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Tacrolimus Tremor Common Side Effect — ESENeph MCQ

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EasyTransplantationTacrolimus Tremor Common Side EffectESENeph

A kidney transplant recipient on Tacrolimus develops tremor. His Tacrolimus trough is 6 ng/mL (within range). The tremor is postural and symmetrical. Is this expected?

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Correct answer: A — Fine postural tremor is a common dose-dependent side effect of Tacrolimus occurring in 15-40% of patients even at therapeutic levels – it does not necessarily indicate toxicity if the trough is within range; dose reduction may help if the tremor is functionally significant

Fine postural tremor is one of the most common neurological side effects of Tacrolimus, occurring in 15-40% of patients. It is dose-dependent but can occur within the therapeutic range. The mechanism involves calcineurin inhibition in neural tissue. It is usually tolerable and does not mandate dose change. If functionally significant (interfering with writing, eating), Tacrolimus dose reduction or switching to Ciclosporin (different neurotoxicity profile – more headache, less tremor) may be considered, weighing against rejection risk. Propranolol can provide symptomatic relief for essential tremor-like symptoms.

Reference: KDIGO 2009 – Transplant; BNF – Tacrolimus ADRs