#183

Alex - thats a good summary. What AI system did you use to generate it?

#184

To add another datapoint to the thread my 48hr drug level with 2mg Dr. Reddy Rapa was undetectable at <2ng/mL. I don’t augment with anything aside from take it with a fatty meal (olive oil). Will try 4mg for my next test but if I take 4mg weekly my glucose and ApoB go
up. On 2mg ApoB was 67, glucose 69, and insulin 1.6. Can’t dose 3mg because the Dr. Reddy tabs don’t split very well.

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#185

I’m guessing the new Deep Research from OpenAI

#186

What is the recommended sirolimus test in the US? The one from Ulta is kind of expensive ($123) to do weekly, which I would like to do for a few weeks.

#187

$25

other options here: How to get a Rapamycin (sirolimus) Blood Level Test

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#188

Why mess around with Siroboon or Dr. Reddys when you can use Zydus or Rapacan? Avoid problematic brands.

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#189

If that’s addressed to me, I’m taking rapamune. My goal with testing serum sirolimus levels is to find the dose with piperine that’s equivalent to 6mg standalone. Ultimately to reduce the cost/hassle of sourcing higher quality rapamycin.

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#190

I thought Dr. Reddy was a reasonable generic Rapa? It was what Dr. Green recommended to all his patients.

#191

Dr. Reddy’s is compounded, correct? I believe the enteric-coated tablets are the best.

(EDIT: Dr. Reddy’s appears to be enteric-coated.)

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#192

Nah not compounded to my knowledge. There is a press release from 2014 saying it is an FDA approved generic equivalent to Rapamune. Generics, to my knowledge, undergo quality control and potency testing.

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#193

No,not compounded. Any of the generics are going to have some sort of barrier or technology for getting the rapamycin through the stomach to the small intestine. Dr. Reddy’s is a generic manufactured in India but sold as a generic in the USA, so its fine (as a general product).

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#194

My pharmacy was giving me siriolimus from Dr. Reddy… got it for a year…hard outter shell like an M&M and beige, triangle shaped. Then they switched to Zydus round greenish tan color.

Rapamycin Sirolimus pills 2mg each

I liked it the best.

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#195

@Agetron

Yes mine are like that except a darker color. Same shape and hard coating.

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#196

@RapAdmin, thanks for sharing this yesterday!!! I was finally motivated to do this after seeing the look on your face when I said I was taking 6mg :)!!! Ha!

I just booked my lab visit for 48 hours after I take my rapa today.

@DrFraser, if I recall, you said to test 48 hours later, am I remembering this correctly? I am double checking my memory because on their website, they seem to say 12-24 hours later… see below.

I’m planning on 48 unless I hear otherwise.

Next Friday I can check my 6th day results to see where it ends up.

On their website, it says the following:

“If measuring peak levels, schedule your blood draw approximately 2-3 hours after taking your Rapamycin dose. This captures the highest concentration of the drug in your blood. If measuring trough levels, schedule your blood draw 12-24 hours before taking your Rapamycin dose. This reflects the lowest concentration and steady-state level in your system.

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#197

So the instructions on the website is for individuals taking it daily. They don’t have instructions for those taking it cyclically.
The instructions for cyclic use is 50 hours post (approximately) for weekly dosing, and 100 hours post if doing every 14 days.
In other posts, I’ve gone through the rationale for this. I like to see a 2.8-3.2 ng/mL on these tests (the 14 day dose is naturally larger than the every 7 day dose to achieve this).
Only a single level is necessary to figure out appropriate modification of dosing with the way I approach this.

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#198

I appreciate the feedback, so 50 hours it will be!

Do you recommend I also do on the day before my next dose to make sure it’s out of my system, or does the 50 hours tell us all we need to know?

