I would go with the doctor’s prescription. The medication provided in the USA is going to be fine (most of the rapamycin is Glenmark sirolimus I believe), and you have higher confidence that its going to have been stored at the correct temperature since manufacture and during storage in the USA.
While Zydus has been good from a quality standpoint (shown via lab analysis), you have no idea what the storage conditions have been since manufacture and its been very hot in India for many months in India this year.
And you get the benefit of working with a doctor who hopefully knows something about rapamycin and will work with you to analyze your lab work and track things.
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Justin
#1164
The "buy in winter does seem sensible, a good idea, thanks for that.
You state: “…it’s no wonder that a lot of them lose potency by the time they arrive in your mailbox.”
Have you any data of substance to point to any “loss of potency,” from any meds shipped from India? Perhaps you could please share that data.
A couple of years ago, there was a study done that I found interesting. It seems that about 40 years earlier than the study a pharmacy closed and its entire stock was warehoused. The warehouse temperature was controlled, so there were no excursions +/-. The study looked at hundreds of meds analyzing them and the reality was that almost all were still very potent.
Hot in India is valid, although “muggy” likely is not. It’s “only” America where our pharmacists count out tallies of pills and place them into non-airtight containers–the dark ages persist in America. I have not seen any imported meds that are not in blister packs or in bottles that are sealed.
I do like the “winter” idea though as I have gotten a recent shipment of “keto” candy bars (no sugar) that were partially melted, and that’s valid even from shipments within America.
I did get one shipment of meds from Optum that was left in my mailbox overnight and the temperature dropped to about zero f. I called the manufacturer and they advised to send them back, and I did.
So maybe September > Nov and March>May would be good.
If I buy my Relugolix I can do a “quality check.” After two weeks my testosterone level should be below 50 nanograms/ml. That might be a quick and dirty "did the heat in India hurt that med test. In other words do that brand/batch of meds do what is expected.
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@Justin - I don’t have any specific studies showing loss of potency of medications shipped from India. I am basing my concern on the realities of transportation conditions in general. As the article states, unless there is a specific chain of transport dedicated to temperature control, such as refrigerated trucks, you are dealing with the vagaries of extreme temperature variation (btw. airplane cargo spaces can sometimes have surprisingly cold temperatures at higher altitudes) - the example given was the 150 degrees in the back of a truck. It doesn’t matter if the package is shipped from India or Timbuktu, it will at some point be transported by truck whether in the country of origin, transfer or destination, such as the USA - if the plane lands at a distribution hub in say, Arizona, or Nevada, and the temperature is 100+ degrees outside, and 150 in the back of the truck, after hours of transport time your meds might be in rough shape no matter where they originally came from, India or a pharmacy in Antarctica 
.
And we do know that meds are affected by temps, obviously some more than others, but even common over the counter drugs like aspirin can break down chemically:
Heat, medications don't mix.
Obviously, every med is different in this respect, so you must have info about every specific drug. For example, I’ve read on this board that some people prefer to store their rapamycin in temperature controlled environments, like a refrigerator. Personally I don’t know how exactly rapamycin is affected by temperature over time - maybe for longer storage a fridge makes sense. But the risk is in not knowing how much exactly a given med loses in potency - here a binary test present/not present might not tell you much. If I buy empagliflozil from India, and then test my urine for the presence of glucose, what does that tell me? If it’s not present, OK, potency zero. But if it is present how do I know that it’s less potent? Maybe it’s my body less affected by empag - I have no way of knowing from a test strip. Only a lab that tests my sample of the empag medication itself, that I got from India, can tell me if it’s fully potent. And how practical is it for me to test every batch of every med I get from India? Btw., I’m not picking on India - the same concerns apply to any meds that are handled by ordinary, non-temperature controlled transportation chain (as the article says). When you go to a pharmacy and pick up a med, you’re hoping that their transportation and storage is designed for purpose. When you are sent a package by mail, you have no idea. YMMV.
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Justin
#1166
Interestingly, the one med from that cache that had actually turned toxic over the 40 years of storage, was aspirin.
The issue that I have is with the Orgovyx that I need to order, even of Medicare it’s $800+ per month, and shipped from India, it’s ~$90, thus an annual savings of $8400, therefore I’m sort of stuck, taking a chance, as it may be. Orgovyx unlike empaglifloxil at least does give me a checkpoint. Therefore, if, let’s say it’s half potency due to heat, there is no direct correlation of urinary glucose output. Whereas’ the Orgovyx it either brings Testosterone down below 20 nanograms or not. Though I’ll agree that even then it may have done the necessary job even with some potency loss.
The take-away I think is to be aware of the risk and act accordingly. So, perhaps the best is to ask when a med was manufactured and then make sure it was both manufactured in the cooler months, though even then, much of what you say is true, no guarantees.
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I have just received rapamycin (Rapacan and Siromus) from India which most likely has been subjected to very warm and possibly cold (on airplanes) conditions exactly as described in this thread unfortunately.
