Atogepant and Relugolix: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 11, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Relugolix
Atogepant
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.
Here's what's going on: Atogepant (Qulipta) is broken down in your body by an enzyme called CYP3A4. Relugolix (Orgovyx) can speed up that enzyme. When the enzyme works faster, your body clears atogepant more quickly, so there's less of it in your system. That means your migraine medicine may not work as well as it should.
The good news is this is very manageable. Your care team can adjust your atogepant dose or choose a different plan depending on which type of migraine you're treating. Please don't change anything on your own. Just check in with your doctor or pharmacist so they can tailor things for you.
Mechanism: Relugolix induces CYP3A4, the enzyme responsible for atogepant metabolism. Neither drug is a prodrug, so induction lowers atogepant exposure (reduced efficacy).
Magnitude (from CYP3A4 inducer studies): rifampin (strong) reduced atogepant AUC ~60% and Cmax ~30%; topiramate (weak) reduced steady-state AUC ~25% and Cmax ~24%.
- Evidence: theoretical for this specific pair.
- Onset: unspecified.
- Management: Episodic migraine, use atogepant 30 or 60 mg once daily with any CYP3A4 inducer. Chronic migraine, avoid concomitant inducer use.
- Monitor for reduced migraine control.
What happens
Reduced atogepant exposure
Interaction Deep Dive
Giving atogepant (a CYP3A4 substrate) together with a CYP3A4 inducer can markedly lower atogepant levels. A pharmacokinetic study showed that combining atogepant with rifAMPin (a strong CYP3A4 inducer) lowered atogepant AUC by 60% and Cmax by 30%. When atogepant was given with topiramate, a weak CYP3A4 inducer, the mean steady-state AUC (0 to tau) of atogepant fell by 25% and the mean steady-state Cmax fell by 24% in healthy subjects. In episodic migraine, when atogepant is used alongside strong, moderate, or weak CYP3A4 inducers, the recommended dose is 30 or 60 mg once daily. In chronic migraine, concurrent use of strong, moderate, or weak CYP3A4 inducers with atogepant should be avoided1.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of atogepant
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise. The main concern is that relugolix may make atogepant less effective for preventing migraines.
Your team can manage this by tailoring your plan:
- For episodic migraine, atogepant is typically dosed at 30 or 60 mg once daily when taken with a CYP3A4 inducer.
- For chronic migraine, this combination is generally avoided, so your team may choose a different approach.
Let your pharmacist or prescriber know you take both, and tell them if your migraines seem harder to control.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
2 reports — tap to read
a) In a pharmacokinetic study, giving atogepant together with steady-state rifAMPin (a strong CYP3A4 inducer) lowered atogepant AUC by 60% and Cmax by 30% in healthy subjects 1.
b) No specific pharmacokinetic studies have evaluated the coadministration of atogepant with a moderate CYP3A4 inducer. When atogepant was given together with topiramate, a weak CYP3A4 inducer, the mean steady-state AUC (0 to tau) of atogepant fell by 25% and the mean steady-state Cmax fell by 24% in healthy subjects 1.
Common questions
Can I take Atogepant and Relugolix together?
Relugolix can lower atogepant levels and make it less effective for migraine prevention; your care team can adjust the atogepant dose (episodic migraine) or avoid the combination (chronic migraine), so check with them before changing anything. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atogepant 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 Atogepant and Relugolix interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise. The main concern is that relugolix may make atogepant less effective for preventing migraines. Your team can manage this by tailoring your plan: For episodic migraine, atogepant is typically dosed at 30 or 60 mg once daily when taken with a CYP3A4 inducer. For chronic migraine, this combination is generally avoided… 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 Atogepant 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 (1)
- Product Information: QULIPTA(R) oral tablets, atogepant oral tablets. AbbVie Inc (per FDA), North Chicago, IL, 2025. DailyMed
Keep reading about Relugolix
Keep reading about Atogepant
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