#1

I’ve been taking Rapamycin for over 4 months without seeing any effects. I looked up “Drug Interactions” on Medscape and may have found the problem. There were several things on the list that I was taking, but I can just quit taking most of them on the day I take the Rappa, however I have adrenal insufficiency and make almost no cortisone (0.07 at last test–normal is 6 to 20.) All the steroids are on the no-no list. I can try leaving the Prednisone off for one or two days, but I’m not sure I can tolerate it. Would Licorice, which recycles cortisol, be any better? (I know I would have to be careful to avoid the deadly side effect of low Potassium.)

I take 6 mgs of Rapa once a week. Would I need to leave off the steroid before and after in addition to the day I take it? How long would I need to leave it off?

Does anyone have any advice? Tomorrow is the day I take it.

I found the following info on Medscape at https://reference.medscape.com/drug/rapamune-sirolimus-343206#3 :

“Drug interactions for rapamycin”

“hydrocortisone will interfere with hepatic intestinal enzyme CYP3A4—use a different drug” also says it will increase the effect of hydrocortisone.

Cortisol reduces effect of Rapa as above.

Prednisone reduces effect the same way as above

Maitake decreases immunosuppressant action –use caution

Quercetin decreases sirolimus effect by level of MDR1 use caution

Tumeric increases affect of CYP3A4

#2

I won’t give any person specific advice on the board.

However, as a general statement, if one is physiologically replacing their corticosteroids, it’s in no way different from a normal person whose body is making it.

The interactions and concerns when searching the respective drugs will be for individuals on immunosuppressive doses of corticosteroids.

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#3

I’ve done both without problems. But I assume your prednisone dose is around 5mg? So that’s nowhere near an immunosuppressant dose, so I don’t believe it should be a major concern.

Totally unrelated… I would caution against the use of prednisone for adrenal issues, and opt for hydrocortisone.
Prednisone, even at low doses, still does affect calcium absorption. Taking it for long periods of time can be disastrous… and lead to osteoporosis. I’ve seen this happen before at only 5mg.

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#4

Thanks. I agree, but my doctor thought Prednisone was better. I’ll go back to hydro-c if he will change my prescription.

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#5

I"m taking 3.75 mgs and sometimes less, but I have a problem. Someone suggested taking it every other day. What would the dosage per if I switch to alternate day dosing? Thanks for your advice.

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#6

Sorry, I didnt even ask… do you have Addison’s disease?

Assuming you do, a dose like 3.75 mg of prednisone is more reasonable… but I would make sure to get a bone density test. Dosing every other day wouldn’t be ideal.

hydrocortisone has a much safer profile, but the disadvantage is that you have to dose it around 3 times a day. For some, that’s too much of an issue. But you just set up a timer, and its very straight forward.

#7

No, not Addison’s, but Secondary AI, most likely caused by prescription Prednisone. I had an incompetent endocrinologist, who insisted that I didn’t have Secondary or Primary, but “some other kind.” It wasn’t until I changed doctors that I found out it was secondary, but by then they said it was too late to correct it by gradually reducing the dose. I’m still trying anyway, but not seeing any improvement. I’m hoping that lowering my dose while taking Rapamycin may be more sucessful. I also have Ehlers-Danolos Symdrome (with MTHFR, Mitral Valve Prolapse, MCAS, and worst of all, POTS. The combination is wicked.)

I’m getting a bone density test this week, but I had X-rays recently and they showed that I already have Scoliosis and de-mineralization. I took Hydrocortisone for several years but the doctor who prescribed my Rapapmycin was adamant that Prednisone was better; so I reluctanty changed back to Prenisone. I will try to get my prescription changed back to Hydro-C.

Can you give me a source that says Prednisone is worse for bones to show him? All I’ve found is that all steroids are bad.

Thank you so very much for taking the time to offer your advice.

#8

Sorry to hear about this. Glucocorticoid-induced adrenal insufficiency (GIAI) is all too common. I don’t mind helping… as I’ve spent a huge amount of time researching corticosteroids for my own issues.

Sure:

The use of prednisolone as hormone replacement therapy results in significantly lower BMD compared to HC. Patients on low-dose HC replacement therapy showed unchanged Z-scores within the normal reference range during the study period.

Ccortisone always has the capacity to reduce the body’s ability to absorb calcium. However… when dealing with adrenal insufficiency, hydrocortisone can be used to better ‘simulate’ the bodies natural cortisol requirement… because it IS cortisol, and it has a short half-life. But with Prednisone… the half life is far longer… in fact the biological half life can be over 40 hours… which is perfect for kicking an autoimmune disease into remission, but awful for simulating our natural cortisol.

I don’t understand why your doctor is so adamant about prednisone for this. I understand its easier/more reliable… but at a huge long-term cost. Sure, those who’ve used it felt completely fine… until several years later when they woke up with a broken hip.

#9

Thank you so much! I had a little HC on hand that hadn’t expired, so I switched back this morning.

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