Bempedoic acid Patient Tips

Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 31, 2025.

1. How it works

• Bempedoic acid works by lowering the production of cholesterol in the liver. It blocks an enzyme needed to make LDL (“bad cholesterol”) and lowers your cholesterol or other lipid levels.
• Bempedoic acid is a prescription medication used along with diet and other lipid-lowering medicines in adults to help lower high cholesterol. It is not a statin drug, but may be used alongside statin treatments. It can also be used alone.
• Bempedoic acid belongs to the class of medicines known as adenosine triphosphate-citrate lyase (ACL) inhibitors. It’s a prodrug and is converted to an active drug in the liver.
• Administration of bempedoic acid alone, or with other lipid-modifying agents, decreases low density lipoprotein cholesterol or “bad” cholesterol (LDL-C), non-high density lipoprotein cholesterol (non-HDL-C), apolipoprotein B (apo B), and total cholesterol (TC) in patients with hyperlipidemia.

2. Upsides

• Bempedoic acid is a prescription medication used with a cholesterol-lowering diet and other LDL cholesterol-lowering medicines, OR used alone when use with other LDL-C lowering therapy is not possible, to reduce LDL-C ("bad" cholesterol) in adults with high blood cholesterol levels (primary hyperlipidemia), including heterozygous familial hypercholesterolemia (HeFH). HeFH is an inherited condition that causes high levels of “bad” cholesterol called low density lipoprotein (LDL).
• It is also used to lower the risk of heart attack and heart procedures like stent placement or bypass surgery (coronary revascularization), adults who cannot take recommended statin treatment (a cholesterol-lowering medicine), OR are not taking a statin, who have known heart disease, or are at high risk for heart disease but without known heart disease.
• Taken as one tablet by mouth, once a day. It can be taken with or without food. No dose titration is needed.
• Is used with other cholesterol-lowering medications like statins, fenofibrate, or bile-acid sequestrants that also help to lower lipids.
• No dosage adjustments are recommended for people with mild or moderate kidney impairment, but there is limited experience in people with severe kidney disease or on dialysis.
• No dosage adjustments are recommended for people with mild to moderate liver impairment, but people with severe liver disease have not been studied.
• No dosage adjustments are recommended based on advanced age. No differences in safety or effectiveness were observed between patients 65 years and older, and younger patients. However, greater sensitivity in older patients cannot be ruled out.
• Dosing changes of bempedoic acid are not recommended when administered with atorvastatin (Lipitor) or rosuvastatin (Crestor), according to the manufacturer, but you may NOT be able to use bempedoic acid with some other statins. Check with your doctor.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Symptoms of the common cold or flu, muscle spasms, back pain, pain in the shoulders, legs or arms, anemia (low red blood cell counts), bronchitis (lung inflammation / infection), increased liver enzymes, kidney problems, gallstones, or stomach pain are listed as some of the most common side effects.
• It is not known if bempedoic acid is safe and effective in people with severe kidney problems including people with end-stage kidney disease who are on dialysis, those with severe liver problems, or in children under 18 years of age.
• In some cases, you may not be able to use simvastatin (Zocor) or pravastatin with bempedoic acid, depending upon your statin dose. Taking simvastatin or pravastatin with bempedoic acid may increase your risk of muscle pain or weakness.
• Tendon rupture has occurred in people using bempedoic acid and may occur within weeks to months of starting treatment. You may not be able to use bempedoic acid if you have a history of tendon disorders or tendon rupture. Symptoms of tendon problems may include pain, swelling, inflammation, and tears of tendons including the upper arm (biceps), shoulder (rotator cuff), and back of the ankle (Achilles). Stop use of bempedoic acid at the first sign of tendon rupture and contact your doctor right away.
• Elevations in serum uric acid have occurred and may lead to gout. This has happened within 4 weeks of starting treatment and may continue. Your doctor may monitor you regularly for elevated uric acid levels with a simple blood or urine test.
• There are not enough available data on bempedoic acid use in pregnant women to evaluate for a risk of major birth defects, miscarriage, or other side effects in the mother or fetus. However, based on it's mechanism of action, it may cause fetal harm.
• Breastfeeding is not recommended with bempedoic acid.
• There are currently no generic alternatives for the brand name drug Nexletol (bempedoic acid). It can be an expensive medicine if your insurance does cover it, but the manufacturer, Esperion Therapeutics, may be able to offer financial assistance or a Nexletol copay card for eligible patients. You can contact them at 1-833-639-5386, Monday-Friday, 8:00 AM-8:00 PM ET.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

