Generally, rapamycin and everolimus from India seems acceptable in quality based on these types of lab tests we’ve seen: Rapamycin / Sirolimus from India, Lab Test Report on Quality / Purity

But - I’m personally not a fan of small Indian Pharma companies because in my opinion it seems that they are more likely to be selling a lower quality product. See this post: Overseas vs obtaining a prescription - #8 by RapAdmin

Also - perhaps of interest: Side Effect Profile for Everolimus: Doses from 10mg to 70mg per Week

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This is not a good paper to draw that inference. As far as I can see, they put rapa directly into the drinking or gavage water with no additional formulants. As is pretty well known, oral rapa has to be protected from stomach acid or it will be degraded before it gets into the small intestine and absorb: trying to get this right was what held up the ITP study, and the ITP, Trivium Vet (for the TRIAD study), and others use various kinds of microencapsulation to ensure delivery intact to the lower GI. Since they here just put it in the water, the absorption will be far lower and the dose is therefore not comparable the same way it would be.

Significantly higher than what?

As above, you would need to somehow adjust the starting dose lower to account for the reduced bioavailability of the straight-up rapa in water get an equivalent dose in pharmaceutically-formulated rapa tablets.

Your point is well taken, but not applicable in this instance. Per the paper, the oral “gavage group received 1.5 mg/kg rapamune”. That’s the nanoparticle-based pharmaceutical formulation you reference at the end of your post.

The daily intraperitoneal injections used in the study @hunterama1 mentioned (Liu et al. 2017) would result in significantly higher levels of everolimus than the 3 times a week every other week intraperitoneal injections of rapamycin used in the study I had just mentioned for comparison (Leontieva et al. 2014). It’s the difference between 14 injections and 3 in a two week period.

I referenced that Blagosklonny paper because it directly compares the same dose of rapamycin given intraperitoneally and orally. But, the different pharmacokinetics of intraperitoneal injections and oral intake are widely known within fields that work with rodents. Most drugs injected i.p. absorb rapidly because the peritoneal membrane has a large surface area and a rich blood supply. So, i.p. injections typically result in higher bioavailability and a faster onset of action compared to the oral route. Drugs injected i.p. typically clear faster, too.

Here’s Matt Kaeberlein on the topic:

Analysis of rapamycin levels in blood suggests that daily i.p. injection of 8 mg/kg yields blood levels of around 1800 ng/mL one hour after injection and 45 ng/mL 24 h after injection (Johnson et al., 2013c). For comparison, blood levels of 3–4 ng/mL rapamycin were measured following dietary delivery at 14 ppm in the same mouse strain (Zhang et al., 2014) and studies from the ITP have reported between 9–16 ng/mL at this dose and 23–80 ng/mL in animals receiving the 42 ppm rapamycin diet (Miller et al., 2011). Thus, daily i.p. injection of 8 mg/kg rapamycin, which appears to be well tolerated in wild type mice (Johnson et al., 2013c), yields circulating levels of the drug that are at least 20-fold higher than the highest concentration that has been carefully tested for effects on normative ageing. (Kaeberlein 2014)

Here’s a helpful figure from (Johnson et al. 2015):

And, to get a better sense of the comparative doses, here’s the math for the highest oral dose:

378 PPM = 378 mg/kg of food = 0.378 mg/g × 4 g average mouse food consumption = 1.512 mg / 0.025 kg average mouse body weight = 60.48 mg/kg body weight.

Approximately 60 mg/kg body weight of encapsulated rapamycin (the same formulation used by the ITP) yielded 709.8 ng/mL, while 8 mg/kg body weight of i.p. injected rapamycin yielded 1842.0 ng/mL.

I hope that clears things up.

