Tacrolimus and Metoclopramide Interaction

Monitoring and Dose Adjustment

• When starting metoclopramide in a patient on tacrolimus, check tacrolimus trough levels within 1-3 days of initiating metoclopramide, as levels can rise relatively quickly, and continue monitoring tacrolimus levels every 2-3 days until stable therapeutic range is confirmed 1
• Be prepared to reduce tacrolimus dose by 25-33% if levels rise 20-50% above target, or by 50% if levels exceed 50% above target 2

Target Therapeutic Ranges

• For lung transplant recipients, the target therapeutic range for tacrolimus is 10-15 ng/mL early post-transplant, then 5-10 ng/mL long-term 2
• For general transplant monitoring, the standard recommended range for tacrolimus is 5-15 ng/mL 3, 4

Clinical Significance

• Proactively monitor tacrolimus levels rather than waiting for clinical signs of tacrolimus toxicity, as metoclopramide can increase the risk of serious adverse reactions 1, 4
• When metoclopramide is discontinued, recheck tacrolimus levels as they may drop, potentially increasing rejection risk 1, 3