Schizandra and Relugolix: 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
Schizandra
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.
Relugolix (Orgovyx) is a medication your doctor prescribed for a specific reason, and it works best at a steady, expected level in your body. Schizandra is an herbal supplement that can act like a "blocker" of one of the pumps (called P-gp) that helps move relugolix out of your body. When that pump is slowed down, more relugolix can build up than intended.
More relugolix in your system can mean a higher chance of side effects. The good news is this is very manageable. Please don't stop either one on your own. Just let your pharmacist or doctor know you're taking Schizandra so they can guide you safely.
Interaction: Schizandra may inhibit P-glycoprotein (P-gp), reducing efflux of the P-gp substrate relugolix and increasing its systemic exposure (higher AUC/Cmax), which raises the risk of relugolix-related adverse effects.
- Direction: Increased relugolix effect (P-gp inhibition, neither drug is a prodrug).
- Magnitude: Not quantified for Schizandra; for reference, erythromycin (a P-gp inhibitor) raised relugolix AUC 3.5-fold and Cmax 2.9-fold.
- Evidence/onset: Probable; onset unspecified.
- Management: Avoid combination. If unavoidable, give relugolix first, separate by at least 6 hours, and monitor more frequently for adverse reactions. Consider interrupting per labeling for short P-gp inhibitor courses.
What happens
Increased relugolix exposure
Interaction Deep Dive
Concurrent administration of relugolix (a P-gp substrate) with P-gp inhibitors should be avoided, because doing so 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 gap of at least 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 permit a brief course of certain P-gp inhibitors, with relugolix resumed once the P-gp inhibitor has been stopped. Should relugolix be interrupted for more than 7 days, it should be restarted using a loading dose of 360 mg on the first day, followed by 120 mg once daily thereafter. A drug interaction study showed that 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
The main strategy here is to avoid combining Schizandra with relugolix when possible. Keep taking relugolix exactly as prescribed, and don't stop or change either product on your own.
- Tell your care team you're taking or considering Schizandra so they can decide the safest plan.
- If both are truly needed, they may have you take relugolix first and separate the doses by at least 6 hours.
- Your team may monitor you more closely for relugolix side effects.
- In some cases they may briefly pause relugolix; if it's held more than 7 days, they'll guide you on restarting.
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 and Cmax of relugolix by 3.5-fold and 2.9-fold, respectively 1.
Common questions
Can I take Schizandra and Relugolix together?
Schizandra can raise relugolix levels and side-effect risk, so it's best to avoid the combination; keep taking relugolix as prescribed and check with your pharmacist or doctor before using Schizandra. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Schizandra and Relugolix 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 Schizandra and Relugolix interaction managed?
The main strategy here is to avoid combining Schizandra with relugolix when possible. Keep taking relugolix exactly as prescribed, and don't stop or change either product on your own. Tell your care team you're taking or considering Schizandra so they can decide the safest plan. If both are truly needed, they may have you take relugolix first and separate the doses by at least 6 hours. Your team m… 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 Schizandra or Relugolix 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 Relugolix
Keep reading about Schizandra
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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