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It’s now late October 2023. This study was published 4 days ago. Please, may a smart person read this study and explain what it means. The standout quote is “ The analysis revealed that the cellular response to everolimus differs dramatically from that of rapamycin and temsirolimus.“

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"Everolimus affects the ubiquitin-proteasome system (UPS) more than sirolimus. This increased effect on the UPS can be considered both good and bad: The good: - Everolimus’ greater impact on the UPS enhances its anti-tumor activity compared to sirolimus. It causes more degradation of proteins involved in cell proliferation and survival. The bad: - Excessive inhibition of the UPS by everolimus can lead to toxic accumulation of proteins in cells. It may also cause more side effects than sirolimus. So the increased effect of everolimus on the UPS has tradeoffs. It improves anti-cancer efficacy but also likely worsens tolerability and side effects.

“Determining if its overall impact is good or bad depends on the clinical context and individual patient factors.”

The normal dosing of everolimus is 10 mg/daily for therapeutic effects on cancer etc.
I would think that a once weekly or even every few days of dosing everolimus wouldn’t have any toxic accumulation of proteins in cells. I know nothing about medicine, so I don’t know, I can only surmise from the literature that I have read.

The aging brain shrinks in old age. Nothing is currently known to stop this. Maybe we can slow it down a little. After my current supply of sirolimus runs out I am going to try everolimus because it can cross the BBB and my old brain can use all of the help it can get.

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Perhaps you found this but here is some information on Sirolimus and Everolimus ability to cross the BBB in mice. It appears both do it poorly but Everolimus about 2x as well as Sirolimus.

BlockquoteRapamycin and everolimus only poorly penetrated into the brain
(brain:plasma ratio 0.0057 for rapamycin and 0.016 for everolimus

https://www.sciencedirect.com/science/article/abs/pii/S0028390818304684?via%3Dihub

I’m not aware of human data.

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I am going to run out of rapamycin in two months.
I am considering switching to Everolimus because of its shorter half life and its apparent ability to cross the BBB.

The reason is that I am anxious to preserve my muscle mass and prevent sarcopenia.
Taking Everolimus once weekly will negate my resistance training for a shorter time.

Because it is more expensive and the equivalent dose is higher, I think I will start with 10 mg weekly. First, without GFJ, and if I have no negative side effects, I will add GFJ.

"Twitter(X)
Mikhail V. Blagosklonny 14
@Blagosklonny

Why are we always talking about rapamycin and not everolimus for longevity?

Actually, there is no difference between these two mTORC1 inhibitors except that everolimus has a shorter half-life in the organism."

Actually, there is a difference in many respects, Perhaps he is just talking about the mTORC1 inhibition.

I am old so I gravitate towards higher doses.

Any thoughts?

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I am much newer to taking rapamycin than most here, but I’m already leaning the same way for the same reason. I’m hesitant to take rapamycin more frequently than once every 2 weeks, and I have still not regained the strength/muscle I lost when in the ICU in 2021.

I speculate that one high, weekly burst of everolimus on a light cardio day would reduce anabolic resistance and prepare my muscles for more effective hypertrophy training the rest of the week.

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After using rapa for about 6 months, I tried Everolimus at 10 mg weekly for about 6 months. After reading Mannick “mTOR inhibition improves immune function in the elderly” I expected it to work as well as or better than rapa. But I didn’t notice any effect, nor did my friend who used it for at the same dosage for about the same length of time. Maybe the dose was too low.

For me rapa had a noticeable effect with reduced systemic inflammation, improved skin appearance, and stabilized body weight after weight loss. Currently I take 5 mg weekly with GFJ.

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Recently academics at the University of London, UK, explored the effects of mTOR inhibitors on the effects of nematode senescence. The conclusion was that the rapamycin analogue, tesirolimus, was similar to rapamycin in extending lifespan, whereas everolimus was less effective.

I don’t think it’s fair to say that everolimus is inferior to rapamycin, because nematodes are so different from humans. What’s everyone’s opinion on this?

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Based on what I know, everolimus has a much shorter halflife than Rapamycin so it clears your system quicker. If the nematode data is similar to human data (a big IF) then it would imply that you don’t want a short quick spike of MTOR inhibition but a more prolonged exposure in your system that declines slowly over time. I feel that this is most probably true.

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Interesting experience! Did you take everolimus with GFJ as well? The DDD of everolimus is 10 mg vs 3 mg for sirolimus so does it mena that 5 mg of sirolimus with GFJ would be 17 mg of everolimus with GFJ?

