#61

It’s quite interesting. But as we’ve all learned from long experience, you can’t just assume the same result from a drug just because it belongs to the same class. And that is why you have to test the specific drug: simvastatin, rosuvastatin, etc. to make sure the effect is present, as well as the protocol (timing, dosage etc.).

I myself am switching from atorvastatin 10mg/day to pitavastatin 4mg/day precisely among other reasons because it has fewer interactions with other drugs - I’m doing this because I’m trying to lessen some of the unknown complications of polypharmacy as I add telmisartan, emplogliflozin, rapamycin and supplements, but the downside might be that I miss out on some synergies as well. That’s why I’m not going to assume that telmi and pita will synergize the same way simva and telmi or rosu and telmi do. We need to see specific combos studied to reach conclusions.

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#62

I they are in the same class as well as have same mechanisms of work they will most likely be synergic. Side effects and their effectiveness may or may not be the same though.

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#63

How do you know they have fewer interactions with the drugs you are taking or will take, and did they really in the first place have interactions with each other?

#64

I suspect that Telmisartan likely caused my severe itchiness, which makes sense given my suboptimal kidney function and the mechanism you describe. I initially started Telmisartan based on a Life Extension article suggesting anti-aging benefits. However, the article was theoretical, and I couldn’t find studies demonstrating anti-aging effects in model organisms or humans. While Telmisartan does show beneficial effects on kidneys in several studies, making it potentially suitable for some, my year-long trial was unsuccessful. As an alternative, I plan to try rilmenidine for blood pressure control, as it has demonstrated anti-aging effects in animal models.

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#65

This is unlikely to be allergy because the effect is not immediate. After taking telmisartan for several weeks itchiness and tiny red spots developed. And it took several weeks after discontinuing Telmisartan for itchiness to completely go away. I want to be clear that the evidence is circumstantial but sufficient for me to avoid telmisartan. It can work well for other people.

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#66

Well, we do know in principle that pitavastatin has fewer DDI (Drug Drug Interactions) than other statins due in part to not being metabolized by P450 (CYP) enzymes, CYP3A4:

And one consequence of the CYP3A4 is that pitavastatin is not affected by GFJ compared to f.ex. the statin I’m taking right now, atorvastatin:

So if I’m taking a drug like rapamycin (which I will shortly), and would wish to enhance its action by suppressing CYP3A4 by any agent, f.ex. GFJ, I am much better off with pitavastatin than atorvastatin - so right there you have a use case for a drug that I am planning on taking.

Another situation, if I wanted to take colchicine (as some on this list do), I am better off taking pitavastatin than pretty much any other statin, because pitavastatin has zero interaction while other statins have very strongly elevated risk of muscle damage:

Another situation - I am going to take telmisartan because I have slightly elevated BP, and if that is not enough, I wil look to take amlodipine - and all calcium channel blockers (CCBs) have interactions with statins that are metabolized by CYP3A4, including atorvastatin which I’m taking right now - the result can be severe kidney damage:

Whereas if you take telmisartan, you might even find synergies with pitavastatin:

Anyhow, one other consideration is important - because of low DDI of pitavastatin compared to other statins, anyone taking appreciable number of supplements, the odds of interaction rises drastically, also in part due to P450 CYP3A4, sometimes you may not even be aware of it.

Finally, every individual is in a unique situation. I happen to struggle with excessive blood sugar, and am prediabetic. Many statins, including the one I am taking right now, atorvastatin elevate BS and can even lead to de novo diabetes. Additionally rapamycin (which I plan on taking) can also raise BS. These are not desirble effects. If I can therefore use a statin that does not have this additive blood sugar effect, then that’s a better statin for me. And that’s pitavastatin, which has been shown to not have any effect on blood sugar (unlike atorvastatin), and does not lead to de novo diabetes (studies I’ve linked to elsewhere).

All in all, I think pitavastatin is a better statin for my situation than the one I am currently taking, atorvastatin. I will soon have the opportunity to test whether I tolerate pitavastatin and whether it works to lower my LDL/ApoB, which it should according to the literature (as I’ll also be taking 4mg/day which is equivalent to 20mg/day of atorvastain, and currently I’m on 10mg/day atorvastatin which I’m tolerating very well).

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#67

Very good thinking, make sure to let us know how you do on these new remedies…

#68

That may or may not be true. For almost half a century, hundreds of studies have proven the safety and efficacy of atorvastatin.
When I was first prescribed a statin, it was Zocor because it was being touted as the newest and greatest thing. I was not able to tolerate Zocor.

Now, Zocor is just a distant also-ran compared to atorvastatin

One of the odd things about statins is that, though they are similar, people can often tolerate one statin and not another.
Until you try pitavastatin for some time and have no adverse side effects, you will not know if it is better for you.