#199

If you want to know the half life of rapamycin for you, you need one test around 48h after taking the rapamycin dose and a second one around 96h (48h after the first test)

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#200

Hi Dr. Fraser. So, I just got my blood level sirolimus results. This is about 49 hours 15 minutes after the last dose. My dose is 6 mg once a week. The result of the test is: 5.6 ng/mL. You say: “I like to see a 2.8-3.2 ng/mL on these tests[…]”. I would therefore imagine you think my blood level of rapamycin 49-50 hours after the last dose is somewhat high for a once weekly 6 mg dose. I’ve been taking the 6 mg a week dose for 11 weeks, and started with one week each of 3, 4, 5 mg before hitting the 6 mg where I stayed for 11 weeks before the test. I take the 6 mg every Saturday, on an empty stomach after an 18-20 hour overnight fast, and after taking the dose, I eat nothing for another 3-4 hours (but drink some matcha tea about 90 minutes after the dose). For my dose I use 6 pills - 1 mg each - of Rapacan brand marketed by Eris (shipped from an Indian pharmacy).

I have just had some dental surgery 12 days ago (bone augmentation and titanium post implantation) which is why I have taken a break from rapamycin - last dose 04/05/25 - and will resume at 6 mg a week probably May 17, or May 24. The break is in case wound healing might be retarded by rapamycin. If the healing seems to progress well, I will resume rapamycin (4-5 weeks after surgery).

My question: what does a level of 5.6 ng/mL mean for me at 6 mg once a week?

I suppose I should also test at the end of 6 days from the last dose - 24 hours before the next dose - to see if my blood level of rapamycin goes to essentially zero, or whether by keeping at that dose and frequency there isn’t some kind of accumulation going on. Thank you!

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#201

My suggestion is that a level of 5.6 ng/mL at that time, likely means that you are spending ~80 hrs/week at a level above 3.0 ng/mL, which from my perspective is a bit much at 50% of the time (I goal for 30% of the time = 50 hours). I don’t know if this is safe. I know with targeting 2.8-3.2 ng/mL at 50 hours I’ve not seen any significant adverse effects.

This is the reason why measuring a level is sensible as I’ve got patients who are similar in size/gender who have deviations of 400% in regard to what dose is required. I don’t know why so much variation - but it is consistent in that individual. It has to be an issue with gut absorption - and most are on the same formulation from CVS - so it isn’t an inter-brand issue.

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#202

Thank you, Dr. Fraser. FWIW, years ago, I had an SNP variant flagged by 23 and me, to the effect that my variant resulted in less efficient cytochrome P450 function, and consequently my ability to clear drugs/medication is slower than average. Perhaps this rapamycin level test is an example of that.

I suppose I should report the effects that I have observed while on rapamycin 6 mg once a week, for 11 weeks. Not a ton, but one positive result, that after a few weeks on rapa, I started to notice that I had almost eliminated joint and tendon soreness during and after exercise. This was both in weight lifting and jogging. Before rapa I had some regular soreness around my right knee patella and some feet bone soreness. It took some weeks, but one day I noticed that I no longer had those symptoms - more precisely, it felt like the vulnerability in those places was still there, just not expressed in soreness, as if tamped down. On the negative side, I definitely had some pimples on my face, usually 2-3 at a time - nose, chin, forehead, and 3-4 on my scalp, under my hair - this too happened after a few weeks on rapa. Not giant or particularly deep, but there - except one, which interestingly appeared some 10 days after my last dose in the rapa break I took before dental surgery - a pretty deep nodule on my nose which is still slowly healing. I almost never had pimples/acne prior to taking rapa.

As to biomarkers, from the rest of my blood test results. No impact on glucose - exactly the same fasting BG and A1c of 5.8 as before (October 2024 test), which is disappointing insofar as I have been on 12.5mg/day empagliflozin (Jardiance) for four months. But at least rapa doesn’t seem to have made it worse. Same for blood lipids. Liver marginally worse AST from 19 to 21, ALP 73 to 86 hard to say if it’s rapa. But hsCRP went down from 0.3 to 0.25 - again minimal change, hard to pin on rapa. Other biomarkers also mostly unchanged or minimally changed.

My plan is to continue with the rapa 6mg once weekly dose after the break, perhaps around May 24, but be more cautious around vaccinations and surgery or significant wounds or bacterial infection opportunities (take breaks more readily). Knowing my rapa levels at this dose are relatively high and potentially risky, I will be especially vigilant for side effects, and more readily take breaks. I will also take another test for rapa levels six days after a dose, one day before next dose to see how low it gets. Cautiously going forward! Thank you again.

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