diff --git a/packs/pf2e/conditions/drained.json b/packs/pf2e/conditions/drained.json
index d85ff7dbaa1..df17c41049c 100644
--- a/packs/pf2e/conditions/drained.json
+++ b/packs/pf2e/conditions/drained.json
@@ -45,8 +45,21 @@
             },
             {
                 "key": "LoseHitPoints",
+                "predicate": [
+                    {
+                        "not": "drained-hp-effective-minus-one"
+                    }
+                ],
                 "reevaluateOnUpdate": true,
                 "value": "max(1,@actor.level) * @item.badge.value"
+            },
+            {
+                "key": "LoseHitPoints",
+                "predicate": [
+                    "drained-hp-effective-minus-one"
+                ],
+                "reevaluateOnUpdate": true,
+                "value": "max(1,@actor.level) * max(0,@item.badge.value - 1)"
             }
         ],
         "traits": {
diff --git a/packs/pf2e/feats/ancestry/versatile-heritages/dhampir/svetocher.json b/packs/pf2e/feats/ancestry/versatile-heritages/dhampir/svetocher.json
index e6db18b17f8..8dbeb6835c1 100644
--- a/packs/pf2e/feats/ancestry/versatile-heritages/dhampir/svetocher.json
+++ b/packs/pf2e/feats/ancestry/versatile-heritages/dhampir/svetocher.json
@@ -34,19 +34,38 @@
                 "value": 1
             },
             {
-                "key": "AdjustModifier",
-                "mode": "add",
-                "selector": "fortitude",
-                "slug": "drained",
-                "value": 1
+                "key": "RollOption",
+                "option": "svetocher"
+            },
+            {
+                "key": "RollOption",
+                "option": "drained-hp-effective-minus-one"
             },
             {
                 "key": "FlatModifier",
                 "predicate": [
-                    "self:condition:drained"
+                    "self:condition:drained",
+                    {
+                        "not": "sanguine-tenacity"
+                    }
                 ],
                 "selector": "hp",
                 "value": "@actor.level"
+            },
+            {
+                "key": "AdjustModifier",
+                "mode": "add",
+                "predicate": [
+                    "self:condition:drained",
+                    {
+                        "not": "sanguine-tenacity"
+                    }
+                ],
+                "selectors": [
+                    "fortitude"
+                ],
+                "slug": "drained",
+                "value": 1
             }
         ],
         "traits": {
diff --git a/packs/pf2e/feats/general/level-11/sanguine-tenacity.json b/packs/pf2e/feats/general/level-11/sanguine-tenacity.json
index a56de3081bd..8aeb57c5440 100644
--- a/packs/pf2e/feats/general/level-11/sanguine-tenacity.json
+++ b/packs/pf2e/feats/general/level-11/sanguine-tenacity.json
@@ -30,6 +30,22 @@
             "title": "Pathfinder #213: Thirst for Blood"
         },
         "rules": [
+            {
+                "key": "RollOption",
+                "option": "sanguine-tenacity"
+            },
+            {
+                "key": "RollOption",
+                "option": "drained-hp-effective-minus-one"
+            },
+            {
+                "key": "FlatModifier",
+                "predicate": [
+                    "self:condition:drained"
+                ],
+                "selector": "hp",
+                "value": "@actor.level"
+            },
             {
                 "key": "Resistance",
                 "type": "bleed",
@@ -62,14 +78,6 @@
                     "str-damage"
                 ],
                 "value": 1
-            },
-            {
-                "key": "FlatModifier",
-                "predicate": [
-                    "self:condition:drained"
-                ],
-                "selector": "hp",
-                "value": "@actor.level"
             }
         ],
         "traits": {
diff --git a/src/module/rules/rule-element/lose-hit-points.ts b/src/module/rules/rule-element/lose-hit-points.ts
index acef8854a01..f6ee96d6195 100644
--- a/src/module/rules/rule-element/lose-hit-points.ts
+++ b/src/module/rules/rule-element/lose-hit-points.ts
@@ -18,14 +18,14 @@ class LoseHitPointsRuleElement extends RuleElement<LoseHitPointsRuleSchema> {
     }
 
     override onCreate(actorUpdates: Record<string, unknown>): void {
-        if (this.ignored) return;
+        if (this.ignored || !this.test()) return;
         const value = Math.trunc(Math.abs(Number(this.resolveValue(this.value)) || 0));
         const currentHP = this.actor._source.system.attributes.hp.value;
         actorUpdates["system.attributes.hp.value"] = Math.max(currentHP - value, 0);
     }
 
     override beforePrepareData(): void {
-        if (this.ignored) return;
+        if (this.ignored || !this.test()) return;
 
         const { actor } = this;
         if (!this.recoverable) {
@@ -35,12 +35,19 @@ class LoseHitPointsRuleElement extends RuleElement<LoseHitPointsRuleSchema> {
     }
 
     override async preUpdate(changes: DeepPartial<ItemSourcePF2e>): Promise<void> {
-        if (!this.reevaluateOnUpdate || this.ignored) return;
+        if (!this.reevaluateOnUpdate || this.ignored || !this.test()) return;
         const previousValue = Math.trunc(Math.abs(Number(this.resolveValue(this.value)) || 0));
         const newItem = this.item.clone(changes);
-        const rule = newItem.system.rules.find((r): r is LoseHitPointsSource => r.key === this.key);
+        const ruleSource = typeof this.sourceIndex === "number" ? newItem.system.rules[this.sourceIndex] : undefined;
+        if (!ruleSource || ruleSource.key !== "LoseHitPoints") return;
         const newValue = Math.trunc(
-            Math.abs(Number(this.resolveValue(String(rule?.value), 0, { resolvables: { item: newItem } }))),
+            Math.abs(
+                Number(
+                    this.resolveValue(String((ruleSource as LoseHitPointsSource).value), 0, {
+                        resolvables: { item: newItem },
+                    }),
+                ) || 0,
+            ),
         );
         const valueChange = newValue - previousValue;
         if (valueChange > 0) {