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#69

Absolutely true. Which is why I said I’ll soon have the opportunity to see if I tolerate pita as well as ator (which I tolerate very well), and to see the effect on my LDL/ApoB. What I meant by “better”, is better on paper, which has to always be verified in real life; but that’s how all choices are made - before we have actual experience, we make a choice based on specs on paper, and then see how life goes.

I’m waiting for my yearly physical, and I’ll ask for a comprehensive test of ApoB and all lipid particles to establish a baseline, and then starting November, I’ll switch to pita and re-test a few weeks later to see how it impacts the lipid numbers. My meds from India should be arriving shortly, but I’ll be introducing them gradually one by one testing along the way, so I can catch the individual effects and possible interactions. So it’ll be a while yet before I’m riding on the entire polypharmacy stack.

We’ll see. From experience I know that whatever the plans, life has a way of forcing its own course, so I may ultimately wind up with an entirely different med stack, lol. Isn’t that how people end up with months/years of med supplies from India they no longer have any use for? C’est la vie.

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#70

After my experience with Rosuvastatin (highly intolerant), I’m just happy to have found Atorvastatin which has fewer side effects for me. To each their own with whatever works!

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#71

Yes, and a much lighter wallet, Oh I forgot just ordered meds of 3 years’ worth for just $200 lol. The prices being so cheap as they are allow for some margin of error/experiment.

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#72

Just to give an update, I bumped up my telmisartan from 40mg to 80mg around 5 days ago. This morning, I felt tired and weak/light headed. I went to check my blood pressure and it was 100/53. Not good.

Despite the evidence seemingly showing not much more of a blood pressure reduction from 40 to 80mg, I can say that’s not my own experience.

Going to skip a dose of telmisartan and then go back to 40mg

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#73

I wonder if a jump from 40 to 80 is too abrupt. Maybe ramp up over time, like 20mg, or even 10mg, every few weeks, very gradually escalate so your body is habituated. You may not reach 80, but stop at a level that’s your personal max, 50, 60, 70, whatever. The key is to go on a gentle incline, give every escalation plenty of time.

FWIW, I intend to start my teli with 20mg, and go very slow, like a couple of months before hitting 30, staying there for a couple of months then 40. It might take a year before I reach either 80, or my personal max, whatever that may be, and whichever comes first. I’m not planning to go beyond 80, unless suddenly some very compelling literature comes out. I know Dr. Fraser is comfortable with 160mg, but if my BP doesn’t go down enough, I’ll throw 2.5 amlo on top of the 80 temi. YMMV.

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#74

Maybe, but my blood pressure kind of borderlines on the low side as it is so I guess this pushed me over the edge. I think it’s a good idea for people with more room for BP reduction but I don’t have much margin for error here.

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#75

You mentioned your BP was boarderline low before switching from 40 to 80mg … may I ask what you were averaging before starting Telmisartan and then at 40mg? Assuming you’re only 80mg measurement was that above 100/53.

#76

Well it varies a lot of course but in the mornings before starting my day, somewhere around 108/60.

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#77

I’m consistently getting 100/60 now with the telmisartan 80 and was worried about it at night. But the couple readings Ive had at night have been fine when I woke up, I’m thinking that melatonin might be modulatory.

Its hard taking so many agents for longevity that tend to all pull (I think) in the lower BP direction. When your taking SGLT2 inhibitors, statins, acarbose, and supplemental stack at the same time…

I don’t feel good hovering around 100/60 either… my reading this morning was 98/60… but I don’t know if I will switch up

#78

One of the underlying principles of longevity medicine is to not cause a serious adverse outcome while trying to theoretically live longer.

Some people don’t have enough blood pressure to take an anti-hypertensive.

If someone with these readings has no symptoms - probably can get away with it, but would need to make sure creatinine and potassium is stable.

However, if the BP gets knocked down a fair bit further, it could cause a fall, which sometimes can be a spiral toward bad health outcomes.

Everyone needs to be cautious to not accidentally off themselves while trying to live longer.

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#79

100/60 is not bad, even 90/60 especially if you are quite young (like teenager young), assuming there are no issues like heart failure or some pathological reason for the low BP. However, once you get up in age, into your 60’s, 70’s, 80’s and so on, the thinking changes a bit, not only because of the danger of falling, fainting, orthostatic hypotension, blacking out etc., but because it is thought that your brain could use a bit more blood circulation with an assist from slightly higher BP - or at least that’s what was commonly accepted in the past, in addition to the fact that it is just harder to keep a lower BP at that age, atherosclerosis, stenosis in the blood vessels, often higher salt intake etc., while you don’t want to load up an elderly person with a bunch of powerful BP meds.

Key is, how do you feel and function at 100/60? If fine, then you’re OK. I’m not a doctor, what does your doc say?

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#80

Very true. That is my case. I’ve had always low BP (usually 100/55) and would not be a good candidate to take anything that lowers my BP further. I even fell couple times when young, and I am always careful when I need to stand up after a relatively long period seating down/on the ground. My question is, Is there something or meds that specifically increase BP?

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