Rankings / Longevity
Longevity — Pharma (Off-Label)
Rapamycin, metformin, acarbose. Prescription drugs with the strongest longevity-in-mammals evidence. Human data is the bottleneck.
| # | Compound | Ev | Bn | Sf | Grade · Score |
|---|---|---|---|---|---|
| 1 | Metformin Biguanide | 8 | 5 | 7 | B+ 7.2 |
| 2 | Acarbose Alpha-glucosidase inhibitor | 6 | 5 | 7 | B- 6.3 |
| 3 | Rapamycin (sirolimus) mTOR inhibitor | 4.5 | 6.5 | 5 | C 5 |
These are prescription drugs used off-label for longevity, and they hold the strongest lifespan evidence in mammals of anything in the database. The catch is the same for all three: the rodent and primate data are compelling, the human longevity data is thin, and that bottleneck — not the mechanism — is what caps their scores.
Rapamycin
Rapamycin (an mTOR inhibitor) extends lifespan in mice more reliably than almost anything the NIA Interventions Testing Program has tested. In humans, PEARL (2024) — the first randomised trial of intermittent rapamycin in healthy adults — found it well-tolerated but did not produce broad significant benefits on its primary measures, with only scattered secondary signals. It is genuinely promising and reasonably safe at intermittent doses, but it has not yet earned a high human-evidence tier.
Metformin and acarbose
Metformin has decades of safety data and tantalising observational hints, but the TAME trial designed to test it as an anti-aging drug has spent years trying to secure funding, so the definitive human evidence does not exist yet — and one study (Konopka, 2019) found metformin can blunt the cardiorespiratory gains from exercise, a real consideration for active people. Acarbose smooths post-meal glucose and extended lifespan in NIA mouse studies, especially in males; in humans it is well understood as a glucose-control drug, far less so as a longevity intervention.
How to read these scores
Do not mistake a moderate evidence tier here for "does not work." It means the mammalian case is strong and the human case is unfinished. These are also the rows where the high-risk banner and the "talk to a clinician" framing matter most — real prescription drugs, with real side effects, used for an indication no regulator has approved.
Frequently asked
Is rapamycin proven to extend human lifespan?
No. Rapamycin has the strongest lifespan evidence of any drug in mice, but human longevity data is limited. The PEARL trial (2024) showed intermittent dosing was well-tolerated in healthy adults without broad significant benefits on its primary endpoints. It is promising, not proven.
Does metformin work as an anti-aging drug?
The evidence is unsettled. Observational data is suggestive, but the TAME trial built to test it has struggled to secure funding, so there is no definitive human result — and one trial found metformin can blunt exercise adaptations, which matters for active people.
Why do these score only moderate if the mouse data is so strong?
Because the rankings weight human evidence heavily. Strong mammalian lifespan data plus thin human outcome data produces a moderate score by design — that gap is the honest state of longevity pharmacology right now.
Scores reflect the published evidence, not a recommendation to use any compound or protocol. Nothing here is medical advice. How we score →