What are the Best Medications for Longevity?

#1

I am currently taking a few medications (plus other supplements not mentioned here) for longevity. Here they are in no particular order:

  1. Rapamycin 4 mg + GFJ bi-weekly
  2. Metformin 500 mg daily
  3. Acarbose 50 mg (with carb-heavy meals)
  4. Bempedoic Acid (140 mg) daily
  5. Ezetemibe (10 mg) daily
  6. Jardiance (Empagliflozin) (12.5 mg) daily

I think each of these is important for my health. However, I’m considering new medications to improve my health. (Placing a new India order soon.)

Here are the current ones I am thinking about. What are your thoughts? Which would be of most benefit?

  1. Tadalifil (History of familial prostate cancer)
  2. Telmisartan (My BP fluctuates between 106-128 depending on time/location)

Any other medications that are even better?

Thanks for the thoughts and input.

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#2

Some context can help guide thoughts and suggestions.

Think you shared a lot about your Apo B and HbA1c, could you share some more holistic blood work and biomarkers?

How do you track on body composition?

What is your exercise regime?

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#3

Its an interesting question. It seems like you are already diving deep into the pool of polypharmacy :slight_smile:

I would be really careful and test a lot if I was adding additional medications. While we know quite well the benefits of many of these drugs, we don’t know much about the longer term impacts of these drugs , nor of these drugs in combination. The permutations and combinations when you get all these medications together (plus our own genetics)… you start venturing off deep into the weeds of pharmacology.

I think back to the presentation by Tim Peterson (formerly a post-doc in the Sabatini lab at MIT), and how his current research is suggesting that we actually may be wrong about the method of action for many well-known drugs, including SSRIs, etc. See here: Senolytics Topically Administered to Skin for Antiaging Effects - #30 by RapAdmin

Warnings aside… I still find these interesting and worthy of continued attention:

  1. 17 Alpha Estradiol: Use and Dosing Experiences
  2. Gout Medication Colchicine Reduce Myocardial Infarction? 2019 N Engl Journal
  3. Gemfibrozil, a lipid-lowering drug, improves damage in a mouse model of aging

But my focus of experimentation right now is more on the topical area. I’m looking to implement my senolytic skin cocktail sometime in the next few months… Senolytics Topically Administered to Skin for Antiaging Effects

As a general observation, it seems like there is a lot of research into the basic biology of compounds like senolytics that may be of value in maintaining skin health, but there is very little interest in going through the FDA approval process for medications for skin health and longevity; it seems like the risk/reward profile for prescription topical ointments is not something that appeals to most biotech or Pharma companies, so we likely won’t see much in terms of development. So, it seems like testing ourselves may be the only way forward in this area. And topical applications seem lower risk than systemic medications.

Related Reading

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#4

The comforting factors are as follows:

  1. Bryan Johnson and Dave Pescoe as well as others are doing well on a greater number of supplements.
  2. Doctors will usually prescribe a dozen medications that synergize to treat a medical issue such as cardiovascular disease.

The medications I am utilizing so far seem to work well together and none of my doctor’s or pharmacists have raised any red flags. Unfortunately I do have to say most of them haven’t heard of Rapamycin, Bempedoic Acid or Acarbose. However they are very familiar with the others. And they just tap my medications into their terminals and there are no conflicts.

I may need to stop citrulline if I take Tadalifil though.

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#5

Which other blood markers do you feel are important?

Unfortunately my BMI is higher than I would like and I am considered overweight. My exercise regime is 6000-10000 steps a day and I use the stairs more often than not at work.

I should increase my exercise though to include resistance training. It’s my literal weakness. :wink:

1 Like
#6

Other biomarkers, for example

  • IGF-1

  • Testosterone, Free and SHBG

  • Homocysteine

  • What your glucose spikes and standard deviation look like via CGM

  • Fasting Insulin

  • In your case perhaps a 2-3 hour OGTT with both insulin and glucose

  • Fasting (and perhaps 24 hr cortisol)

  • Omega 3 index

  • Dexa scan for body composition and then perhaps get a withings or other bioimpedense scale

  • Some form of cardio metrics (does not have to be VO2 max, eg what power / how many miles would you get if you did 30-45 min at Zone 2 talk test threshold)

  • Some strength metrics - how many push ups, what can you squat and deadlift

I upped the focus on the last ones because it - as you allude to - seems that the by far most important thing you could do is to take your exercise regime to the next level and at the same time solve your BMI/overweight and especially body composition.

The amount you can gain longevity impact wise from nailing exercise and body comp is probably on part from with all the meds (besides perhaps the Apo B ones) combined !!!

Would truly try to make that a top priority for longevity optimization and you’ll at the same time maximize healthspan too.

