Q: 48 year old male s/p single lung transplant ten days ago developed tremors all over the body associated with confusion. What could be the likely cause?

Answer: Prograf toxicity

Prograf (FK 506,Tacrolimus) is a commonly used medicine in transplant patients and its level should be monitored closely. Dosage should be adjusted based on the trough levels of medication. Normal trough level is 5-15 ng/ml.

Prograf toxicity may cause blurred vision, liver and renal failure, tremors, hyperkalemia, hypomagnesemia, and neurological problems such as seizure, encephalopathy, cerebral edema, confusion etc.