Bempedoic acid

Pronunciation: bem-pee-doe-ick az-sid
Generic name: bempedoic acid
Brand name: Nexletol
Dosage form: oral tablet
Drug class: Miscellaneous antihyperlipidemic agents

Medically reviewed by Carmen Pope, BPharm. Last updated on Apr 18, 2024.

What is bempedoic acid?

Bempedoic acid is an oral tablet for high cholesterol that may be used to:

• lower the risk of heart attack and heart procedures (for example stent placement or bypass surgery), in adults not taking a statin who have known heart disease or are at high risk for heart disease
• reduce low-density lipoprotein (also called "bad" cholesterol or LDL) in adults with high cholesterol  (also called primary hyperlipidemia), including those with heterozygous familial hypercholesterolemia (HeFH) (an inherited form of high cholesterol). It may be used alongside dietary changes and other cholesterol-lowering medicines or alone.

Bempedoic acid works by blocking an enzyme called adenosine triphosphate-citrate lyase (ACL) that is involved in the production of cholesterol by the liver. This lowers LDL-C levels in the blood. The bempedoic acid brand name is Nexletol.

Bempedoic acid was first FDA-approved on February 21, 2020, under the brand name, Nexletol. There is no Nexletol generic. 

Bempedoic acid side effects

Bempedoic acid may cause serious side effects, including the following.

Increased levels of uric acid in your blood (hyperuricemia). This can happen within 4 weeks of starting treatment and continue throughout. Your healthcare provider will monitor your blood uric acid levels while you are taking Nexletol. High levels of blood uric acid may lead to gout. Call your healthcare provider if you have the following symptoms of hyperuricemia and gout:

• severe foot pain especially in the toe joint
• warm joints
• swelling
• tender joints
• joint redness.

Gout may happen more in people who have had gout before but also can happen in people who have never had it before.

Tendon rupture or injury. Tendon problems can happen in people who take bempedoic acid. Tendons are tough cords of tissue that connect muscles to bones. Symptoms of tendon problems may include pain, swelling, tears, and inflammation of tendons including the arm, shoulder, and back of the ankle (Achilles).

• Tendon rupture can happen while you are taking bempedoic acid. Tendon ruptures can happen within days or months of starting bempedoic acid.
• The risk of getting tendon problems while you take bempedoic acid is higher if you:
  • are over 60 years of age
  • are taking antibiotics (fluoroquinolones)
  • have had tendon problems
  • are taking steroids (corticosteroids)
  • have renal failure.
• Stop taking bempedoic acid immediately and get medical help right away if you get any of the following signs or symptoms of a tendon rupture:
  • hear or feel a snap or pop in a tendon area
  • bruising right after an injury in a tendon area
  • unable to move the affected area or put weight on the affected area
• If you suspect a tendon rupture, do not take bempedoic acid until this has been ruled out by your healthcare provider. Avoid exercise and using the affected area. The most common areas of pain and swelling are the rotator cuff (the shoulder), the biceps tendon (upper arm), and the Achilles tendon at the back of the ankle. This can happen with other tendons.
• Talk to your healthcare provider about the risk of tendon rupture with continued use of bempedoic acid. You may need a different lipid-lowering medicine to treat your cholesterol levels.

The most common side effects of bempedoic acid affecting 2% or more people include:

• symptoms of the common cold, flu, or flu-like symptoms
• back pain
• stomach pain
• high uric acid levels
• increased liver enzymes
• muscle spasms
• pain in the shoulder, legs, or arms
• anemia
• bronchitis.

Tell your healthcare provider if you have any side effect that bothers you or that does not go away. These are not all the possible side effects of bempedoic acid. For more information, ask your healthcare provider or pharmacist. Call your healthcare provider for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Warnings

It is not known if bempedoic acid is safe and effective in:

• people with severe liver problems
• severe kidney problems including people with end-stage kidney disease who are on dialysis
• children under 18 years of age.

Elevations in serum uric acid have occurred. Your healthcare provider will monitor your uric acid levels and you for symptoms of gout and treat if appropriate.

Bempedoic acid is associated with an increased risk of tendon rupture within weeks to months of starting treatment. The risk is higher in those who are over 60 years of age, taking corticosteroids or fluoroquinolones, in patients with renal failure, and in those with previous tendon disorders. Tell your doctor right away if you experience joint pain, swelling, or inflammation of a joint.

May cause fetal harm. Breastfeeding is not recommended.

Bempedoic acid cost

The cost of prescription drugs varies depending on your insurance plan and which pharmacy you use. Bempedoic acid is only available under the brand name, Nexletol. Refer to our price guide page for more information about Nexletol cost.

You may also be eligible for a Nexletol copay card or Nexletol coupon. Ask your doctor or pharmacist if you qualify. There is no Nexletol generic.

Before taking bempedoic acid

Before you start taking bempedoic acid, tell your healthcare provider about all your medical conditions, including if you:

• have or had gout.
• have or had tendon problems
• have severe kidney problems.
• have severe liver problems
• are pregnant, think you might be pregnant, or plan to become pregnant
• are breastfeeding or plan to breastfeed.

Pregnancy

Bempedoic acid may cause harm to your unborn baby. You and your healthcare provider will decide if you should take
it while you are pregnant. If you become pregnant during bempedoic acid treatment, tell your healthcare provider right away and call Esperion at 1-833-377-7633 to share information about the health of you and your baby.

Breastfeeding

It is not known if bempedoic acid passes into your breast milk. You and your healthcare provider should decide if you will take bempedoic acid or breastfeed. You should not do both.

How should I take bempedoic acid?

Bempedoic acid is only available as Nexletol. Take Nexletol exactly as your healthcare provider tells you to take it. Check with your healthcare provider or pharmacist if you are not sure.

• Take 1 Nexletol 180 mg tablet by mouth each day. Each tablet contains 180mg of bempedoic acid.
• You may take it with or without food.

What happens if I miss a dose?

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and just go back to your regular dosing schedule. Do not take two doses at once.

What happens if I overdose?

If you take too much bempedoic acid, call your Poison Control Center at 1-800-222-1222 or go to the nearest hospital emergency room right away.

What other drugs will affect bempedoic acid?

Bempedoic acid may affect the way other medicines work, and other medicines may affect how bempedoic acid works. Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements. Tell your healthcare provider if you take simvastatin or pravastatin (other cholesterol-lowering medicines). Taking statins with bempedoic acid may increase your risk of developing muscle pain or weakness (myopathy).

Know the medicines you take. Keep a list of them to show your healthcare provider and pharmacist when you get a new medicine.

Storage

Store Nexletol in the original package at room temperature between 68ºF to 77ºF (20ºC to 25ºC).

Do not throw away the packet that helps to keep your medicine dry (desiccant).

Keep bempedoic acid and all medicines out of the reach of children.

Ingredients

Active Ingredient: bempedoic acid.

Inactive Ingredients: colloidal silicon dioxide, hydroxyl propyl cellulose, lactose monohydrate, magnesium stearate, microcrystalline cellulose, and sodium starch glycolate.

Tablet coating: partially hydrolyzed polyvinyl alcohol, polyethylene glycol, talc, and titanium dioxide.

Bempedoic acid is only available as Nexletol; there is no Nexletol generic. Tablets are available as a single strength, Nexletol 180 mg which contains 180mg bempedoic acid.

Manufacturer

Esperion Therapeutics, Inc.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer