Monocular 3D object detection (Mono 3Det) aims to identify 3D objects from a single RGB image. However, existing methods often assume training and test data follow the same distribution, which may not hold in real-world test scenarios. To address the out-of-distribution (OOD) problems, we explore a new adaptation paradigm for Mono 3Det, termed Fully Test-time Adaptation. It aims to adapt a well-trained model to unlabeled test data by handling potential data distribution shifts at test time without access to training data and test labels. However, applying this paradigm in Mono 3Det poses significant challenges due to OOD test data causing a remarkable decline in object detection scores. This decline conflicts with the pre-defined score thresholds of existing detection methods, leading to severe object omissions (i.e., rare positive detections and many false negatives). Consequently, the limited positive detection and plenty of noisy predictions cause test-time adaptation to fail in Mono 3Det. To handle this problem, we propose a novel Monocular Test-Time Adaptation (MonoTTA) method, based on two new strategies. 1) Reliability-driven adaptation: we empirically find that high-score objects are still reliable and the optimization of high-score objects can enhance confidence across all detections. Thus, we devise a self-adaptive strategy to identify reliable objects for model adaptation, which discovers potential objects and alleviates omissions. 2) Noise-guard adaptation: since high-score objects may be scarce, we develop a negative regularization term to exploit the numerous low-score objects via negative learning, preventing overfitting to noise and trivial solutions. Experimental results show that MonoTTA brings significant performance gains for Mono 3Det models in OOD test scenarios, approximately 190% gains by average on KITTI and 198% gains on nuScenes.