Relugolix and Levoketoconazole: 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
Relugolix
Levoketoconazole
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.
These two medicines are not meant to be used together. Both relugolix (Orgovyx) and levoketoconazole (Recorlev) can affect your heart's electrical rhythm in a way called QT prolongation. When you take both, that effect can add up and raise the risk of a dangerous, irregular heartbeat.
The good news is that this is something your care team watches for closely. If you have been prescribed both, don't stop anything on your own. Instead, reach out to your doctor or pharmacist right away so they can review your medicines and choose a safer plan for you.
Contraindicated combination. Both agents can prolong the QT interval; concurrent use produces additive QTc prolongation and increases the risk of ventricular arrhythmias, including torsades de pointes.
- Mechanism: additive pharmacodynamic QT prolongation (levoketoconazole effect is dose-related).
- Direction: increased QT-related risk (neither is a prodrug; this is a PD, not PK, interaction).
- Evidence: theoretical; onset unspecified.
- Management: avoid coadministration. If unavoidable and clinically necessary, the care team should reassess therapy, obtain baseline/follow-up ECGs, correct electrolytes (K+, Mg2+), and consider an alternative agent.
What happens
An increased risk of QT interval prolongation and an increased risk of torsade de pointes
Interaction Deep Dive
Prolongation of the QT interval linked to levoketoconazole occurs in a dose-dependent manner. Because of this, giving levoketoconazole together with other agents capable of prolonging the QT interval and provoking ventricular arrhythmias, such as torsades de pointes, is contraindicated1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Because this pairing is contraindicated, the usual approach is to avoid using them together rather than simply adjusting a dose.
- Keep taking both exactly as prescribed until you speak with a professional, but contact your pharmacist or prescriber promptly to review this combination.
- Your care team may choose an alternative medicine, or monitor your heart rhythm more closely (for example with ECGs) and check electrolytes if both must be used.
- Tell your team about any fainting, dizziness, palpitations, or irregular heartbeat right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Relugolix and Levoketoconazole together?
Relugolix and levoketoconazole can both prolong the QT interval, and using them together is contraindicated because the risk adds up. Contact your doctor or pharmacist promptly to review a safer option. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Relugolix and Levoketoconazole interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Relugolix and Levoketoconazole interaction managed?
Because this pairing is contraindicated, the usual approach is to avoid using them together rather than simply adjusting a dose. Keep taking both exactly as prescribed until you speak with a professional, but contact your pharmacist or prescriber promptly to review this combination. Your care team may choose an alternative medicine, or monitor your heart rhythm more closely (for example with ECGs)… 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 Relugolix or Levoketoconazole 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: RECORLEV(R) oral tablets, levoketoconazole oral tablets. Xeris Pharmaceuticals Inc (per FDA), Chicago, IL, 2023. DailyMed
Keep reading about Relugolix
Keep reading about Levoketoconazole
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