Relugolix and Trimipramine: 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
Trimipramine
No brand names on recordRelugolix
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. Trimipramine is an older antidepressant, and relugolix (Orgovyx) is used to treat prostate cancer by lowering testosterone. Each one can slightly stretch out a part of your heartbeat called the QT interval. When taken together, that effect can add up, which in rare cases can lead to an irregular heartbeat.
This concern is based on how the drugs work rather than lots of real-world cases, so try not to worry. Please don't stop either medicine on your own. Your care team can manage this well, often by checking your heart rhythm and your blood minerals (like potassium and magnesium) and keeping them in a healthy range. Ask your pharmacist or doctor if you have questions.
Effect: Additive QT interval prolongation with concurrent trimipramine (a TCA with known QT-prolonging potential) and relugolix (androgen deprivation via GnRH antagonism can prolong QT).
- Mechanism: Additive pharmacodynamic QT prolongation; not a metabolic/prodrug interaction.
- Direction: Increased torsades risk.
- Evidence: Theoretical; onset unspecified.
- Severity: Major.
Management: Avoid combination when possible. Weigh benefit of ADT against risk in congenital long QT, CHF, or recurrent electrolyte disturbance. If coadministered, avoid agents causing hypokalemia/hypomagnesemia, correct electrolyte abnormalities, and consider periodic ECG and electrolyte monitoring.
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 and antagonists can lengthen the QT interval. In patients who have congenital long QT syndrome, congestive heart failure, or recurrent electrolyte disturbances, as well as those receiving drugs recognized to prolong the QT interval, weigh whether the benefits of androgen deprivation therapy such as relugolix are greater than the possible risks 1. Where feasible, refrain from using relugolix at the same time as QT prolonging agents. Should coadministration be necessary, steer clear of drugs that produce electrolyte abnormalities (namely, hypokalemia or hypomagnesemia) 2, correct any electrolyte abnormalities, and consider periodic monitoring of ECGs and electrolytes 1.
Why it happens (mechanism)
Additive QT interval prolongation
How to manage this interaction
Keep taking both medicines as prescribed unless your care team tells you otherwise. Because both can add to QT prolongation, your team has good ways to keep you safe.
- Your doctor will weigh the benefits of relugolix against your personal heart risks (such as a history of long QT, heart failure, or electrolyte problems).
- They may check periodic ECGs and blood electrolytes (potassium and magnesium) and correct any lows.
- They may avoid other medicines that lower those minerals.
Tell your pharmacist or prescriber about fainting, palpitations, dizziness, or a new irregular heartbeat, and mention all your other medications.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) A study assessed male patients undergoing androgen deprivation therapy (ADT) using individual case safety reports from VigiBase, the international pharmacovigilance database, and identified 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 arose in the absence of other agents recognized to raise TdP risk; nevertheless, exposure to 1 drug and to 2 or more drugs with conditional, possible, or known TdP risk was documented in a portion of the 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. 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. Patients were receiving ADT mainly for prostate cancer, with some treated for prostatism and androgenic alopecia. Most patients were on ADT monotherapy (83%), while 17% were on ADT combination therapy 3.
Common questions
Can I take Relugolix and Trimipramine together?
Taking trimipramine with relugolix can add up to prolong the QT interval and raise the risk of an irregular heartbeat. This is manageable with heart-rhythm and electrolyte monitoring, so keep taking both as prescribed and review them with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Relugolix and Trimipramine 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 Trimipramine interaction managed?
Keep taking both medicines as prescribed unless your care team tells you otherwise. Because both can add to QT prolongation, your team has good ways to keep you safe. Your doctor will weigh the benefits of relugolix against your personal heart risks (such as a history of long QT, heart failure, or electrolyte problems). They may check periodic ECGs and blood electrolytes (potassium and magnesium)… 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 Trimipramine 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 Trimipramine
Keep reading about Relugolix
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