Tacrolimus and progesterone

AliEm14

So I’ve been talking for a while about my issues with elevated ALP. It’s more common in small patients (which I am) and female donors, and it’s been kind of accepted this will always be something I struggle with.

i’ve been tracking my ALP flare ups for a few months and consistently they happen during the luteal phase of my cycle. Like it’s a running joke that if I have high ALP we know I’m going to start my period soon. And they lower themselves within a week or so (which would be when I move from luteal to menstrual phase).

I’ve been talking to other transplant patients who have also had higher ALP levels in conjunction with their hormone levels, which I noted as weird. I knew there had to be something there but I’m not a science person, and I also know very little research has been done using female test subjects.

so recently I was looking up tacrolimus for an herbalism course I’m taking, finding out how exactly it works in the body to avoid herbs that interact with tacrolimus in any way. And I discovered one of the thing tacrolimus does it potentiates (amplifies) progesterone in the body. when you think about it, the luteal phase is when a woman is at peak progesterone level.

so, being the curious cat I am, I looked up progesterone and the liver. One of the things high progesterone does is cause elevated ALP levels.

in my head it’s so obvious this is a contributor to my struggles.

does anyone know if there’s been any research done on hormone levels (specifically progesterone) and tacrolimus?

AliEm14

I thought I’d share what I came across, in case anyone else is searching.

I brought this up with my doctor last week, and the conversation went a lot like “I’ve never heard of this, let’s look at the most obvious reasons for your high ALP first.” Which I get ruling out things, but in my gut I knew this was it. A few hours later my doctor called me back and the first words out of his mouth were “you were right.”

primarily in liver and kidney transplants, menstruating women can have fluctuations in ALP, which is due to tacrolimus increasing progesterone in the body. In peak progesterone time, the luteal phase of the cycle, the high progesterone can cause elevated ALP levels and liver enzymes. He sent me a few pdfs for my own research, if anyone is interested I can email those along. But if you are a menstruating woman, this could be something to consider.

its fairly new research since previously none of the studies were conducted in women. It was just assumed female bodies would react the same as men to tacrolimus, which obviously isn’t the case.