What medications can slow down aging in a generally healthy adult or geriatric individual?

Medications to Slow Down Aging

There are currently no FDA-approved medications specifically indicated to slow down aging in healthy adults, and the available guidelines strongly caution against polypharmacy in older adults, emphasizing that the primary goal should be optimizing quality of life, functional independence, and avoiding medication-related harm rather than adding preventive medications. 1

Current State of Evidence

No Guideline-Recommended Anti-Aging Medications

• Major geriatric medicine guidelines do not recommend any medications specifically for "anti-aging" purposes in healthy older adults. 1
• The European Society of Cardiology and American Geriatrics Society emphasize that therapeutic decisions in older adults should be based on comprehensive individual geriatric risk assessment, including life expectancy, time to benefit or harm, and goals of care—not on adding medications to slow aging. 1
• The concept of "time to benefit" is critical: many preventive medications take years to provide benefits, while adverse drug reactions can occur early in treatment. 1

The Polypharmacy Problem

• Polypharmacy (typically defined as ≥5 medications) has increased dramatically in older U.S. adults—from 24% in 2000 to 39% in 2012—and is the strongest predictor of prescribing problems and adverse drug events. 1
• Adding medications to "slow aging" in healthy older adults directly contradicts current best practices, which focus on deprescribing inappropriate medications to reduce adverse drug reactions, falls, cognitive impairment, and mortality. 1
• Age-related changes in pharmacokinetics (reduced renal/hepatic clearance, increased body fat) and pharmacodynamics (altered end-organ responsiveness) fundamentally increase the risk of adverse drug events in older adults. 1

Research-Stage Compounds (Not Guideline-Recommended)

While several compounds show promise in preclinical and early clinical research, none are currently recommended by major medical societies for healthy aging:

Tier 1: Most Studied (But Not Guideline-Approved)

• Rapamycin (mTOR inhibitor): Preclinical evidence suggests it may slow cellular senescence and organismal aging, with therapeutic effects demonstrated in diverse age-related diseases in animal models. 2, 3
• Metformin: Shows promise particularly for cardiovascular and cancer mortality reduction in research settings, though its primary indication remains type 2 diabetes. 4, 3
• NAD+ precursors: Appear to promote better organ function and increased physical resistance in animal studies. 4, 3
• Senolytics: Target senescent cells and show promise in preclinical models. 3

Tier 2: Less Robust Evidence

• Acarbose, spermidine, lithium, and resveratrol have shown some efficacy in animal models but lack sufficient human clinical trial data. 4, 3

Critical Limitations

• These compounds lack randomized controlled trial evidence in representative older adult populations with functional and well-being outcomes. 5
• Most aging research excludes the very populations who would use these medications: adults ≥75 years, those with multimorbidity, frailty, or functional impairments. 1
• Clinical trials would need to demonstrate benefit in maintaining functional independence and quality of life—not just biomarkers—to justify use in healthy older adults. 1

What Guidelines Actually Recommend

Focus on Deprescribing, Not Adding Medications

• The 2019 AGS Beers Criteria® identifies potentially inappropriate medications to AVOID in older adults, not medications to add for anti-aging. 1
• Statins have been identified as candidates for deprescribing in older adults with limited life expectancy, multimorbidity, or frailty—the opposite of an anti-aging recommendation. 1
• When reviewing medications in older adults, clinicians must consider remaining life expectancy, time to benefit, and goals of care—not chronological age alone. 1

Prioritize Non-Pharmacological Interventions

• Physical inactivity and poor diet are modifiable shared risk factors for major age-related diseases that should be addressed before considering any pharmacological intervention. 1
• Exercise and nutritional interventions promote healthy aging and can help manage adverse drug reactions. 5
• The degree of frailty—not chronological age—should guide therapeutic decisions, with severe frailty typically observed in 12-24% of older adults. 1

Goals of Care in Older Adults

• In older adults with limited life expectancy or advanced diseases, goals of care should focus on preserving functional independence, quality of life, and alleviating distressing symptoms—not adding preventive medications. 1
• Secondary prevention medications that take several years to provide benefits may no longer be appropriate when they can produce adverse drug reactions early in treatment. 1

Common Pitfalls to Avoid

• Do not prescribe medications off-label for "anti-aging" based solely on preclinical animal data or biomarker studies. 5, 3
• Avoid the "prescribing cascade" where adverse drug events from one medication are treated as new conditions requiring additional medications. 1
• Do not assume that medications proven effective in younger, healthier populations will have the same benefit-risk profile in older adults with multimorbidity. 1
• Recognize that certain drugs can impair the ability to exercise and consume a healthy diet—key non-pharmacological interventions that promote healthy aging. 5

The Bottom Line

Current evidence-based geriatric medicine strongly opposes adding medications to "slow aging" in healthy older adults. 1 The focus should be on:

1. Comprehensive geriatric assessment to identify and treat actual diseases 1
2. Deprescribing inappropriate medications to reduce polypharmacy 1
3. Promoting exercise, nutrition, and other non-pharmacological interventions 1, 5
4. Aligning treatment goals with functional independence and quality of life 1

If future "gerotherapeutics" are developed that genuinely slow the aging process, they would need to demonstrate benefit in large, representative clinical trials with functional outcomes and acceptable safety profiles before guideline-based recommendations could be made. 5, 3, 6