Estradiol and Troleandomycin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Troleandomycin
No brand names on recordEstradiol
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.
What happens
Increased contraceptive exposure and an increased risk of intrahepatic cholestasis
Interaction Deep Dive
Coadministration of troleandomycin and combinational oral contraceptives (COCs) may increase COCs exposure and may also increase risk of intrahepatic cholestasis1. Troleandomycin combined with oral contraceptives has been associated with liver dysfunction 4378. Three cases of jaundice were reported in women on oral contraceptives and troleandomycin 5. Theoretically, macrolide antibiotics may alter intestinal flora and affect enterohepatic circulation of estrogens/progestins; however, contraceptive efficacy was maintained during roxithromycin treatment 6.
Why it happens (mechanism)
Inhibition of combination contraceptive metabolism
Literature reports
4 reports — tap to read
a) Concomitant troleandomycin and oral contraceptive therapy may be associated with an increased risk for hepatotoxicity. Twenty-four cases of jaundice have been reported in women taking both troleandomycin and an oral contraceptive. The women had previously taken oral contraceptives for several months to years without evidence of hepatotoxicity. In general, 2 to 15 days after starting troleandomycin 1 to 3 grams daily, intense pruritus developed and was followed by jaundice 2 to 5 days later. Serum bilirubin, alkaline phosphatase, and serum alanine aminotransferase were typically elevated. Eight patients had evidence of cholestasis. After drug therapy was discontinued, jaundice and pruritus gradually disappeared, but persisted more than 1 month in 20 patients and more than 2 months in 6 patients. Twenty patients later resumed taking oral contraceptives without recurrence of the jaundice 2.
b) Twelve patients receiving oral contraceptives developed intrahepatic cholestasis 2 to 20 days after beginning troleandomycin therapy 34.
c) Three cases of jaundice were reported in women on oral contraceptives and troleandomycin 5.
d) Theoretically, macrolide antibiotics may alter intestinal flora and affect enterohepatic circulation of estrogens/progestins; however, contraceptive efficacy was maintained during roxithromycin treatment 6.
Common questions
Can I take Estradiol and Troleandomycin together?
Increased contraceptive exposure and an increased risk of intrahepatic cholestasis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Estradiol and Troleandomycin interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Estradiol or Troleandomycin 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 (8)
- Product Information: ALESSE(R) 28 oral tablets, levonorgestrel ethinyl estradiol oral tablets. Cadence Health (per FDA), New York, NY, 2024.
- Miguet JP, Vuitton D, Pessayre D, et al: Jaundice from troleandomycin and oral contraceptives (letter). Ann Intern Med 1980; 92:434. PubMed
- Fevery J, Van Steenbergen W, Desmet V, et al: Severe intrahepatic cholestasis due to the combined intake of oral contraceptives and triacetyloleandomycin. Act Clin Belgica 1983; 38:242-245. PubMed
- Claudel S, Euvrard P, Bory R, et al: Intra-hepatic cholestasis after taking a triacetyloleandomycin-estroprogestational conbination (letter). Nouv Presse Med 1979; 8:1182.
- Plottin RRF, Mingat J, & Bessard G: Jaundice by interaction of troleandomycin and contraceptive pills. La Nouvelle Presse Medicale 1979; 8:1694.
- Meyer B, Muller F, Wessels P, et al: A model to detect interactions between roxithromycin and oral contraceptives. Clin Pharmacol Ther 1990; 47:671-674. PubMed
- Haber I & Hubens H: Cholestatic jaundice after triacetyloleandomycin and oral contraceptives. The diagnostic value of gamma-glutamyl transpeptidase. Acta Gastroenterol Belgica 1980; 43:475-482.
- Rollux R, Plottin F, Mingat J, et al: Jaundice by interaction of troleandomycin and contraceptive pills (letter). Nouv Presse Med 1979; 8:1694.
Keep reading about Troleandomycin
Keep reading about Estradiol
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
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