Troleandomycin Estrogens

Prednisolone [Corticosteroid] [See Steroids and Table VI-1] Interactions T Effects W/ clarithromycin, erythromycin, estrogen, ketoconazole, OCPs, troleandomycin X effects W/ antacids, aminoglutethimide, barbiturates, cholestyramine, colestipol, phenytoin, rifampin X effects OF anticoagulants, hypoglycemics, INH, salicylates, vaccine toxoids EMS Infxns may be masked OD May cause wt gain, T hair growth, acne, HTN, peripheral edema, and sore muscles symptomatic and supportive... 

Most reports associating cholestatic jaundice with the concomitant use of oral contraceptives and macrolides have implicated troleandomycin (163-166). The exact mechanism of this interaction has not been established. Troleandomycin possibly inhibits the metabolism of estrogens and progestagens (133). In most patients jaundice persisted for more than a month after the antibiotic was withdrawn. 

Perol R, Hincky J, Desnos M. Hepatites cholestatiques lors de la prise de troleandomycine chez deux femmes prenant des estrogenes. Nouv Presse Med (1978) 7, 4302. 

Ketoconazole can lead to reduced clearance of CS and a mild increase in levels (62,66,67). In addition, patients with significant liver or renal failure, age older than 65 years (68), or women receiving exogenous estrogen have increased unbound concentrations of prednisolone (69). Conversely, hyperthyroid patients have lower levels (70). There is one case report of an increased prothrombin time occurring in a patient on a stable dose of coumadin who subsequently received prednisone (71). This interaction seems rare and may be overshadowed by other drugs and events in the patient. Troleandomycin, a macrolide, has been shown to reduce clearance of methylprednisolone, but not prednisone (72). 

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