Thousands of transplant patients have taken 2 to 6 mg daily of rapamycin for decades without experience, any life-threatening or altering side effects. The chance that taking six or even 10 mg weekly is going to produce a lethal or more detrimental effect appears extremely unlikely at best
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Also, I might not have the details 100% but Matt Kaeberlain mentioned once there was a case report of someone trying to take about 100-120mg of rapamycin in a suicide attempt and all he had was a headache
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To be fair, a lot of transplant patients die of sepsis. Letās not think taking high dose Rapamycin has no effect on this.
Transplant patients are also plugged into tertiary medical systems with concierge level access to specialists. Every ER knows to treat a transplant patient with IV antibiotics if their heart rate is up in slightest or fever or whatever sepsis marker you want to look at.
They are a dramatic example of the best medicine the US has to offer. The average person, even the average Rapamycin taking person, does not have this. Yet they still die of sepsis well above the non transplanted.
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Thanks for reposting. You are a true inspiration. After two aortic valve replacements, two stents in hospice and a dozen moderate maladies . such as bacterial endocarditis. Pancreatitis and gallbladder removal at 71 I started on 8 mg of rapamycin weekly and it has completely turned my health and cognitive ability
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More than you wanted to know. 
Oddly, my local WINCO grocery store has a house brand that looks similar to Gillette premium blades and last a very long time.
āA relatively small number of factories (notably in Egypt, Russia, Germany, South Korea, and the Czech Republic) produce blades that get sold under dozens of brand names. Itās entirely plausible your house-brand blade is coming from the same factory or using the same steel and similar coatings as a blade costing three times as much. The branding and marketing margin on premium blades is substantial.ā
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Before this study I had already been pretty convinced that it reduced my athletic performance and made me more tired. However, Iām also convinced it improved my gums around my wisdom teeth. Most recently the dentist claimed āyou are proof that we donāt need to remove wisdom teethā, despite for years before taking rapa, they always told me there was some inflammation and that I need to floss/brush my wisdom teeth more (I did not change my dental habits - floss every day and brush in the morning and before bed). I intend to take it on occasion when I donāt expect to be doing much exercise and generally at 3mg.
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Hi, thanks for sharing this. Are you taking a straight 20mg of Rapamycin or using ketoconazole with a lower dose? I think you talked about using ketoconazole in an earlier post? I am using 2mg with 1 ketoconazole tablet an hour before,fortnightly , and about to resume weights at the gym so thinking about shifting to a higher 3-weekly dose but unsure of what might be optimalā¦
Iām just using 20 rapamycin tablets. I did dose a few times with ketoconazole and no difference was noted, but Iād prefer to keep it simple.
This comment sparked joy 
I went from 8mg weekly to 16mg every 14 days as a result of the study. It was already in the back of my mind to take it less often due to @John_Hemmingās approach, so it was no big deal for me to try it.
I definitely donāt have enough muscle, however, at the same time, I have gained tremendous functional strength since starting rapa (not because of rapa), so Iām not actually worried if rapa has blunted any of my muscle growth. Itās functional strength that is the most important as we age, so Iām told.
Iāve noticed two thingsā¦
I feel off the charts fantastic after the big dose!!
But also, after my second large dose, I did get sick for the first time in a decadeā¦ hard to know if it was causal or a coincidenceā¦ but the comical part is Iām pretty sure I got sick from attending the longevity conference in Berkeley:). BTW, getting sick at 60 feels a lot different than at 50!
If I should get sick again, I will go back to weekly dosing and not give it much thought.
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What I would say is that if you take a large dose it is probably worth avoiding going to infectious places (Meetings etc) for a period of time after taking the dose.
I avoided taking Rapamycin last week because I was planning on going to a wedding on Saturday.
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No, wrong.
Sirolimus-induced interstitial lung disease (ILD or IP) is a dreaded and terryfying disease occuring in up to 11% of transplant patient.
"Interstitial Pneumonitis (IP) is one of the pulmonary complications associated with mammalian Target of Rapamycin-Inhibitors (mTOR-Is). Sirolimus and everolimus belong to mTOR-Is. According to studies, IP is caused by both.
According to studies, the incidence rate of IP related to these drugs is 4-11% [6, 7]. The incidence of IP after sirolimus therapy in Iranian kidney transplanted patients was 9.7% [9]. This complication could appear early after the beginning of mTOR-Is or a few years later."
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It seems that it this, unsurprisingly, is driven in part by the trough.
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Yes, could be.
But depending on the mechansim of Sirolimus-induced interstitial lung disease it could be also caused by higher doses (autoimmune repsonse, T-cell mediated hypersensitivity,ā¦).
