Relugolix and Rilpivirine: 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
Rilpivirine
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.
Both of these medicines can affect your heart's rhythm. Rilpivirine (an HIV medicine) and relugolix (used for prostate cancer, which works by lowering testosterone) can each slightly stretch out a part of your heartbeat called the QT interval. When you take them together, that effect can add up, which in rare cases could lead to an irregular heartbeat.
This is a theoretical concern based on how the drugs work, not something reported often. The good news is your care team can manage it easily. They may check your heart with an EKG and keep an eye on your blood minerals like potassium and magnesium. Keep taking both as prescribed and talk with your doctor or pharmacist about any dizziness, fainting, or fluttering heartbeat.
Mechanism: Additive QT interval prolongation (PD interaction). Both rilpivirine and relugolix (via androgen deprivation) are independently associated with QTc prolongation; neither is a prodrug and there is no PK component here.
- Direction/effect: Additive increase in QTc, raising torsades de pointes risk.
- Onset: Unspecified.
- Evidence: Theoretical.
- Management: Avoid concomitant use when possible. Weigh benefit of ADT in patients with congenital long QT, CHF, or electrolyte disturbances. If combined, correct and maintain normal K+/Mg2+, avoid other QT-prolonging or electrolyte-depleting agents, and consider periodic ECG and electrolyte monitoring.
What happens
Increased risk of QT interval prolongation
Interaction Deep Dive
When relugolix is taken 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. 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 risks1. Where feasible, do not combine relugolix with agents that prolong QT. 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 ECG and electrolyte monitoring 1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. Because the risk here is that the two together can add to QT prolongation, your care team has clear ways to manage it.
- They will weigh the benefit of relugolix therapy against your personal heart risk, especially if you have long QT syndrome, heart failure, or frequent electrolyte problems.
- They may check periodic ECGs and blood electrolytes (potassium and magnesium), correcting any that are low.
- They may avoid other medicines that lower electrolytes or prolong QT.
Tell your pharmacist or doctor right away about fainting, palpitations, or dizziness, and share your full medication list.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A study looked at male patients undergoing androgen deprivation therapy (ADT) using individual case safety reports from VigiBase, the international pharmacovigilance database, and found 184 cases of acquired long-QT syndrome (aLQTS) and/or torsades de pointes (TdP; 11% of cases were 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 happened without concurrent use of other agents recognized to elevate TdP risk; nonetheless, use of 1 drug and of 2 or more drugs carrying conditional, possible, or known TdP risk was noted in a portion of aLQTS/TdP events (23% or 43%) and sudden death events (18% and 22%). The agents regarded as ADTs included abiraterone, gonadotropin-releasing hormone agonists and antagonists, nonsteroidal androgen receptor inhibitors used for prostate cancer, and 5-alpha-reductase inhibitors used 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 roughly 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. The patients were taking ADT chiefly for prostate cancer, with some treated for prostatism and androgenic alopecia. The majority were on ADT monotherapy (83%); 17% were receiving ADT combination therapy 3.
Common questions
Can I take Relugolix and Rilpivirine together?
Rilpivirine and relugolix can each prolong the QT interval, so together the effect may add up; use them together only when needed 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 Rilpivirine 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 Rilpivirine interaction managed?
Keep taking both medicines as prescribed unless your prescriber tells you otherwise. Because the risk here is that the two together can add to QT prolongation, your care team has clear ways to manage it. They will weigh the benefit of relugolix therapy against your personal heart risk, especially if you have long QT syndrome, heart failure, or frequent electrolyte problems. They may check periodic… 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 Rilpivirine 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 Rilpivirine
Keep reading about Relugolix
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