reviewers noted a high degree of heterogeneity in the included studies.Gerards 2015
Case reports exist of peripheral neuropathy, exacerbation of myasthenia gravis, and erectile dysfunction associated with red yeast rice.Kumari 2013, Liu 2018
Studies of Monascus have shown no toxicity at doses much higher than typical dosing in both long- and short-term therapy. In rats fed Monascus at 50 times the human dose, no abnormalities in behavior or in blood and urine testing were observed.Heber 1999
This information relates to an herbal, vitamin, mineral or other dietary supplement. This product has not been reviewed by the FDA to determine whether it is safe or effective and is not subject to the quality standards and safety information collection standards that are applicable to most prescription drugs. This information should not be used to decide whether or not to take this product. This information does not endorse this product as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about this product. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this product. This information is not specific medical advice and does not replace information you receive from your health care provider. You should talk with your health care provider for complete information about the risks and benefits of using this product.
This product may adversely interact with certain health and medical conditions, other prescription and over-the-counter drugs, foods, or other dietary supplements. This product may be unsafe when used before surgery or other medical procedures. It is important to fully inform your doctor about the herbal, vitamins, mineral or any other supplements you are taking before any kind of surgery or medical procedure. With the exception of certain products that are generally recognized as safe in normal quantities, including use of folic acid and prenatal vitamins during pregnancy, this product has not been sufficiently studied to determine whether it is safe to use during pregnancy or nursing or by persons younger than 2 years of age.
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