There are many ways to start working on above, in a stepwise, fun and 2024 way. Happy to discuss and brainstorm more here if helpful.

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#7

Dutasteride seems like a no bainer for hair, prostate and skin health. Plus it stacks well with tadalafil for additional prostate protection and zero risk of side effects.

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#8

A great question.

I think all the items I’ve put in my blog on neurocognitive decline are also longevity meds.

If your BMI is high - why not, if no contraindication get on a GLP-1 agent? Cost is always an issue, but depending upon where you reside, compounded ends up often coming in ~$100/month.

A PDE-5, primarily tadalafil, due to the long half life should be on the list.

Hormone normalization for life is also sensible, goaled at levels you’d have had in your 20’s.

There is then all the supplements, which I think we have less evidence for.

Depending upon your age, do you do Dasatinib/Fisetin every 3 months for 3 days?

Do you do Methylene Blue, Nattokinase, Serrapetase, and/or BPC 157?

The challenge is do we end up not benefiting you as we add more medications, as they hit the same pathways, and do we just add toxicity or other risks? There is a need to streamline this.

Our data is often focused on testing just one drug - what happens when we combine 10 drugs - which is probably on the conservative side for most on the board?

I liked the recent study showing synergism with SGLT2-i and GLP-1 agents as being more beneficial together than in isolation.

The only other comment - I think, if not good medical reason for it - I’d get rid of metformin. We have much better agents - go with an SGLT2-i, GLP +/- acarbose. Optimize metabolism that way - I think sarcopenia is an independent health risk, and metformin seems to increase the risk.

I’m no longer prescribing this as part of a longevity protocol.

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#9

I think Tadalifil is the next one I am going to add. I have BPH, and this will help address this health problem. Also, the cognitive defense is amazing.

Now the question is which brad to use. I got the following quotes:

Viagra 50mg = 7 USD Per Strip of 2 Tablets.

Viagra 100mg = 14 USD per strip of 2 Tablets.

Cialis 10mg = 15 USD per strip of 2 Tablets.

Cialis 20mg = 7.6 USD per strip of 1 Tablet.

Tadacip 20 Tablet ; Tadalafil (20mg) ; Cipla Ltd = 1 USD for 4 tablets.

Vidalista , Tadalafil 20 mg = 1.5 USD for 10 tablets

Vidalista , Tadalafil 5 mg = 1 USD for 10 tablets.

The last one seems like a winner, but it’s so much cheaper than all the other options that I am concerned about the quality.

I can’t find anything about the manufacturer of Vidalista, so I may try the Tadacip.

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#10

Not sure of your location, but Tadalafil is pretty cheap in the US. I buy 30 X 5mg from Amazon for about $13.

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#12

Get this the next time you’re in the USA, prices are very low for generic with GoodRX: 30 X 20mg tablets for $20 US.

https://www.goodrx.com/cialis?form=tablet&dosage=20mg&quantity=30&label_override=tadalafil-cialis

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#13

@DeStrider

Do you have diabetes and/or hypercholesterolemia? Or are these meds for longevity?

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#14

Are you currently recommending these to anyone?

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#15

Very limited cases. I’m less happy with the evidence on these than with some of the other things I do. The methylene blue is something I will more commonly utilize. There is a fair bit of review of the literature required on each of these, and I simply haven’t had the opportunity to do the deep dive on each of these to have an evidence based opinion.

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#16

Are you asking me? No I don’t have diabetes. My ApoB was 85-90 prior to Rosuvastatin/Ezetimibe however, so those are indicated in my case. So it’s just longevity stuff

#17

@ Virilius

I hope you’re joking on “zero risk of side effect?” Have you looked at side effects of 5-AR inhibition? Role of DHT in well being, mood, cognitive and sexual function? Data linking anti-androgens to dementia? Granted 5-AR blockade is less aggressive than anti-androgens or LHRH agonists, but the data still needs to be considered. 5-AR blockade has significant potential side effect.

I would deem avodart and proscar as high side effect with low level upside. You may keep some hair and reduce your risk of Gleason 6 prostate cancer (clinically insignificant and not treated in majority of men) by 25% but that’s about it. Not that appealing in my eyes.

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#18

Sorry not you. The op. What do you take Willow bark for?

#19

Okay… but what about arthrocleurosis prevention… calcium and plaque build up in the arteries… using proscar/finasteride.

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#20

@KarlT I had pre-diabetes and high cholesterol. Now that I am taking these meds, both problems have been fixed and are in more optimal ranges.

HBA1C was 5.7… now 5.4
LDL was 120 … Now 65

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#21

Can Cialis pills be split? For my BPH, I read I should take 5 mg daily. 20 mg seems a bit much. Or did I read the wrong advice?

1 Like