Relugolix and Sotalol: 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
Sotalol
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 your medicines can affect the timing of your heartbeat. Doctors call this QT prolongation, which just means the heart takes a little longer to reset between beats. Sotalol is known to do this, and relugolix (which lowers testosterone as part of prostate cancer treatment) can add to that effect. When you take them together, the effect can stack up, and in rare cases that can lead to an irregular heartbeat.
The good news is this is very manageable. Your care team may check your heart with an ECG and keep an eye on your blood minerals like potassium and magnesium. Please keep taking both exactly as prescribed and talk with your pharmacist or doctor about this combination.
Effect: Additive QT interval prolongation. Sotalol is a class III antiarrhythmic with intrinsic, dose-dependent QT-prolonging (potassium channel blocking) effects; androgen deprivation from relugolix (a GnRH antagonist) may independently prolong the QT interval. Combined use is a pharmacodynamic, additive interaction.
- Direction: Increased QT prolongation / torsades risk.
- Evidence: Theoretical; severity rated major.
- Management: Avoid concomitant use when possible. If required, correct and avoid hypokalemia/hypomagnesemia, and perform periodic ECG and electrolyte monitoring. Reassess risk in patients with congenital long QT, CHF, or electrolyte instability.
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 or antagonists can itself lengthen the QT interval. In patients who have congenital long QT syndrome, congestive heart failure, or recurrent electrolyte abnormalities, 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 potential risks1. Where feasible, do not use relugolix alongside QT prolonging agents. Should coadministration be necessary, refrain from using drugs that produce electrolyte abnormalities (that is, hypokalemia or hypomagnesemia)2, correct any electrolyte abnormalities, and consider periodic monitoring of ECGs and electrolytes1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Both drugs can lengthen the QT interval, so your care team will weigh the benefit of relugolix therapy against the added heart-rhythm risk. Here is what they typically do:
- Where possible, they consider whether the two can be avoided together.
- If both are needed, they watch your potassium and magnesium and correct any low levels.
- They may check periodic ECGs to keep an eye on your heart rhythm.
Keep taking both exactly as prescribed. Do not stop either on your own. Ask your pharmacist or prescriber whether ECG and electrolyte checks are planned, and report symptoms like fainting, palpitations, or dizziness.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a study assessing male patients on 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% fatal cases), 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, exposure to 1 drug and to 2 or more drugs carrying conditional, possible, or known TdP risk was noted in some aLQTS/TdP (23% or 43%) and sudden death (18% and 22%) events. The agents classified 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. Patients had a median age of about 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 receiving ADT primarily for prostate cancer, with some being treated for prostatism and androgenic alopecia. Most patients were on ADT monotherapy (83%); 17% were on ADT combination therapy 3.
Common questions
Can I take Relugolix and Sotalol together?
Sotalol and relugolix can both prolong the QT interval, and together the effect may add up. Keep taking both as prescribed, but ask your care team about ECG and electrolyte monitoring. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Relugolix and Sotalol 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 Sotalol interaction managed?
Both drugs can lengthen the QT interval, so your care team will weigh the benefit of relugolix therapy against the added heart-rhythm risk. Here is what they typically do: Where possible, they consider whether the two can be avoided together. If both are needed, they watch your potassium and magnesium and correct any low levels. They may check periodic ECGs to keep an eye on your heart rhythm. Kee… 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 Sotalol 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 Sotalol
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