A 45-year-old man post-renal transplant on tacrolimus develops hyperkalaemia (K⁺ 6.5 mmol/L). His tacrolimus trough level is elevated at 18 μg/L

Question

A 45-year-old man post-renal transplant on tacrolimus develops hyperkalaemia (K⁺ 6.5 mmol/L). His tacrolimus trough level is elevated at 18 μg/L (target 8–12). eGFR is 40 mL/min/1.73m². He recently started fluconazole for oral thrush. What is the most likely precipitant?

Accepted Answer

Dietary potassium excess

Answer

Lisinopril alone

Answer

NSAIDs (ibuprofen) in combination with RAAS blockade and MRA

Answer

Rhabdomyolysis

Answer

Spironolactone alone

Tacrolimus-Fluconazole Interaction — RACP Adult Medicine MCQ

A 45-year-old man post-renal transplant on tacrolimus develops hyperkalaemia (K⁺ 6.5 mmol/L). His tacrolimus trough level is elevated at 18 μg/L (target 8–12). eGFR is 40 mL/min/1.73m². He recently started fluconazole for oral thrush. What is the most likely precipitant?