My urologist diagnosed me as having Prostatitis. She put me on an antibiotic for 14 days. Just wondering your thoughts on if I should stop Rapamycin during these two weeks?
Absolutely stop the Rapamycin.
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FWIW: my husband had prostatitis bouts, on and off, for years. Urologist prescribed antibiotics, but they never really helped. Seems it is not clear whether the problem is caused by bacteria or virus. I read that saw palmetto and cranberry might help, and they have, almost unbelievably so. Since he started taking these two regularly (just plain old over the counter supplements) he has had only one minor bout, and it cleared as soon as he took a bit extra of the supplements.
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Deborah, can you please provide links to the brands of Cranberry and Saw Palmetto supplements your husband uses and if he does the dosages stated on the bottles of each? Thanks.
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We get both of these from Puritan’s Pride. He also takes Vitamin C, Fish oil, D and, by the way, lysine, which has stopped his cold sores. Found it interesting that when he told his doctor about the supplements stopping the prostatitis, the response was barely a shrug.
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You’d think the recommendation to stop Rapamycin would be the sensible one - as it would stand to logic that maximizing your humoral immunity would be the goal. However, if you are on antibiotics, you are relying on those to defeat the infection.
As a corollary, there has been the discussion on corticosteroids (like prednisone or dexamethasone) in regard to whether they worsen outcomes if given alongside antibiotics for an infectious issue. These agents are clearly immunosuppressant. We have pretty solid data, saying that they don’t worsen outcomes. We know in Community Acquired Pneumonia, that outcomes are actually improved with steroid for patients with more severe disease.
There is also the issue of whether the prostatitis is due to a bacterial pathogen.
I’m not so certain that I’d be able to make a recommendation - as having an anti-inflammatory immunomodulator might not be a bad plan. I’d however say that if you have a definite bacterial infection that is not being treated with an antibiotic - it would be a clear recommendation to not take Rapamycin.
Just my assessment on this - not any specific medical advice. But think this stuff is not a straight forward clear answer.
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I think the question is simpler than you’re making it. “Should you take Rapamycin while taking antibiotics for an infection?”
I’d go with “no”. Simple risk vs benefit. Although small, is there a risk of Rapamycin causing reduced immune function? Possibly. Do you want that while infected? We’ve certainly heard anecdotal stories of Rapa related to infection from Matt K. And Dr Greene.
What’s the benefit of Rapamycin while being on antibiotics for an infection? I’m not aware of any. Downside of delaying your regular dose of Rapa until after antibiotics? None.
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I disagree. Using the same logic, you’d assume prednisone would be definitively harmful in infectious processes. Certainly with no antibiotic, we see much worse outcome. However, with antibiotic, we see no worse outcome in multiple conditions; and in one well studied condition, we see improved outcome.
My point isn’t to tell someone to use Rapamycin while they have in infection - the point is that this question doesn’t have a known answer, and it is entirely possible that it would be helpful in this situation.
Having an immunomodulatory agent in the setting of infection is not always harmful. As someone who has looked at the data from studies over many years, the answer to an obvious simple question is not always what is expected.
Irrespective, I don’t know the answer to this one, but as much as there is no compelling reason to take the medication, there is no compelling reason to stop it either.
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Curious, were you taking any SGLT2i before this?
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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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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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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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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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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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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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Yes. I have been on Farxiga for quite a while. Why do you ask?
@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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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.
I’m not sure there is any increased risk of prostatitis on an SGLT2.
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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