Relugolix and Pipamperone: 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
Pipamperone
No brand names on record
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 electrical rhythm. Relugolix (Orgovyx) lowers testosterone, and that hormone change can slightly stretch out part of your heartbeat called the QT interval. Pipamperone, an antipsychotic-type medicine, can do the same thing. When you take both, those effects can add up and, in rare cases, lead to an irregular heartbeat.
The good news is this is a possible risk, not a certainty, and your care team can manage it. They may check your heart with an ECG and keep an eye on blood minerals like potassium and magnesium. Please keep taking both as prescribed and talk with your pharmacist or doctor about this combination.
Effect: Additive QT-interval prolongation with combined relugolix and pipamperone.
Mechanism: Pharmacodynamic (additive), not pharmacokinetic. Androgen deprivation from GnRH antagonists such as relugolix can prolong QT; pipamperone is a butyrophenone-type antipsychotic with recognized QT liability. Neither is a prodrug relevant here.
- Direction/magnitude: Increased QTc; magnitude not quantified.
- Onset: Unspecified.
- Evidence: Theoretical.
Management: Avoid concomitant use when possible. Weigh benefit of ADT against risk in congenital long QT, CHF, or electrolyte disturbance. If used together, avoid agents causing hypokalemia/hypomagnesemia, correct electrolytes, and consider periodic ECG and electrolyte monitoring.
What happens
Increased risk of QT interval prolongation
Interaction Deep Dive
When relugolix is given together with agents 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 with congenital long QT syndrome, congestive heart failure, or recurrent electrolyte disturbances, as well as in those receiving medications recognized to prolong the QT interval, weigh whether the advantages of androgen deprivation therapy such as relugolix are greater than the possible risks 1. Where feasible, do not use relugolix alongside 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 can manage this combination safely with some routine precautions.
- Keep taking both medicines as prescribed unless your doctor tells you otherwise.
- Your team may order periodic ECGs to watch your heart rhythm and check electrolytes like potassium and magnesium.
- Low potassium or magnesium can increase the risk, so your team will correct these if they drop.
- Tell your doctor if you have a personal or family history of long QT syndrome, heart failure, or fainting spells.
Report symptoms like palpitations, dizziness, or fainting to your pharmacist or prescriber promptly.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In an analysis of male patients treated with androgen deprivation therapy (ADT) using individual case safety reports from VigiBase, the international pharmacovigilance database, investigators 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%) associated with ADT arose without concurrent use of other agents known to raise TdP risk; nevertheless, use of 1 drug and 2 or more drugs carrying conditional, possible, or known TdP risk was documented in a portion of aLQTS/TdP (23% or 43%) and sudden death (18% and 22%) events. The agents 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 median patient age was approximately 76 years, and the median time to onset was 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 taking ADT chiefly for prostate cancer, with some receiving it for prostatism and androgenic alopecia. Most patients were on ADT monotherapy (83%); 17% were receiving ADT combination therapy 3.
Common questions
Can I take Relugolix and Pipamperone together?
Relugolix and pipamperone can each prolong the QT interval, and together the effect may add up. Keep taking both as prescribed and let your care team monitor your ECG and electrolytes. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Relugolix and Pipamperone 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 Relugolix and Pipamperone interaction managed?
Your care team can manage this combination safely with some routine precautions. Keep taking both medicines as prescribed unless your doctor tells you otherwise. Your team may order periodic ECGs to watch your heart rhythm and check electrolytes like potassium and magnesium. Low potassium or magnesium can increase the risk, so your team will correct these if they drop. Tell your doctor if you have… 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 Pipamperone 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 Relugolix
Keep reading about Pipamperone
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