Clomipramine 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
Clomipramine
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 clomipramine (an antidepressant) and relugolix (Orgovyx, a hormone therapy). Both of these medicines can affect the timing of your heartbeat in a way doctors call QT prolongation. When two drugs that do this are taken together, the effect can add up and, in rare cases, lead to an irregular heartbeat.
The good news is this is a known, manageable concern. Your care team can weigh the benefits, keep an eye on your heart rhythm with an EKG, and check your blood minerals like potassium and magnesium. Please keep taking both medicines as prescribed and talk with your pharmacist or doctor so they can watch out for you.
Effect: Additive QT-interval prolongation with concurrent clomipramine (a tricyclic antidepressant with known QT effects) and relugolix (a GnRH antagonist; androgen deprivation itself may prolong QT).
- Mechanism: Pharmacodynamic additive QT prolongation, not a metabolic/PK interaction.
- Direction: Increased risk of QTc prolongation / torsades de pointes.
- Evidence: Theoretical; severity rated major.
- Management: Avoid concomitant use when possible. If required, correct and avoid electrolyte abnormalities (hypokalemia, hypomagnesemia), and consider periodic ECG and electrolyte monitoring. Assess risk more carefully in congenital long QT, CHF, or frequent electrolyte disturbances.
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 and antagonists can itself lengthen the QT interval. In patients who have congenital long QT syndrome, congestive heart failure, or recurrent electrolyte disturbances, as well as in those receiving drugs recognized to prolong the QT interval, weigh whether the benefits of androgen deprivation therapy such as relugolix outweigh the possible risks 1. Where feasible, do not combine relugolix with QT prolonging agents. Should coadministration be necessary, refrain from using drugs that produce electrolyte disturbances (that is, hypokalemia or hypomagnesemia) 2, correct any electrolyte disturbances, and consider periodic monitoring of ECGs and electrolytes 1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Your care team has several straightforward ways to keep this safe:
- Keep taking both exactly as prescribed unless your doctor tells you otherwise.
- Your team may check periodic EKGs to watch your heart rhythm.
- They may monitor blood minerals like potassium and magnesium and correct them if they run low.
- Where possible, they may consider whether an alternative to one drug is appropriate.
Tell your pharmacist or prescriber if you have a history of heart rhythm problems, heart failure, or long QT syndrome, and report any fainting, dizziness, or palpitations right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A study examined male patients undergoing androgen deprivation therapy (ADT) using individual case safety reports from VigiBase, the international pharmacovigilance database. It identified 184 cases of acquired long-QT syndrome (aLQTS) and/or torsades de pointes (TdP; 11% of which were fatal), along with 99 cases of sudden death linked to ADT. The majority of aLQTS/TdP cases (62%) and sudden death cases (88%) associated with ADT arose without concurrent use of other medications known to elevate TdP risk; nevertheless, use of 1 drug and of 2 or more drugs with conditional, possible, or known TdP risk was documented in a portion of aLQTS/TdP events (23% or 43%) and sudden death events (18% and 22%). The medications regarded 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 patients had a median age of about 76 years, with a median time to onset of 170 days (range, 7 to 4884 days) for aLQTS/TdP events and 92 days (range, 0.25 to 4984 days) for sudden death events. Patients were primarily receiving ADT for prostate cancer, while some were treated for prostatism and androgenic alopecia. The majority of patients were on ADT monotherapy (83%); 17% were receiving ADT combination therapy 3.
Common questions
Can I take Clomipramine and Relugolix together?
Taking clomipramine and relugolix together can add up their effect on your heart's rhythm (QT prolongation), so your care team may monitor your EKG and blood minerals; keep taking both as prescribed and report any fainting or palpitations. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clomipramine 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 Clomipramine and Relugolix interaction managed?
Your care team has several straightforward ways to keep this safe: Keep taking both exactly as prescribed unless your doctor tells you otherwise. Your team may check periodic EKGs to watch your heart rhythm. They may monitor blood minerals like potassium and magnesium and correct them if they run low. Where possible, they may consider whether an alternative to one drug is appropriate. Tell your ph… 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 Clomipramine 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 Clomipramine
Keep reading about Relugolix
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