• Bempedoic acid has been shown in studies to decrease LDL-C (“bad cholesterol”) levels and may be given in combination with other cholesterol-lowering treatments, or it can be used alone. It is also used to lower the risk of heart attack and heart procedures like stent placement or bypass surgery in certain people. This medicine is usually well-tolerated, but it may infrequently increase your risk of gout or tendon rupture. In studies, the most common reason people stopped treatment was due to muscle spasms, diarrhea, and pain in an extremity, like arms or legs.

5. Tips

• Take your medicine exactly as your healthcare provider tells you to take it. Contact them if you have any side effects that bother you or do not go away.
• Tell your healthcare provider if you have ever had a serious allergic reaction this medicine; it has been reported to cause serious allergic reactions with symptoms such as angioedema (swelling), wheezing, rash, and urticaria (hives). Do not use bempedoic acid if you have had a previous serious allergic reaction to bempedoic acid or any of the inactive ingredients in this medicine.
• Stop taking bempedoic acid and call your doctor right away or get emergency medical help right immediately if you have any signs or symptoms of a serious allergic reaction such as: swelling of the face, lips, mouth or tongue; wheezing; skin rashes, redness, or swelling; severe itching; dizziness or fainting; fast heart beat or pounding in your chest.
• Your healthcare provider will schedule a laboratory appointment to analyze your blood lipid levels within 8 to 12 weeks after you start bempedoic acid treatment.
• Taking statins with bempedoic acid may increase your risk of muscle injury. Contact your healthcare provider if you experience muscle pain.
• If you have or have ever had gout, high uric acid levels or problems with your tendons, tell your healthcare provider before you start treatment. Let your doctor know if you have kidney or liver problems before you start taking bempedoic acid.
• Call your healthcare provider if you have the following symptoms of high uric acid and gout, such as severe foot pain especially in the toe joint; tender joints; warm joints; joint redness or swelling.
• Stop taking bempedoic acid and get emergency help right away if you have any signs or symptoms of a tendon rupture, such as you hear or feel a snap or pop in a tendon area, you have bruising right after an injury in a tendon area, or you are unable to move the affected area or put weight on the affected area. Avoid using the affected area.
• You may be at a higher risk of tendon rupture if you are over 60 years of age, take corticosteroids (like prednisone, often called steroids), are taking antibiotics (like a fluoroquinolone, which includes ciprofloxacin, levofloxcin and others), have kidney problems, or have had previous tendon problems.
• Let your doctor know if you are pregnant or planning a pregnancy before treatment starts. Tell your healthcare provider right away if you become pregnant while taking this medicine. If you become pregnant during treatment, you and your doctor will decide if you should continue this medicine. If you are pregnant during bempedoic acid (Nexletol) treatment, you are encouraged to call Esperion at 1-833-377-7633 to share information about the health of you and your baby.
• Breastfeeding is not recommended with Bempedoic acid. If you are breastfeeding or plan to breastfeed, tell your doctor before treatment. You and your doctor will determine if you should breastfeed or take the medicine. You should not do both. It is not known if Bempedoic acid passes into your breast milk.
• This medicine may be taken at any time of the day or night; however, you should try to take your medicine at the same time each day.
• Taking statins with bempedoic acid may increase your risk of muscle injury. Contact your doctor if you experience muscle pain.
• Do not share this medicine with anyone else, even if they have the same medical condition as you do, It may harm them.
• You will need to follow a cholesterol-lowering diet and exercise plan while taking this medicine. Ask your doctor if you need information on a diet plan or food choices. If you smoke, discuss options for a smoking cessation plan to help you quit. This may include medicine and group therapy.
• If you cannot afford this medicine, the manufacturer, Esperion Therapuetics, may be able to help you lower your costs. You can call them at 1-833-639-5386, Monday-Friday, 8:00 AM-8:00 PM ET.
• Do not stop using any medications without first talking to your doctor.

