Some red yeast rice products contain a substance (monacolin K) that is chemically identical to the active ingredient in lovastatin (Altoprev), a prescription medication that lowers cholesterol. Because there is variability in quality from manufacturer, the amount of monacolin K can vary widely from product to product.
Products that contain monacolin K can cause the same types of side effects as lovastatin, which include damage to the muscles, kidneys and liver. In the United States, the Food and Drug Administration has ruled that dietary supplements that contain more than trace amounts of monacolin K are unapproved drugs and can't be sold legally as dietary supplements.