Some macrolide antibiotics cause clinical drug interactions, resulting in altered metabolism of concomitantly administered drugs, via formation of an inactive cytochrome P-450 complex. In the present study, the formation of a cytochrome P-450 type I binding spectrum and a metabolic intermediate complex by troleandomycin and dirithromycin was assessed in liver microsomes obtained from untreated rats and phenobarbital-or dexamethasone-pretreated rats. Troleandomycin produced a type I binding spectrum and metabolic intermediate complex in microsomes from dexamethasone-and phenobarbital-pretreated rats. Dirithromycin did not produce a detectable type I binding spectrum but formed a small cytochrome P-450 metabolic intermediate complex (6% of that formed by troleandomycin) in microsomes from dexamethasonepretreated rats only. The formation of a cytochrome P-450 type I binding spectrum and a metabolic intermediate complex by troleandomycin, erythromycin, dirithromycin, and erythromycylamine was also assessed in microsomes prepared from human livers. Troleandomycin and erythromycin formed a type I binding spectrum and a metabolic intermediate complex which were larger in microsomes from subjects on barbiturate therapy than in microsomes from subjects with no recent barbiturate exposure. Erythromycylamine did not form a detectable type I binding spectrum with any of the human microsomal samples, but a small metabolic intermediate complex was formed with microsomes from a subject on phenobarbital, phenytoin, and propranolol therapy. Dirithromycin did not form a detectable type I binding spectrum or a metabolic intermediate complex in any human liver sample. Preclinical quantitation of the human metabolic intermediate complex may be helpful in predicting the possibility of clinical drug interactions of new drug candidates.A number of classes of xenobiotic compounds such as amphetamines, arylamines, methylenedioxybenzenes, dioxolanes, and hydrazines interact with cytochrome P-450, resulting in the formation of a cytochrome P-450 type I binding spectrum and, subsequent to reduction of the drugenzyme complex with NADPH, a characteristic metabolic intermediate (MI) complex (10). Among those compounds producing cytochrome P-450 MI complexes are the macrolide antibiotics erythromycin, oleandomycin, troleandomycin, clarithromycin, and roxithromycin, although the latter two macrolides are weak formers of cytochrome P-450 MI complexes (13). Three additional macrolide antibiotics, josamycin, midecamycin, and spiramycin, do not form cytochrome P-450 MI complexes (4, 13). Cytochrome P-450 MI complex formation by erythromycin and troleandomycin results in the formation of a metabolically inactive cytochrome P-450 species (3, 11). Furthermore, administration of these macrolide antibiotics results in clinical pharmacokinetic interactions with steroids (8), theophylline (2), and cyclosporin (5). It was, therefore, of interest to determine if dirithromycin, a new macrolide antibiotic, and erythromycylamine, a metabolite of dirithromycin, ...