#9

Curious, were you taking any SGLT2i before this?

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#10

First do no harm. We don’t know if it will help or hurt, but could confuse the situation. The Urologist certainly won’t prescribe it. I’d skip a dose or two. We use prednisone as an anti inflammatory; is Rapa a reasonable substitute?

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#11

I think we are saying the same thing - but you are more comfortable and certain in saying stop it. There is no evidence to support that recommendation is my point. Conversely would I use my medical license to specifically prescribe this to someone with an active infection? No I wouldn’t because that would be a deliberate act that I don’t have evidence for. I’m simply pointing out that it may well be quite helpful in this situation, and making a firm recommendation to someone to stop it is also without solid evidence.
Rapamycin may well be helpful and decrease inflammatory response. I suspect it would. It certainly isn’t going to decrease the ability to get better from an infection that is susceptible to the prescribed antibiotic. I’d suggest that prednisone is a more potent immunosuppressant and we know that steroids while getting antibiotics do not worsen cure rates, in isolation.

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#12

That’s taking it out of context. Steroids in this setting are used for brief period of time to reduce the inflammation. Long-term steroids are definitely immunosuppressive and can increase a chance of an infection.

In this case I presume the OP has taken rapamycin chronically which can increase chances of the infection.

There is also a lot medical information missing… is this bacterial prostatitis? What antibiotic ? What is the rapamycin dose and frequency. How old is the patient ? Other risk factors ? etc. etc.

Given the scarcity of medical context, I agree with KarlT, that unless this rapamycin was prescribed for a specific medical reason by a physician, the most prudent action would be to discontinue it… and ask the urologist or his PCP about when and if it’s feasible to restart it.

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#13

We aren’t talking about risk of infection. We are talking about whether rapamycin will affect getting better from an infection while being on antibiotics.

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#14

So if your patient develops an infection while taking a chronic immunosuppressant without a solid medical indication (other than purported longevity benefits) you wouldn’t even adjust the dose ?

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#17

I’ve not said what I’d do either way. I’m simply pointing out that in the specific setting of having a bacterial infection, and treating it with an antibiotic that the bacteria is susceptible to, I have no clear indication of whether Rapamycin might be useful or harmful.

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#18

Yes. I have been on Farxiga for quite a while. Why do you ask?

#19

@lsutiger - We have discussed elsewhere that SGLT2i can lead to increased UTIs and perhaps prostatitis. The UTI risk seems less likely in men (and prostatitis not common), but might be something to be extra careful about.

Do you have a sense for how much glucose you might be excreting via urine via farxiga?

eg: Are you on a high dose of the farxiga and/or eat a lot of carbs and/or are you insulin resistant (when not on the SGLT2i)

And/or how much did the farxiga lower your average glucose/HbA1c and/or glucose spikes?

Or have you tested amount of glucose in your urine?

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#20

Glucose was high in Urine as expected with taking Farxiga.
I don’t eat a lot of carbs and I’m not insulin resistant when not on Farxiga.

Farxiga did not lower my glucose numbers nor A1C but I’m on metformin as well and was on metformin a long time before starting Farxiga.

#21

I’m not sure there is any increased risk of prostatitis on an SGLT2.

#22

Neo - great and insightful question here. Putting through a bunch of glucose to the urine is a feeding ground for bacteria. I’d say holding this, if you have an infection in the urinary tract is 10 fold more relevant than holding the rapamycin.
I find that high glucose levels whether in urine or body wide, makes antibiotics remarkably less effective and makes infections respond slowly and treatment failures are much more common whether in urine, lung, or soft tissue.
In the ER, if I see a patient with a urinary system infection and on an SGLT2 inhibitor - it is an automatic hold on this. This is same issue when I see limb cellulitis in a diabetic and their blood sugar is 400 mg/dL. The treatment failure is markedly different to when the blood sugar is 120 mg/dL. Pretty relevant stuff.

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#23

Thank you both Neo and Dr. Fraser. I will hold the Farxiga for now.

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#24

My experience from decades of painful prostate pain is that prostatitis is a symptomatic, complex condition that, in quite a few cases, is not very well understood. I like to share some of my experiences. The best way for me has been to manage my painful prostate through a trial-and-error approach.

  • If you have a bacterial infection, then you might be treated with the proper antibiotics. But then again, you might be prone to reoccurring bacterial infections or non-bacterial prostatitis.

Even if there is no sign of a bacterial infection, you might try antibiotics anyway. In my special case, I always got a short time of complete relate from doxycycline. Then, after a week or so, the discomfort grew back again. This is not a strange observation, not now that I have learned that doxycycline has other effects than just being an antibacterial agent. It comes with anti-inflammatory actions, and together with azithromycin and vitamin C, it might act on stem cells.

Since my symptoms have gotten much less irritating, I don’t treat them with antibiotics anymore. But when I did, I got the best effect from Sulfametoxazol 400mg + 80 mg trimetoprim mornings and evenings for three weeks and then once a day for another 4–5 weeks.

I have also had relief from pumpkin seed oil and Viagra.

Another intriguing personal observation is that, when I do a senolytic protocol with fisetin 30 mg/kg body weight, mixed with oil and black pepper, I get restored prostate function and short period of complete relief from any symptoms that I still might have.

In my case, a non-bacterial, painful prostate is still a mysterious condition that requires a lot of patience and a trial-and-error approach.

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#25

One last thing on this - with any bacterial infection – it is critical to tightly manage blood glucose into as close to a normal range as possible. Letting it run high makes it very difficult to the antibiotics to overwhelm the bacteria who enjoy feasting on glucose. I find treatment failures go way up when patients have hyperglycemia - or worse yet obesity (without weight adjust antibiotic dosing - which few physicians and pharmacists seem to address) and hyperglycemia.

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#26

Interesting insights – and yes, just like women with interstitial cystitis - often times it isn’t infection - sometimes antibiotics help, but other treatments often are the key. The anti-inflammatory effects of macrolide or tetracycline antibiotics may be the active ingredient, not the antibiotic effect. There is a lot we don’t know and patient’s individual experiences on what works for them is an area for learning.

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#27

I think we want to be sure the other direction though, and until we are we should be careful - and @lsutiger might want to especially be so right now

Btw, here is one of the threads where it had been discussed elsewhere

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#28

This case clearly illustrates why medical providers typically don’t make “curbside consultations”. You need to have patient’s whole medication information - HPI, past medical history, med lists, physical exam, potential tests before make any recommendations.

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#29

@lsutiger I would advise you to discuss all of this with your Urologist, rather than assuming a group of strangers on the internet are correct. And I don’t mean that as an insult to anyone trying to help here.

Unfortunately, even on this forum, there are some individuals at the far extremes of the bell curve.

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#30

KarlT, indeed, I will be discussing all of this with my urologist. The info shared on my post, however, has helped provide me with the information to have a better conversation with my urologist. Thank you all for your input.

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