indication

For the treatment of Pneumococcal pneumonia due to susceptible strains and group A beta-hemolytic streptococcal infections of the upper respiratory tract.

pharmacology

Troleandomycin is a macrolide antibiotic that is similar to erythromycin. It is active in vitro against the following gram-positive organisms: Streptococcus pyogenes and Diplococcus pneumoniae.

mechanism of action

Troleandomycin acts by penetrating the bacterial cell membrane and reversibly binding to the 50 S subunit of bacterial ribosomes or near the "P" or donor site so that binding of tRNA (transfer RNA) to the donor site is blocked. Translocation of peptides from the "A" or acceptor site to the "P" or donor site is prevented, and subsequent protein synthesis is inhibited.

toxicity

Symptoms of overdose include diarrhea, nausea, stomach cramps, and vomiting.

drug interactions

Aminophylline: The macrolide, troleandomycin, may increase the effect and toxicity of theophylline derivative, aminophylline.

Aprepitant: This CYP3A4 inhibitor increases the effect and toxicity of aprepitant

Astemizole: Increased risk of cardiotoxicity and arrhythmias

Carbamazepine: The macrolide, troleandomycin, may increase the effect of carbamazepine.

Cisapride: Increased risk of cardiotoxicity and arrhythmias

Citalopram: Possible serotoninergic syndrome with this combination

Colchicine: Severe colchicine toxicity can occur

Cyclosporine: The macrolide, troleandomycin, may increase the effect of cyclosporine.

Dihydroergotamine: Possible ergotism and severe ischemia with this combination

Eletriptan: The macrolide, troleandomycin, may increase the effect and toxicity of eletriptan.

Eplerenone: The macrolide, troleandomycin, may increase the effect and toxicity of eplerenone.

Ergotamine: Possible ergotism and severe ischemia with this combination

Erlotinib: This CYP3A4 inhibitor increases levels/toxicity of erlotinib

Fluoxetine: Possible serotoninergic syndrome with this combination

Methysergide: Possible ergotism and severe ischemia with this combination

Oxtriphylline: The macrolide, troleandomycin, may increase the effect and toxicity of the theophylline derivative, oxtriphylline.

Pimozide: Increased risk of cardiotoxicity and arrhythmias

Tacrolimus: The macrolide antibiotic, Troleandomycin, may increase the blood concentration of Tacrolimus. Monitor for changes in the therapeutic/toxic effects of Tacrolimus if Troleandomycin therapy is initiated, discontinued or altered.

Terfenadine: Increased risk of cardiotoxicity and arrhythmias

Theophylline: The macrolide, troleandomycin, may increase the effect and toxicity of theophylline.