Initial Posting: 9/13/2013    Last Update: 8/8/2017
Answer: Red yeast rice is effective because it naturally contains cholesterol-lowering "statin" compounds, such as lovastatin. However, studies in which statin drugs have been given with high-dose niacin therapy suggest that this is not a helpful combination for most people and there are safety concerns. The same issues are likely to arise with the combination of red yeast rice and high-dose niacin therapy, so this combination should be carefully evaluated. For more details about the effects of statins given with high-dose niacin, see the Niacin section of theB Vitamins Product Review (which includes our tests of niacin and other B vitamins).
Be aware that some evidence suggests that taking phytosterols in addition to red yeast rice may be helpful.