Relugolix and Sarecycline: 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
Sarecycline
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.
Let's talk about taking sarecycline (an acne antibiotic) together with relugolix (Orgovyx). Sarecycline can block a pump in your gut called P-gp that normally limits how much relugolix gets absorbed. When that pump is blocked, more relugolix can build up in your body, which can raise the chance of side effects like hot flashes, tiredness, or other reactions.
The good news is this is very manageable. Please don't stop either medicine on your own. Your pharmacist or doctor can adjust timing, watch you a little more closely, or pick another plan so you stay safe and your treatment keeps working.
Effect: Increased relugolix exposure. Sarecycline may inhibit intestinal P-glycoprotein (P-gp), reducing efflux of relugolix (a P-gp substrate) and increasing its AUC/Cmax. For reference, erythromycin (a P-gp inhibitor) raised relugolix AUC 3.5-fold and Cmax 2.9-fold.
- Direction: Higher relugolix levels, increased risk of adverse reactions.
- Severity/Evidence: Major; probable. Onset unspecified.
- Management: Avoid concomitant use if possible. If unavoidable, give relugolix first, separate dosing by at least 6 hours, and monitor adverse reactions more frequently. For short P-gp inhibitor courses, relugolix may be interrupted up to 2 weeks; if interrupted >7 days, restart with a 360 mg loading dose then 120 mg daily.
What happens
Increased relugolix exposure
Interaction Deep Dive
Concurrent administration of relugolix (a P-gp substrate) with P-gp inhibitors should be avoided, since this combination can raise relugolix exposure and thereby heighten the likelihood of adverse reactions linked to relugolix. When coadministration cannot be avoided, give relugolix or relugolix/estradiol/norethindrone acetate first, allow a minimum of 6 hours between doses, and increase the frequency of monitoring for adverse reactions12. Relugolix therapy may be paused for as long as 2 weeks to accommodate a brief course of specific P-gp inhibitors, with relugolix resumed once the P-gp inhibitor is stopped. Should relugolix be interrupted for more than 7 days, it should be reinitiated using a loading dose of 360 mg on day one, followed by 120 mg once daily thereafter. In a drug interaction study, giving relugolix (P-gp substrate) together with erythromycin (P-gp inhibitor) raised relugolix AUC by 3.5-fold and Cmax by 2.9-fold1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of relugolix
How to manage this interaction
This interaction is manageable with your care team's help. Keep taking both medicines exactly as prescribed unless your doctor or pharmacist tells you otherwise.
- Avoiding the overlap: Your team may prefer not to use these together, or may choose a different acne treatment.
- Timing: If both are needed, they may have you take relugolix first and separate the two doses by at least 6 hours.
- Monitoring: Your team may watch you more closely for relugolix side effects.
- Pausing: For a short antibiotic course, your doctor may briefly interrupt relugolix and restart it afterward, sometimes with a loading dose.
Ask your pharmacist before starting or stopping anything.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a drug interaction study, giving relugolix (a P-gp substrate) together with erythromycin (a P-gp inhibitor) raised the AUC of relugolix by 3.5-fold and its Cmax by 2.9-fold 1.
Common questions
Can I take Relugolix and Sarecycline together?
Sarecycline can raise relugolix levels by blocking the P-gp pump, increasing the risk of relugolix side effects. Don't stop either drug on your own; your care team can manage this with timing, monitoring, or an alternative. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Relugolix and Sarecycline 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 Sarecycline interaction managed?
This interaction is manageable with your care team's help. Keep taking both medicines exactly as prescribed unless your doctor or pharmacist tells you otherwise. Avoiding the overlap: Your team may prefer not to use these together, or may choose a different acne treatment. Timing: If both are needed, they may have you take relugolix first and separate the two doses by at least 6 hours. Monitoring:… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Relugolix or Sarecycline 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 (2)
- Product Information: ORGOVYX oral tablets, relugolix oral tablets. Sumitomo Pharma America, Inc (per FDA), Marlborough, MA, 2025. DailyMed
- Product Information: MYFEMBREE(R) oral tablets, relugolix, estradiol, norethindrone acetate oral tablets. Myovant Sciences Inc (per FDA), Brisbane, CA, 2021. DailyMed
Keep reading about Sarecycline
Keep reading about Relugolix
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