No

Antibiotic, Macrolide

Adjunct in the treatment of corticosteroid-dependent asthma due to its steroid-sparing properties; antibiotic with spectrum of activity similar to erythromycin

C

Hypersensitivity to troleandomycin, other macrolides, or any component; concurrent use with cisapride

Use with caution in patients with impaired hepatic function; chronic hepatitis may occur in patients with long or repetitive courses

>10%: Gastrointestinal: Abdominal cramping and discomfort (dose-related)

1% to 10%:

Dermatologic: Urticaria, rashes

Gastrointestinal: Nausea, vomiting, diarrhea

<1%: Rectal burning, cholestatic jaundice

Symptoms of overdose include nausea, vomiting, diarrhea, hearing loss

Following GI decontamination, treatment is supportive

CYP3A3/4 enzyme substrate; CYP3A3/4 and 3A5-7 enzyme inhibitor

Decreases methylprednisolone clearance from a linear first order decline to a nonlinear decline in plasma concentration. Troleandomycin also has an undefined action independent of its effects on steroid elimination. Inhibits RNA-dependent protein synthesis at the chain elongation step; binds to the 50S ribosomal subunit resulting in blockage of transpeptidation.

Time to peak serum concentration: Within 2 hours

Elimination: 10% to 25% of dose excreted in urine as active drug; also excreted in feces via bile

Oral:

Adjunct in corticosteroid-dependent asthma: 14 mg/kg/day in divided doses every 6-12 hours not to exceed 250 mg every 6 hours; dose is tapered to once daily then alternate day dosing

Adults: 250-500 mg 4 times/day

May be administered with food; presence of food delays absorption, but has no effect on the extent of absorption

Administer around-the-clock instead of 4 times/day

Hepatic function tests

Macrolides reported to cause nightmares, confusion, anxiety, or mood lability

Contraindicated with pimozide; concurrent use with carbamazepine or triazolam may produce additive toxicity; monitor

No information available to require special precautions

No effects or complications reported

Complete full course of therapy; notify physician if persistent or severe abdominal pain, nausea, vomiting, jaundice, darkened urine, or fever occurs

Monitor hepatic function tests

Capsule: 250 mg

Brenner AM and Szefler SJ, "Troleandomycin in the Treatment of Severe Asthma," Immunol Allergy Clin North Am, 1991, 11(1):91-102.

Kamada AK, Hill MR, Brenner AM, et al, "Effect of Low-Dose Troleandomycin on Theophylline Clearance: Implications for Therapeutic Drug Monitoring," Pharmacotherapy, 1992, 12(2):98-102.

Spector SL, Katz FH, and Farr RS, "Troleandomycin: Effectiveness in Steroid-Dependent Asthma and Bronchitis," J Allergy Clin Immunol, 1974, 54(6):367-79.

Tartaglione TA, "Therapeutic Options for the Management and Prevention of Mycobacterium avium Complex Infection in Patients With the Acquired Immunodeficiency Syndrome," Pharmacotherapy, 1996, 16(2):171-82.