6. Response and effectiveness

• In two 52-week long, placebo-controlled studies with over 3,000 patients, bempedoic acid was evaluated in adults with heterozygous familial hypercholesterolemia or established heart disease whose LDL-C levels were still high despite statin treatment at the highest tolerated dose, alone or with other lipid-lowering therapies.
• In study 1, bempedoic acid was added to the maximally tolerated statin dose, either alone (with only the statin) or with other lipid-lowering therapies. At 12 weeks, bempedoic acid lowered LDL-C levels by a mean of 18% compared to placebo, a statistically significant effect.
• In study 2, bempedoic acid was added to the maximally tolerated statin dose (or no statin at all) either alone or with other lipid-lowering therapies. At 12 weeks, bempedoic acid lowered LDL-C levels by a mean of 17% compared to placebo, a statistically significant effect.
• In both trials, the maximum LDL-C lowering effects occurred at Week 4. Your healthcare provider will check your lipid levels 8 to 12 weeks after you start treatment.
• Approval for cardiovascular risk reduction and LDL-C lowering were based on data generated from the CLEAR Outcomes trial in nearly 14,000 patients with, or at high risk, of cardiovascular disease. The primary end point was a four-component composite of major adverse cardiovascular events, defined as death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization. Patients were followed for a median duration of 3.4 years.
• In the study, patients who received bempedoic acid experienced a significantly lower risk by 13% for major adverse cardiovascular outcomes (death from cardiovascular causes, nonfatal myocardial infarction, nonfatal stroke, or coronary revascularization). In the study, LDL-C was reduced by 20%, C-reactive protein was reduced by 22%, and blood sugar (glucose) was not elevated by bempedoic acid compared to placebo.
• Overall, bempedoic acid was generally safe and well tolerated, but participants in the study taking bempedoic acid vs, placebo had higher incidences of elevated liver enzymes (4.5% vs. 3%), kidney problems (11.5% vs. 8.6%), gout (3.1% vs. 2.1%) and gallstones (2.2% vs. 1.2%).

7. Interactions

• Medicines that interact with bempedoic acid may either decrease its effect, increase its side effects, or change how other medicines work. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor or pharmacist about how drug interactions should be managed.
• Do NOT use bempedoic acid with doses of simvastatin (Zocor) greater than 20 mg or with doses of pravastatin greater than 40 mg. This may cause an increase in the statin level and may cause or worsen myopathy (muscle damage). Especially tell your healthcare provider if you take or plan to take simvastatin or pravastatin with bempedoic acid.
• There are no known food or beverage interactions with bempedoic acid, but because it may used alongside a statin or other cholesterol-lowering drug, there may interactions with those medicines (for example, grapefruit juice).
• Caution is advised if bempedoic acid is used concomitantly with drugs that are substrates of OATP1B1 or 1B3, particularly those with a narrow therapeutic range.
• Concomitant administration of bempedoic acid may potentiate the risk of tendon rupture or injury associated with fluoroquinolones (for example: ciprofloxacin or levofloxacin) and corticosteroids (such as prednisone, dexamethasone or methylprednisolone).
• Check with your pharmacist and doctor to review your medications for possible drug interactions with bempedoic acid. Tell your healthcare providers about all the medicines you take, including prescription and over-the-counter (OTC) medicines, vitamins, and herbal or dietary supplements.
• Note that this list is not all-inclusive and includes only common medications that may interact with bempedoic acid. Refer to the prescribing information for a complete list of interactions.

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Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use bempedoic acid only for the indication prescribed.

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

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