#380

Love it, so melatonin and continuous ketone (and glucose) monitors could be part of the strategy to optimize / minimize risks around DKA

Any other ideas for what could be included in a comprehensive strategy to minimize any DKA risks?
(I for one would like to still do 16/8 to 18/6 feeding windows and 3-5 day water only fasts now and then)

1 Like
#381

I know that there are a lot of topics that discuss safest and best ways to order rapa and other medicines from India

Does anyone have advice or is there is any forum topic on how to order medicines from EU countries to the US?

( - esp in cases like this where they are off patent there and not yet in the US -

that seems even safer than from India - even if it might cost more)

#382

Oh, no question, ordering off-patent medications rom Europe would be much safer and better… if it could be accomplished. The issue is that (unlike India) these countries have well-functioning healthcare and legal systems that are optimized to serve their populations - and selling drugs to people outside of the EU is likely not legal or certainly not as easy as ordering from India.

But perhaps if you have a prescription it might be possible in some areas… for example perhaps you could get a prescription from EuDoc using a friend’s address in Europe, then with that prescription buy medication from an online European pharmacy, have it shipped to a friend in Europe, and then have it shipped to you in the US by your friend. Just brainstorming here…

2 Likes
#383

Germany is the only country in EU that allows sending prescription medicines.
The only other possibility is that ypu get a prescription and a friend who fills it in pharmacy and sends it to you, but medicines shouldn’t be declared as they are forbidden to send in and out of EU.

PS I should add that Germany has highest medicine prices in EU, e.g. rapamycin is usually around 120-140 EUR for 30x1mg in most EU countries, in Germany it is almost 500 EUR…

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#384

I believe only dapaglifozin is generic.

#385

You’re right. Even that may be hard. European doctors rarely prescribe off-label: they mostly follow national guidelines. So you’d struggle to get a prescription for anything “exotic” first (I include SGLT2 inhibitors in “exotic” drugs, for someone without T2D/CKD/HF).

You could try to buy from non-EU European countries like Serbia, Kosovo, Montenegro, Ukraine, and Turkey. But I am not sure it would be much safer than India (I would trust Turkey though). And these products may not even be approved and available there.

Yes, dapagliflozin is generic in Canada, the US and the EU but in the US the generic cannot be sold until October 2025.

In November 2023: Lupin Receives Tentative Approval from U.S. FDA for Canagliflozin Tablets

Same for empagliflozin in the US: US generics launch and approval for Dr Reddy’s and Lupin

Ertugliflozin is also approved as generic in the US: First Generic Drug Approvals | FDA

It looks like empa and cana are not generic in the EU though.

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#386

I think I’d read somewhere that Indian meds are good quality, plus I was surprised to read that a few of big pharma actually make their medicines in India. So far everything I’ve bought from India has been good (meaning it has had the desired/supposed effect)

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#387

Empagliflozin improves mitochondrial dysfunction in diabetic cardiomyopathy by modulating ketone body metabolism and oxidative stress

1-s2.0-S2213231723004111-ga1_lrg
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Open access article:

https://www.sciencedirect.com/science/article/pii/S2213231723004111

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#388

Any sense on when and from where (normal pharmacy’s?) they will actually be available in the US?

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#389

No idea on the Lupin product launch. I’m sure we’ll hear about it when it becomes available (and it will show up at places like CostPlusDrugs.

Some other related news:

SGLT2 Inhibitors Appear Protective Against GI Cancers

Results of a global network database of patients with type 2 diabetes suggest that sodium-glucose cotransporter-2 inhibitors could reduce the incident risk for gastrointestinal cancers except pancreatic cancer. In a comparison of SGLT2 and dipeptidyl peptidase-4 inhibitors, patients started on SGLT2 inhibitors had almost a 15% lower risk for these malignancies.

The study showed protection against cancers of the colon, esophagus, stomach, small intestine, rectosigmoid junction, rectum, anus, liver, bile duct and gallbladder among the 1,412,780 individuals drawn from 92 U.S. medical centers in the TriNetX database of more than 200 million patients.

Screen Shot 2024-01-10 at 10.20.39 PM
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Full Story:

https://www.gastroendonews.com/PRN/Article/12-23/sodium-glucose-cotransporter-2-inhibitors-gastrointestinal-cancers/72224

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#390

Here’s the paper: S321 Lower Incidence of Gastrointestinal Cancers in Sodium Glucose Co-Transporter-2 Inhibitor-Treated Patients With Type 2 Diabetes Mellitus: A Population-Based Cohort Study in the United States

Too bad the authors did not look at the dose relationship and at each SGLT2. Does more/longer SGTLi use prevent cancer more? Which SGLT2 is best?

This paper is also good: Sodium‐glucose cotransporter 2 inhibitors versus dipeptidyl peptidase 4 inhibitors on new‐onset overall cancer in Type 2 diabetes mellitus: A population‐based study

To the best of our knowledge, this is the first territory‐wide study that does a direct comparison of the effect of SGLT2I and DPP4I on overall and pre‐specified cancer risk in a cohort of Asian patients. The main findings of this study are as follows: In comparison with DPP4I,
(i) SGLT2I were associated with a lower risk of all‐cause mortality, cancer‐related mortality and new‐onset overall cancer;
(ii) SGLT2I were related to a lower risk of new‐onset breast cancer;
(iii) when stratified according to the medication subtype, dapagliflozin and ertugliflozin both demonstrated a reduced risk of new‐onset malignancy, with the former also presenting with a lower risk of breast cancer.

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#391

Potentially another SGLTi super power (weak data/signal for now, more research needed…):

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#392

Is this a good price, have never bought before. Seems a bit high, NO?

200 tablets Empagliflozin 25 mg - $ 160

Thanks,

#393

I wish that was true.

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#394

Invokana 100mg Tablet , Canagliflozin (100mg) , Johnson & Johnson Ltd = 7.5 USD for 10 tablets.

My last quote from Jagdish

1 Like
#395

As fas as I am concerned i only care if it is generic in India. Very good chunk of people on these boards order from India. I have to assume though that if it is not generic yet in USA it can’t be produced/generic in India either?

#396

that’s pretty cheap, plus the real deal from J&J. I was more interested in Indian prices, since I don’t want to bother to go through a doc at home.

#397

Are you sure that is not some for of copay, this is what shows in search results: more like $20 per pill here in USA lol

CVS Pharmacy

Invokana

30 tablets 100mg

Logo of CVS Pharmacy

$619.93

BINPCNGroupMember ID

009893DCAE1RXGD6KU609576

#398

I updated my post to indicate that was the quote from Jagdish (India).

1 Like
#399

Same. I order from there a lot and never once was disappointed

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