Dr. Kevin Toman explains why rapamycin has become a landmark treatment for feline heart disease after the Trivium study showed it can slow or halt progression. In his clinical experience with 70 cats, 11 of 14 re-examined after six months improved or stayed stable. The drug also reduces arthritis pain, dental disease, and kidney problems, dosed at roughly 1 mg per 7 pounds weekly.
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Well, hey you guys, welcome back to The Longevity Vet. I'm Dr. Kevin Toman, and I'm glad you're here. Today we're going to take a deep dive into rapamycin for our cats—what we know, what we don't know, and what we hope. Why this video? Because I've been working with rapamycin in cats for almost a year now, primarily around hypertrophic cardiomyopathy, and I've been using rapamycin in dogs for almost 7 years, both for its anti-cancer benefits and for longevity. So I've been around the Rapamycin game for a while, and during that time I've had the same questions pop up time and time again. So this little video is my effort to answer as many questions as possible for folks who are considering the use of Rapamycin for their cats. Who am I? Well, my name is Dr. Kevin Toman, and I graduated back in 1986 from UC Davis Veterinary School, so that officially makes me an old fart. And during those 39 years of veterinary practice, I've developed a passion for longevity science in both dogs and cats. That led me to my work with Rapamycin and eventually to running a website called www.helpingpetslivelonger.com. One thing I'm not: a YouTube star. So you're going to find there's some stuttering and some stammering, maybe even a whole new sentence being restarted again, so bear with me, give me some grace, and we'll get through this together. So with those things being said, let's get cracking. Why is rapamycin such a big deal for our cats? Well, rapamycin is a big deal for our cats because about 2 years ago, a company called Trivium came out with a study that showed rapamycin was successful in reducing, or sometimes even stopping, the progression of fatal hypertrophic cardiomyopathy in our cats. Why is that such a big deal, you ask? Because in the 40 years that I've been in veterinary practice, if I told you that your cat had hypertrophic cardiomyopathy, what I was really telling you is your cat's going to die. Until Rapamycin. Rapamycin is the first drug that we have that's been proven beneficial in slowing, or sometimes even stopping, the progression of fatal HCM, and that is in fact a big deal. Now here's the better part about Rapamycin and HCM treatment, and that is that Rapamycin appears to play very well with the drugs that you and I typically use for the treatment of our HCM kitties. The atenolols, the pro— the benazeprils, the pimobendans, the clopidogrels. No problem with using rapamycin right alongside them. Now, does rapamycin work in every cat to minimize progression of HCM? No, it does not. We have about 70 cats under therapy at this point in time, and of those 70 cats, we've had about 14 cats who have undergone recheck echo exams after at least 6 months on rapamycin. Of those 14 cats who have been rechecked, 11 have improved, either with stable HCM measurements or in a couple of cases, actual improvement in ventricular diameter, which is just fascinating to me. It is interesting to know that of the 3 cats who did not improve to rapamycin therapy, 2 of them were genetic brothers and sisters, so it does suggest that there is a genetic susceptibility to Rapamycin and its benefits. Moving right along, one of the other things that is so interesting about Rapamycin is the fact that it reduces inflammation from one pointy end of your cat to the other pointy end. So not only does this help older cats with painful arthritis, but in particular, Rapamycin has been shown to benefit two different forms of oral disease in our cats. One, the periodontal disease that can affect anybody— humans, dogs, cats— the simple development of infections and inflammation along the gum line and the tooth roots. The other, however, is the other thing that Rapamycin has been proven to benefit is a kitty-specific disease called stomatitis, which is an autoimmune disease that creates big cold sores on our cat's gums, sometimes from one end of the— from one side of the cat to the other. And until the use of Rapamycin, there were many times where you and I would have had to extract every tooth in a cat's body, one by one by one, to eliminate the pain of stomatitis. So the fact that Rapamycin helps a percentage of these cats is just another really amazing part of, of Rapamycin's benefits. One thing we don't know yet is this: Rapamycin has been proven in other species, both humans and primates, to improve chronic kidney disease. And because chronic kidney disease is such a— is so common, I mean, it will affect every older cat at some point in their life. If Rapamycin also not only improves cardiac function but reduces arthritic pain, the pain of stomatitis, pain of periodontal disease, and helps chronic kidney disease, I think it's pretty safe to say that Rapamycin would be the, the very biggest, uh, change in the very biggest improvement in cat medicine over the 40 years of my veterinary practice. Now, we don't know whether Rapamycin benefits chronic kidney disease in cats, but it's actively being studied at both Ohio State and Florida State Universities, and their vet schools are supposed to have that data out by 2026. So fingers crossed, kids, fingers crossed. What's the dosing like on Rapamycin? It's interesting that the TRIVIUM study showed that higher doses were less successful in treating HCM than lower doses, and their recommendations for treating the HCM in our cats were a rapamycin dose of 0.3 milligrams per kilogram given once weekly. Let me repeat that: 0.3 milligrams per kilogram given once weekly, which translates into a dose of approximately 1 milligram per 7 pounds body weight. Now before you go out and buy your own Rapamycin, one of the other things that's very important for you to understand is this: Rapamycin is degraded by this acid that is present in your stomach, the acids present in mine, or your kitty's stomachs, and there's nothing more heartbreaking than go out and spend a bunch of money on Rapamycin only to learn that not a lick of it has been absorbed. So If you're using Rapamycin in your cat, you want to make sure that that, that Rapamycin has been protected against stomach acidity. And there's a couple of different ways to do that. We sell a coated tablet, a tablet of Rapamycin that's been coated with a substance that prevents acid from destroying that tablet. It also confers delayed absorption so that the pill passes through the stomach before it's actually absorbed. The other version of Rapamycin that we use is an oral oil-based suspension, which has been proven on the human side to prevent acid degradation of Rapamycin. So let me repeat, if you're thinking you can just go out and buy Rapamycin powder or generic Rapamycin tablet, please just be cautious. Make sure that that product has acid resistance or you're just wasting your money. And I guess that's about all I have to say. Let me repeat what I said earlier. I run www.helpingpetslivelonger.com. If you have questions about your cat and Rapamycin, whether it will work, what other drugs it might interact with, just any old thing at all, please let me know. We are all in this together, and I will help you if I can. I'm Dr. Kevin Toman at The Longevity Vet. Thank you very much and have a great night. Bye now.
