It
is funny you mentioned red yeast rice, we had been talking about that in my
clinical rotation. The problem my PCP has with it is she feels the patient is
likely still going to have side effects, and as you mentioned, the contents of
the supplements are not well regulated and exact dosing can be a problem.

I
decided to look into this a bit more and the newest information I found was a
meta analysis from 2017 from the British Journal of Clinical Pharmacology from
January 2017 which stated the safety of red yeast rice was comparable to that
of statins, having the same active chemical, but did not discuss myalgia
specifically (Mazzanti, Moro, Raschi, Da Cas & Menniti-Ippolito, 2017).

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Another
analysis in the Journal of Clinical Pharmacy and Therapeutics from 2016 found
no difference in outcomes when simvastatin was compared with RYR, although some
of the evidence reviewed suggested RYR being more effective in decreased LDL
and some found simvastatin more effective at raising HDL, but were not
statistically significant. GI side effects seemed to appear equally, but there
was no mention of myalgia (Ong &Aziz, 2016)

This
looks to be something I will have to continue to look into.