Atazanavir and Relugolix: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atazanavir
Relugolix
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
You've been prescribed two medicines that can each affect your heart's rhythm. Atazanavir (Reyataz) is an HIV medicine, and relugolix (Orgovyx) is used for prostate cancer. Both can slightly stretch out part of your heartbeat, called the QT interval. When taken together, that effect can add up, which in rare cases could lead to an irregular heartbeat.
The good news is this concern is mostly theoretical, and it's very manageable. Your care team can check an ECG and your blood minerals (like potassium and magnesium) from time to time to keep things safe. Please don't stop either medicine on your own. Just talk with your pharmacist or doctor so they can watch out for you.
Effect: Additive QT-interval prolongation when atazanavir is combined with relugolix. Androgen deprivation from GnRH antagonists such as relugolix may prolong QT, and atazanavir also carries QT/PR-prolongation potential; the mechanism is pharmacodynamic (additive), not a CYP/prodrug issue.
- Direction: Increased QT-prolongation risk (additive PD effect).
- Onset: Unspecified.
- Evidence: Theoretical.
- Severity: Major.
Management: Weigh benefit versus risk, especially in congenital long QT, CHF, or frequent electrolyte disturbances. Avoid concurrent use when possible. If required, avoid agents causing hypokalemia/hypomagnesemia, correct electrolyte abnormalities, and consider periodic ECG and electrolyte monitoring.
What happens
Increased risk of QT interval prolongation
Interaction Deep Dive
When relugolix is given together with medications that prolong the QT interval, the effects on the QT interval are additive. The androgen deprivation produced by GnRH agonists or antagonists can itself lengthen the QT interval. For patients who have congenital long QT syndrome, congestive heart failure, or recurrent electrolyte disturbances, as well as those receiving drugs recognized for prolonging the QT interval, weigh whether the advantages of androgen deprivation therapy such as relugolix outweigh the possible risks 1. Where feasible, do not use relugolix alongside QT prolonging agents. Should combined use be necessary, refrain from using drugs that produce electrolyte disturbances (namely, hypokalemia or hypomagnesemia) 2, correct any electrolyte disturbances, and think about periodic monitoring of ECGs and electrolytes 1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Both medicines can affect your heart rhythm, but your care team has clear ways to manage this together.
- Keep taking both exactly as prescribed unless your doctor tells you otherwise.
- Your team may check ECGs and blood electrolytes (like potassium and magnesium) from time to time.
- They will work to keep your electrolyte levels normal, since low levels can raise the risk.
- In some cases they may weigh whether an alternative is a better fit for you.
Tell your pharmacist or prescriber if you feel dizziness, fainting, or a pounding or irregular heartbeat, or if you have vomiting or diarrhea that could lower your electrolytes.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A study assessed male patients undergoing androgen deprivation therapy (ADT) using individual case safety reports from VigiBase, the international pharmacovigilance database, and identified 184 cases of acquired long-QT syndrome (aLQTS) and/or torsades de pointes (TdP; 11% of cases fatal), along with 99 cases of sudden death linked to ADT. The majority of aLQTS/TdP cases (62%) and sudden death cases (88%) tied to ADT arose without concurrent use of other agents recognized to raise TdP risk; nevertheless, use of 1 drug and of 2 or more drugs carrying conditional, possible, or known TdP risk was reported in a portion of aLQTS/TdP events (23% or 43%) and sudden death events (18% and 22%). The agents classified as ADTs included abiraterone, gonadotropin-releasing hormone agonists and antagonists, nonsteroidal androgen receptor inhibitors indicated for prostate cancer, and 5-alpha-reductase inhibitors indicated for androgenic alopecia and prostatism. Among the 10 ADTs assessed, 7 showed a disproportional association (reporting odds ratio, 1.4 to 4.7) with aLQTS, TdP, or sudden death, namely leuprorelin, goserelin, triptorelin, degarelix, bicalutamide, finasteride, and dutasteride. The median patient age was approximately 76 years, and the median time from onset to aLQTS/TdP events was 170 days (range, 7 to 4884 days), while for sudden death events it was 92 days (range, 0.25 to 4984 days). Patients were receiving ADT chiefly for prostate cancer, with some treated for prostatism and androgenic alopecia. The majority of patients were on ADT monotherapy (83%); 17% received ADT combination therapy 3.
Common questions
Can I take Atazanavir and Relugolix together?
Taking atazanavir and relugolix together can add up their effects on your heart's QT interval, so your care team may monitor ECGs and electrolytes and keep those levels in check. Don't stop either drug on your own; talk with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atazanavir and Relugolix interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Atazanavir and Relugolix interaction managed?
Both medicines can affect your heart rhythm, but your care team has clear ways to manage this together. Keep taking both exactly as prescribed unless your doctor tells you otherwise. Your team may check ECGs and blood electrolytes (like potassium and magnesium) from time to time. They will work to keep your electrolyte levels normal, since low levels can raise the risk. In some cases they may weig… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Atazanavir or Relugolix need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: ORGOVYX oral tablets, relugolix oral tablets. Sumitomo Pharma America, Inc (per FDA), Marlborough, MA, 2025. DailyMed
- Lyon AR, Lopez-Fernandez T, Couch LS, et al: 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association (EHA), the European Society for Therapeutic Radiology and Oncology (ESTRO) and the International Cardio-Oncology Society (IC-OS). Eur Heart J 2022; 43(41):4229-4361.
- Salem JE, Yang T, Moslehi JJ, et al: Androgenic effects on ventricular repolarization: a translational study from the international pharmacovigilance database to iPSC-cardiomyocytes. Circulation 2019; 140(13):1070-1080. PubMed
Keep reading about Atazanavir
Keep reading about Relugolix
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