Sudden drop in Tacro level..thoughts?

Hi Everyone  I hope all of you are doing well.  I am 5 years post kidney tx.  My Tacro has consistently come back 5-6.  I had a trough today, and it dropped to 3.2!  I have not missed any doses,  I have not taken any new medications.  I know Tacro can change; however, I'm wondering what might have happened.  My stress level was higher, since I was getting the EvuSheld vaccines for COVID prevention that morning also.  My father was recently diagnosed with cancer, and my daughter is also experiencing some health issues.  Does stress and increased metabolism affect the level?  If so, how? The only other change is that I tried taking in 8 glasses of H2O/day instead of my usual 6.  Now I'm thinking I may have diluted it if that is possible.  I will get a redraw, but I was just wondering if anyone has any thoughts on this.  It aseems a big change suddenly.  Lab error also crossed my mind.  Thanks everyone for any comments.  God Bless all.

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  • Hello,

    My Tacro level has always varied quite a bit until I figured out that the timing was everything. It is important to always have very close to the same amount of time between your last dose and when you have the blood drawn - even 15 minutes can make a difference. Thus I take my meds twice daily at 9am and 9pm, so try to have my labs drawn at 9am the morning after my last tac dose at 9pm the night before.

  • I have this problem too.  My level goes too high, we adjust the dose, then a few months later my level goes too low.  I can't figure it out.  My level shot up to 11-12 last Sept.  Changed the dose and I've been stable around 6 until I tested on 6/13/22.  My level was 3.5, so my doc had me add 0.5mg to my evening dose.  A month later my tacro level is 3.2 !!!  What the heck?  I just wish I knew why this is happening...


    • Yes, my doctors have no answers either. My next labs are in August, will see how it goes. 

  • Hello everone, 

    I have an update: My Tacro went up this time around from 4.8 to 5.5, and we have no idea why the sudden drop. I haven't had this happen in 14 years since the transplant. My GFR went down to 56 and Creatinine up to 1.4. However, this has happened to me over the years where it goes up and down. My Creatinine base line since the transplant has fluctuated between 1.1-1.3 so although the doctor is not concerned, it is always worrysome for me. Scheduled for a repeat by my Nephrologist on the 18th of June for a double check. All other lab results were perfect. 

  • I recall something my neph said last year about changes he was seeing in levels due to a change in the brand of tacrolimus used by pharmacies.  Mine had also gone down a little.  You might ask about this.

  • What a coincidence with so many people reporting similar issue! I too had TAC levels drop from 5-6 to 2.54. The dose was increased and now it is back to 5.5. Maybe it was Covid booster dose that upset the balance. I only hope it has not damaged the graft.

  • Hello  Chris, 

    I had same issue in 2018-19 - Low Tacro level and higher Createtine level. Me and my doctor worked hard to back to desrired level but no luck.  What I felt that time was due to my physical activity as I joined Crossfit that time.   After trying for 1 year, my doctor switched me to Belatacept.  

    I think it just happened without any reason atleast for me.   Check with your doc regarding Belatacept,  my createtine is back to normal and no stress to maintain tacro level. 

    Please keep us posted :) Good luck. 



  • This is so interesting, I logged in to communicate to all what my sister's Nephrologist told her at her appointment today, and I find this coincidence which may not be one at all. My sister appt went well with the exception that her Tacro level was very low howevering aroung 3.0 when it has always been over 6. My Tacro also went down to 4.8 on my last blood work when it has always been above 6 as well. Now, you mentioned this, and I am sure this has to do with the vaccines. In addition, my sister's physician told her to not get another COVID-19 vaccine because they were seeing organ rejection and he has patients hospitalized because of this. I work in healthcare and have a friend who works with Cancer patients, she told me that they have seen an increased of cancer returning in patients that have been in remission from lymphoma. I will not be getting another COVID-19 vaccine.

  • Hi Chris,

    All of the issues you mentioned usually would raise your Creatinine, with the exception of the added water intake. Consider what else has changed, for a moment. Did you have labs drawn at a different time? Maintaining draws at 12 hrs. from your last dose will ensure accurate results.

    It most likely is an aberration. You may be correct that the lab was in error. The best course is to retest before making any other changes. Good Luck! 

    • Thank you for your input.  Labs were due at 9.  They only had one phlebotomist, so it was drawn at 9:15.  Only 15 minutes ate,  but still.  Whenever I tell them it is a timed trough, they always say "you have an hour".  I disagree.  But I'm not sure 15 min would cause such a drop.  Waiting to hear today from transplant center.  I'm sure we will start with a redraw.  Have a happy, healthy day!

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