Telmisartan 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
Telmisartan
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.
Here's what's going on. Relugolix (Orgovyx) is moved out of your body with the help of a little "pump" called P-gp. Telmisartan (Micardis) can slow that pump down. When the pump slows, more relugolix stays in your bloodstream, which can raise your chances of side effects from relugolix.
The good news is this is very manageable. Please don't stop or change either medicine on your own. Just let your pharmacist or doctor know you take both. They may adjust timing, watch you a little more closely, or make another plan that keeps you safe.
Effect: Increased relugolix exposure. Relugolix is a P-gp substrate; telmisartan inhibits intestinal P-gp-mediated efflux, raising relugolix AUC/Cmax. Neither is a prodrug here, so this is a straightforward increase in relugolix effect.
- Direction: Higher relugolix levels, greater risk of adverse reactions.
- Magnitude: Reference P-gp inhibitor (erythromycin) increased relugolix AUC 3.5-fold and Cmax 2.9-fold.
- Evidence: Probable; severity major.
- Management: Avoid if possible. If unavoidable, give relugolix first, separate doses by at least 6 hours, and monitor more frequently. Interruption/reload protocols per labeling apply.
What happens
Increased relugolix exposure
Interaction Deep Dive
Do not use relugolix (a P-gp substrate) together with P-gp inhibitors, because doing so can raise relugolix exposure and thereby heighten the likelihood of adverse reactions linked to relugolix. When the combination 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. Once the P-gp inhibitor is stopped, relugolix can be resumed. Should relugolix be held for more than 7 days, restart it with a 360 mg loading dose on day one, followed by 120 mg once daily thereafter. A drug interaction study showed that giving relugolix (P-gp substrate) alongside erythromycin (P-gp inhibitor) raised relugolix AUC and Cmax by 3.5-fold and 2.9-fold, respectively1.
Why it happens (mechanism)
Inhibition of P-gp-mediated efflux transport of relugolix
How to manage this interaction
Keep taking both exactly as prescribed unless your care team tells you otherwise. This combination can be managed.
- Your team may prefer to avoid using them together when another option exists.
- If both are needed, they may have you take relugolix first and separate the two doses by at least 6 hours.
- They may monitor you more closely for relugolix side effects.
- In some cases relugolix may be paused during a short course of the other drug, then restarted per your prescriber's instructions.
Ask your pharmacist or doctor before making any change, and report new or worsening symptoms.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a study examining drug interactions, giving relugolix (a P-gp substrate) together with erythromycin (a P-gp inhibitor) raised relugolix's AUC by 3.5-fold and its Cmax by 2.9-fold 1.
Common questions
Can I take Telmisartan and Relugolix together?
Telmisartan can raise relugolix levels and side-effect risk by slowing a transporter (P-gp), so tell your care team you take both; they can space the doses and monitor you or choose another plan. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Telmisartan 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 Telmisartan and Relugolix interaction managed?
Keep taking both exactly as prescribed unless your care team tells you otherwise. This combination can be managed. Your team may prefer to avoid using them together when another option exists. If both are needed, they may have you take relugolix first and separate the two doses by at least 6 hours. They may monitor you more closely for relugolix side effects. In some cases relugolix may be paused… 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.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Telmisartan 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 Telmisartan
Keep reading about Relugolix
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