16th May 2025

A 35-year-old patient who has recently been commenced on tacrolimus following a renal transplantation presents to the emergency department generally unwell with dysarthria and tremors.

A 35-year-old patient who has recently been commenced on tacrolimus following a renal transplantation presents to the emergency department generally unwell with dysarthria and tremors. Initial bedside investigations, pending bloods, include an ECG, which shows QTc prolongation. You suspect tacrolimus toxicity may be the cause of this presentation. 

Tacrolimus toxicity can often present with multiple different signs and symptoms including electrolyte disturbances, tremors, visual changes, dysarthria, renal impairment, and ECG changes such as QTc prolongation.

What is commonly the first sign of tacrolimus toxicity?

Select the SINGLE most appropriate option from the list below. Select ONE option only.