Ethinyl Estradiol; Norethindrone with Troleandomycin Interaction Details
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 12, 2023
Interaction Effect
Altered contraceptive effectiveness and risk of hepatotoxicity
Interaction Summary
Troleandomycin combined with oral contraceptives has been associated with liver dysfunction; erythromycin may have less propensity for such . Theoretically, macrolide antibiotics may alter intestinal flora and affect enterohepatic circulation of estrogens/progestins; however, contraceptive efficacy was maintained during roxithromycin treatment .
Severity
Moderate
Onset
Delayed
Evidence
Established
How To Manage Interaction
Monitor for symptoms of hepatotoxicity or use a less hepatotoxic antibiotic. Advise patients to use a barrier method of birth control in addition to the combination contraceptive.
Mechanism Of Interaction
Inhibition of combination contraceptive metabolism
Literature Reports
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 .
B) Twelve patients receiving oral contraceptives developed intrahepatic cholestasis 2 to 20 days after beginning troleandomycin therapy . Three cases of jaundice were reported in women on oral contraceptives and troleandomycin .
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.