Is anyone taking everolimus? It looks interesting as it crosses the BBB + shorter half-life + seems better than rapamycin for neuroprotection in longitudinal studies:

But does it have the same safety profile as rapamycin?

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When I took 10mg everolimus per week and felt weak within a few days. When I took 6mg rapa per week and did not experience this reaction. now I returned to 6 mg/week rapa again.


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Thanks for the feedback. According to the WHO the daily defined dose of everolimus is 1.5 mg so half the sirolimus dose: ATCDDD - ATC/DDD Index

If this is correct and transferable to “longevity” doses then your 10 mg dose of everolimus would be equivalent to 20 mg of sirolimus?! This might explain the fatigue?

@John_Hemming what are your thoughts on everolimus vs sirolimus ?

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I haven’t looked at everolimus. I like Rapamycin itself because there is quite a lot of data on it. It would I think be helpful to have a shorter half life, but as far as now is concerned Rapamycin is what I am using when I take it and there would have to be a really good reason for me to look at an alternative.

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On the dosing - let us remember, that the famous Mannick study used everolimus, not sirolimus. On these boards we often tend to conflate the two when it comes to the results of this study. And I often see the justification for rapamycin dosing protocols also based upon this study - it established the once weekly timing (in one of the arms) and found the 5mg/1-week to be the most effective with least sides. But again, this is for everolimus. From this many somehow found an indication for 6mg/1-week of rapamycin as suitable. But if everolimus has a much shorter half life, how does the once a week optimal timing for everolimus translate to a supposedly optimal also once a week timing of rapamycin? And if there’s a significantly different dosing effect between them, how does the optimal 5mg everolimus dose translate to a 6mg optimal rapamycin dose? Btw., let us note that there has been no adjustment of dosage for weight in the Mannick study. And there has been no weight adjustment in the mice ITP as far as I know - though one could argue that mice are mostly very similar in weight (plus if the rapamycin is incorporated into the chow, how do you control for different mice eating different amounts, depending on individual appetite). But for dogs and cats, the rapamycin dose is adjusted for weight (0.15mg per kg), because there are significant weight/size differences among cats and dogs both. So my question is where do human beings fall in this consideration? Clearly less uniform compared to mice, but certainly not as widely divergent as dogs (think mastif vs daschund), if we ignore the obesity factor. At the same time, there is significant size difference between men and women - perhaps that accounts for part of the difference in outcomes in the PEARL trial between men and women at the same dose, which did not account for weight/size (there were some significant effects in women at the highest dose, while no effect reached significance in men - perhaps due to size/dose effect?). Should we account for size in rapamycin and everolimus doses in humans a la dogs, or not, a la mice?

Many questions, few answers.

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I haven’t seen studies compare everolimus and sirolimus directly with respect to their ability to cross the BBB. Everolimus frankly doesn’t cross well and may not be significantly different than sirolimus IMHO.

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I need to do more research but I found: Everolimus and Sirolimus in Transplantation-Related but Different 2018

One of the key differences between sirolimus and everolimus in these studies was that at therapeutically relevant concentrations everolimus, but not sirolimus, could distribute into brain mitochondria [34, 50]. Interestingly, at very high concentrations sirolimus could also be found in brain mitochondria and when this was the case, sirolimus also was able to antagonize the negative effects of cyclosporine on mitochondrial metabolism. In addition, at concentrations close to the therapeutic range, sirolimus increased while everolimus decreased cyclosporine concentrations in mitochondria [34].

Everolimus isn’t super brain penetrant but is approved for some kind of epilepsy so it does affect the brain: https://www.sciencedirect.com/science/article/abs/pii/S0028390820303658

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The key question for the brain is the extent to which mitochondria are shared between cells in the brain and the rest of the body.

If they are shared in a significant manner then you can improve brain mitochondria (gradually) by improving the mitochondria elsewhere.

Given that exercise appears to help cognition and that would be the mechanism most likely to cause this effect I think it is possible to improve the brain via the rest of the body. The response would be slower, but still there.

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