Troleandomycin Phenobarbital

Others Acetaminophen, amiodarone, carbamazepine, delavirdine, efavirenz, nevirapine, quinidine, repaglinide, sildenafil, tadalafil, trazodone, vardenafil Amiodarone, amprenavir, atazanavir, ciprofloxacin, cisapride, clarithromycin, diltiozem, erythromycin, fluconazole, fluvoxamine, grapefruit juice (in high ingestion), indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, norfloxacin, ritonavir, telithromycin, troleandomycin, verapamil, voriconazole Carbamazepine, efavirenz, glucocorticoids, macrolide antibiotics, nevirapine, phenytoin, phenobarbital, rifabutin, rifapentine, rifampin, St. John s wort... 

Isoniazid Avasimibe Bosentan Carbam- a2epine" Clotrimazole Cyproterone acetate Hyperforin Lovastatin Mifepristone Nelfinavir Nifedipine Omeprazole Paclitaxel Phenobarbital Phenytoin Rifabutin Rifampin"" Rifapentine Ritonavir Simvastatin Sulfinpyrazole Topotecan Troglitazone Troleandomycin Vitamin E Vitamin K2 Yin zhi wuang... 

Clinically important, potentially hazardous interactions with atazanavir, carbamazepine, clarithromycin, itraconazole, ketoconazole, nefazodone, nelfinavir, phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, ritonavir, saquinavir, St John s wort, troleandomycin, voriconazole, warfarin... 

Clinically important, potentially hazardous interactions with aluminum, aminophylline, carbamazepine, carbimazole, cyclosporine, daclizumab, diuretics, etoposide, etretinate, grapefruit juice, indomethacin, isoniazid, itraconazole, ketoconazole, licorice, live vaccines, methotrexate, naproxen, oral contraceptives, pancuronium, phenobarbital, phenytoin, rifampicin, troleandomycin... 

Increased effects (P450 3A4 inhibitors) cimetidine, danazol, diltiazem, erythromycin, troleandomycin, clarithromycin, fluoxetine, isoniazid, niacinamide, nicotinamide, propoxyphene, ketoconazole, itraconazole, verapamil,and valproate Decreased effects (P450 3A4 inducers) cisplatin, doxorubicin, felbamate, rifampin, phenobarbital, phenytoin, primidone, theophylline... 

Carbamazepine, dexamethasone, glutethimide, nevirapine, phenobarbital, phenytoin, pregnenolone-16a-carbonitrile, progesterone, rifabutin, rifampin, ritonavir, St. John s Wort, sulfadimidine, sulfinpyrazone, troglitazone, troleandomycin... 

Troleandomycin caused a modest fall in the plasma phenobarbital levels of one patient. 

A patient phenobarbital and carbamazepine had a modest fall in plasma phenobarbital levels from about 40 to 31 micrograms/mL, and a rise in carbamazepine levels, when given troleandomycin. The general importance of this single report is uncertain, but this modest is probably of limited clinical importance. For a discussion of the rise in carbamazepine levels with troleandomycin, see Carbamazepine + Macrolides, p.531. 

Troleandomycin and, to a lesser extent, clarithromycin and erythromycin can reduce the clearance of methylprednisolone, thereby increasing both its therapeutic and adverse effects. A patient receiving long-term clarithromycin developed Cushing s syndrome after starting treatment with inhaled budesonide. There appears to be no pharmacokinetic interaction between erythromycin and inhaled ciclesonide. Similarly, prednisolone appears not to be affected by macrolides, except possibly in those also taking enzyme-inducers such as phenobarbital. Isolated case reports describe the development of acute mania and psychosis in two patients, apparently due to an interaction between prednisone and clarithromycin. 

Troleandomydn. A study found that prednisolone clearance was not affected by troleandomydn in 3 patients, but was reduced by about 50% by troleandomycin in one patient who was also taking phenobarbital, which is an enzyme inducer. ... 

Prednisolone seems not to interact with troleandomycin and may be a non-interacting alternative, except possibly in those taking enzyme-inducers (e.g. phenobarbital). 

Especially the inhibition or induction of cytochrome P450 subtype 3A4 (CYP 3A4) is clinically relevant, because a variety of active substances and food substances (e.g. grapefruit juice) are able to affect this enzyme. Substances inhibiting CYP 3A4 include ciclosporin, dihydropyridines, verapamil, midazolam, paclitaxel, simvastatin, lovastatin, atorvastatin, cimetidine, erythromycin, troleandomycin, ketoconazole (and other azoles). Substances inducing CYP 3A4 include steroids, rifampicin, phenobarbital and St John s wort. 

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