What would be the best way of testing considering this?
The only way I know of, is testing it in my own blood:
- Since I am new to this, gradually increase my dosage (1 mg first week, 2 mg next week, etc…) until I experience side effects or reaching 6(?) mg.
- Then follow your recommended FAQ-procedure for blood testing
How to get a Rapamycin (sirolimus) Blood Level Test - #10 by RapAdmin
Blood test 1: Right before taking my next weekly dose
Blood test 2: 1 to 2 hours after taking 6 mg rapamycin (to find approximate peak)
Blood test 3: 2(?) days later (to have a reference point on the decay curve)
This is what I have received according to Forveda India:
*30 strips (300 tablets) Rapacan 1 mg @ 150 Euros
34 strips (204 tablets) Siromus 1 mg @ 187 Euros"
“Rapacan has the expiry of January 2026 and the brand was of Biocon which is now owned by Eris (As the Biocon sold the brand to Eris few months back).
Siromus is by Zydus and has expiry of March 2026.”
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Thx DeStrider, I hadn’t heard of this before. I’ll give it a go.
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That is the only realistic way to test the efficacy of the the medication. If you are in Europe this may be difficult to do. It may not be worth the effort.
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Thanks, I plan to do blood testing. Regarding Europe, actually my local hospital has Sirolimus blood testing and if I cannot get a referral there I can take a flight to Poland to do the Sirolimus blood test in Poland for ~40 USD (150 PLN):
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Maybe this is why the Jardiance I received had so little effect. We went on domestically purchased Rybelsus after the last dose of that imported Jardiance, and it was like night and day difference. I know that they are 2 different drugs, however, the Jardiance had zero effect on my Hba1c or my appetite.
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Well, it’s hard to know if the Jiardance you received had impaired potency. That said, empagliflozil - and other SGLT2i based meds - by itself does not typically lower A1c much if at all if the A1c is not much above 6% or so. In general, lowering A1c is not a very strong effect of this medication, although of course many people do experience some lowering, particularly if their levels were high to begin with. It also does not affect appetite as much as Rybelsus, because that is a GLP-1 inhibitor which is the crucial mechanism by which semiglutide curbs appetite; and yes, Rybelsus does lower A1c, although some of the effectiveness of this medication on those biomarkers is mediated precisely by the patients consuming fewer calories. Empagliflozil (and SGLT2is in general) do not generally affect appetite, and so if you don’t consume less food (calories), then it’s not all that surprising that the A1c is not much affected. Calories is not the whole answer, but it’s part of it.
If appetite is a problem, then Rybelsus (and other GLP-1 inhibitors) is going to be far more effective in reaching your goals, especially if weight control is one of your goals. In this respect, Rybelsus is certainly superior. However, some here don’t care about appetite suppression, or are cautious about insulin, and therefore pick SGLT2i drugs because that’s what was used in the ITP (although ITP used canagliflozin, which also partially inhibits SGLT1). It is entirely possible that if they ran an ITP trial with semiglutide, you’d get an even better result than with SGLT1/2i compounds - and I dearly wish they would!
This is a long way of saying that while your Jiardance might have been rendered subpar by the problems with transportation and storage, the fact that it didn’t affect A1c and appetite, while Rybelsus did, is not the smoking gun, as even fully potent Jiardance might give you similar results - as you say, it’s just a different drug than Rybelsus.
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What do you think? Did it get seized?
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adriank
#1174
Mine is another week away…
I’m not sure. I’ve had it come to me with tape on the box from customs saying they’ve opened and evaluated the box, but then sent it on to me.
If they’re going to continue to hold it you’ll get a letter in the mail telling you.
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Out of curiosity, was the quantity of meds large, like 300+ count? Also was the package physically large, because it contained many different meds?
I ask, because I intend to purchase a bunch of different meds, including some which have to be taken daily, so the quantity is going to be high. I’ve seen claims made by various people that if you keep the package down to small dimensions it’s less likely to be picked by customs to be checked in the first place, and if you keep the med count below a certain number, like 300 pills, they’re more likely to let it go as they’ll classify it as for personal use.
In any case I figure it’s safer to break up a purchase into more packages, purely so that if it gets stopped or lost, you don’t lose as much $ investment at once. But I’ve seen folks say they’ve bought like 1000+ pills at once and received the package no problem, so I’m trying to gather data (for the USA).
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Vlasko
#1177
“Held in Customs” just means it’s being processed by US Customs.
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Hmm. It has never said “held” for me over a dozen orders or so. It’s a new status.
432, no more than 100 of one type.
2 weeks ago I had 490+5 inhalers in a pretty large box go through customs in less than a day.
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Thanks! Yikes, 100 is not a high count at all… this would mean A LOT of packages for stuff I want, lol!
I had a 1200 count parcel breeze through customs in record time. The package was about 3’x2’ in size.
Vlasko
#1181
It was recently added to the USPS tracking system. A package is “held” until it’s processed and then either released or seized.
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