Severe Intrahepatic Cholestasis Due to the Combined Intake of Oral Contraceptives and Triacetyloleandomycin

Summary

Severe intrahepatic cholestasis occurred in 12 young females taking regularly oral contraceptives, 2–20 days after the intake of triacetyloleandomycin (TAO). Severe itching and jaundice lasted for 12–14 weeks. The pronounced increase in serum bilirubin contrasted sharply with the moderate increase in alkaline phosphatase levels. The gamma-glutamyltranspeptidase activities were normal or only slightly elevated, as has been found usually in women taking oral contraceptives. The liver biopsy taken in one patient showed a pure cholestasis. The combined intake of TAO and oral contraceptives is incriminated as toxic phenomena occur rarely when the drugs are taken separately. Indeed TAO seems to block the further metabolism of oestrogens. It is felt that oral contraceptives are a contraindication for treatment with TAO.