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Obviously the size of the dose affects the trough.
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I got a chatGPT(5.5) paid response which gave me the trough issue. I have access to that now and here it is:
Sirolimus-induced interstitial lung disease (ILD), also called sirolimus-associated pneumonitis, is uncommon but well recognized. The reported frequency depends on the patient population, dose, and how carefully patients are monitored.
Estimated incidence:
- Solid organ transplant recipients: approximately 2ā11% in published series.
- Patients taking sirolimus for other indications (e.g. lymphangioleiomyomatosis or some cancer treatments): generally <5%, although estimates vary.
- Healthy participants in longevity studies: appears to be very rare, with only isolated case reports, but the number of people studied is much smaller than in transplant populations.
Risk factors
Several factors have been associated with a higher risk:
- Higher sirolimus blood trough concentrations (particularly >10ā15 ng/mL).
- Recent conversion from another immunosuppressant (especially calcineurin inhibitors).
- Pre-existing lung disease.
- Male sex (reported in some studies).
- Impaired kidney function, which is common in transplant recipients and may increase exposure.
- Longer duration of therapy (often develops after 2ā12 months, though earlier and later cases occur).
Symptoms
Typical symptoms include:
- Dry cough.
- Progressive shortness of breath.
- Fever (sometimes).
- Fatigue.
- Reduced exercise tolerance.
CT scans often show ground-glass opacities, patchy infiltrates, or an organizing pneumonia pattern.
Diagnosis
There is no single diagnostic test. Diagnosis usually relies on:
- Compatible symptoms and CT findings.
- Excluding infection (particularly important because sirolimus suppresses immunity).
- Improvement after reducing or stopping sirolimus.
Bronchoscopy with bronchoalveolar lavage is often performed in transplant patients to rule out infection.
Prognosis
The outlook is generally good:
- Most patients improve within weeks to a few months after stopping or reducing sirolimus.
- Corticosteroids are sometimes used if symptoms are severe.
- Permanent lung damage is uncommon if the condition is recognized early.
Relevance to low-dose longevity use
For people taking weekly low-dose sirolimus for potential healthspan benefits (for example 5ā10 mg once weekly), there are currently very few reported cases of ILD. Most published cases have involved:
- Daily dosing.
- Higher cumulative exposure.
- Transplant recipients taking multiple immunosuppressive drugs.
That said, anyone taking sirolimus who develops a persistent dry cough, increasing breathlessness, or unexplained fever should seek prompt medical evaluation, as ILD is a rare but potentially serious adverse effect that is usually reversible if identified early.
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After exhaustive research on rapamycin and side effects, your mention of the relationship between sepsis and rapamycin is the first I have heard of. Could you please provide evidence?
Iām not worried about and didnāt mention any lethal or life altering effect. Both 6-9mg per week or every two weeks are low dose. It is just about trying to find the right balance where I basically pop a pill, forget about it, and donāt notice any side effects either short or long term. Iāve had intermittent mouth ulcers with 6-9mg per week and slightly decreased energy and exercise performance in the couple of days afterwards which if you are taking it every week do add up.
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No one studies it so I donāt really have a paper to quote.
It is an immunosuppressant and increased infections are well described and dose dependent.
Transplant patients get sepsis more than non transplant patients. They are given antibiotics earlier to prevent. They are on multiple drugs that cause this and these have overlapping and synergistic effects. Most are not on Rapa so it is really tough. Tacrolimus is much more common.
Interestingly, so much of the Rapamycin searchās are bogged down by longevity talk which refers to low dose. There is no evidence that low dose Rapamycin increases risk.of sepsis but nothing has really been adequately powered to look at that over the long term (to my knowledge). And yes, Rapamycin helps fight infections and with sepsis too.
The FDA package insert mentions sepsis as a risk. Infection risk is well described. Sepsis comes from infections. None of it is a stretch. That being said, it is a consideration not a insurmountable problem.
Lymphoma is also a risk of immunosuppression.
I do think flu vaccines and pneumovax are just common sense things to do, even more so if taking Rapamycin. Also holding Rapamycin around the time of any surgery. These 3 things probably cut the risk of dying from sepsis by 50% or more. I think these 3 things are essentially mandatory or should be.
It is 100% possible that low dose Rapa actually reduces the risk of dying from sepsis. I suspect we may never know because that kind of power doesnāt come cheaply.
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Please provide evidence to support your allegations
Not sure if it was this or this in combination with something else but I went from once a week to once a fortnight or more. Iām not as strict on dosing it now. I still like rapamycin a lot and will continue taking it but I see value in allowing the body to have periods without it.