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Tacrolimus Toxicity — RACP Adult Medicine MCQ

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ModerateNephrologyTacrolimus ToxicityRACP Adult Medicine

A 50-year-old liver transplant recipient on tacrolimus develops new-onset diabetes, alopecia, and fine tremor. He also has posterior reversible encephalopathy syndrome (headache, seizures, visual disturbance with parieto-occipital white matter oedema on MRI). What is the most likely causative immunosuppressant?

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Correct answer: B — Tacrolimus

New-onset diabetes, alopecia, tremor, and PRES are characteristic of tacrolimus toxicity. Tacrolimus is 100× more potent than ciclosporin as a calcineurin inhibitor. PRES is a recognised complication (especially with supratherapeutic levels). Both calcineurin inhibitors are nephrotoxic, but tacrolimus causes more diabetes and neurotoxicity than ciclosporin.

Reference: AMH – 2025 – Tacrolimus; TSANZ 2024