What is Bempedoic Acid: Uses, Dosage, Side Effects and More

Bempedoic acid is a newer cholesterol-lowering medication that helps reduce "bad" LDL cholesterol levels in your blood. It's specifically designed for people who need extra help managing their cholesterol, especially when statins alone aren't enough or when statins cause uncomfortable side effects.

This medication works differently from statins, targeting a specific enzyme in your liver that produces cholesterol. Think of it as another tool in your doctor's toolkit to help protect your heart and blood vessels from the long-term effects of high cholesterol.

What is Bempedoic Acid Used For?

Bempedoic acid is primarily used to lower LDL cholesterol in adults with atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia. These are medical terms for conditions where your body either has trouble managing cholesterol naturally or has already developed plaque buildup in your arteries.

Your doctor might prescribe this medication if you're already taking a statin but still need additional cholesterol reduction. It's also an option if you can't tolerate statins due to muscle pain or other side effects that make those medications difficult to take.

The medication is typically used as part of a comprehensive approach that includes a heart-healthy diet and regular exercise. It's not meant to replace these lifestyle changes but rather to work alongside them for better cholesterol control.

How Does Bempedoic Acid Work?

Bempedoic acid works by blocking an enzyme called ATP citrate lyase in your liver, which is involved in cholesterol production. This is a different pathway than statins use, making it a complementary option rather than a replacement.

The medication is considered moderately effective at lowering LDL cholesterol, typically reducing levels by about 15-25% when used alone. When combined with a statin, the cholesterol-lowering effect can be even more significant, helping you reach your target levels more effectively.

One unique aspect of bempedoic acid is that it's what doctors call a "prodrug." This means it becomes active only after your body processes it, specifically in the liver where cholesterol is made. This targeted activation may help reduce some of the muscle-related side effects that can occur with other cholesterol medications.

How Should I Take Bempedoic Acid?

Bempedoic acid is typically taken once daily as a 180mg tablet, and you can take it with or without food. Most people find it easier to remember when they take it at the same time each day, such as with breakfast or dinner.

You should swallow the tablet whole with a glass of water. Don't crush, chew, or break the tablet, as this can affect how the medication is absorbed and processed by your body.

If you're taking other medications, especially blood thinners like warfarin, your doctor may need to monitor you more closely. Bempedoic acid can increase the effects of certain blood thinners, so timing and coordination with your healthcare provider is important.

How Long Should I Take Bempedoic Acid For?

Bempedoic acid is typically a long-term medication that you'll need to take continuously to maintain its cholesterol-lowering benefits. Most people need to take it for months or years, similar to other cholesterol medications.

Your doctor will likely check your cholesterol levels after about 8-12 weeks of treatment to see how well the medication is working. Based on these results, they might adjust your dose or recommend additional treatments to help you reach your cholesterol goals.

It's important not to stop taking bempedoic acid suddenly without talking to your doctor first. If you discontinue the medication, your cholesterol levels will likely return to their previous higher levels, which could increase your risk of heart problems over time.

What Are the Side Effects of Bempedoic Acid?

Most people tolerate bempedoic acid well, but like all medications, it can cause side effects in some individuals. The good news is that serious side effects are relatively uncommon, and many people experience no side effects at all.

Here are the most common side effects you might experience, keeping in mind that these affect only a small percentage of people taking the medication:

• Upper respiratory tract infections (similar to a common cold)
• Muscle spasms or pain, though typically milder than with statins
• High uric acid levels, which your doctor can monitor with blood tests
• Back pain or general body aches
• Abdominal pain or discomfort
• Bronchitis or cough

These side effects are generally mild and often improve as your body adjusts to the medication. If you experience any persistent or bothersome symptoms, don't hesitate to discuss them with your healthcare provider.

There are some less common but more serious side effects that require immediate medical attention. While these are rare, it's important to be aware of them:

• Signs of tendon problems, such as sudden severe pain or inability to move a joint
• Severe muscle pain or weakness that doesn't improve
• Signs of gout, including sudden, severe joint pain and swelling
• Unusual fatigue or weakness that persists

If you experience any of these more serious symptoms, contact your doctor promptly. They can help determine whether the symptoms are related to the medication and adjust your treatment plan if necessary.

Who Should Not Take Bempedoic Acid?

Bempedoic acid isn't suitable for everyone, and your doctor will carefully consider your medical history before prescribing it. There are certain conditions and situations where this medication should be avoided or used with extra caution.

You should not take bempedoic acid if you have severe liver disease or if liver function tests show significant abnormalities. Since the medication is processed by the liver, impaired liver function can affect how your body handles the drug.

If you're pregnant, planning to become pregnant, or breastfeeding, bempedoic acid is not recommended. The safety of this medication during pregnancy and breastfeeding hasn't been established, so your doctor will likely suggest alternative approaches to managing your cholesterol during these times.

People with a history of tendon problems or certain genetic conditions affecting muscle function may need special monitoring or alternative treatments. Your doctor will discuss these considerations with you based on your individual medical history.

Bempedoic Acid Brand Names

Bempedoic acid is available under the brand name Nexletol when used alone. This is the most commonly prescribed form of the medication that you'll likely encounter at the pharmacy.

There's also a combination medication called Nexlizet, which contains both bempedoic acid and ezetimibe (another cholesterol-lowering drug). Your doctor might prescribe this combination if you need the benefits of both medications to reach your cholesterol targets.

Both brand names contain the same active ingredient, but the combination version provides additional cholesterol-lowering power by blocking cholesterol absorption in your intestines as well as reducing cholesterol production in your liver.

Bempedoic Acid Alternatives

If bempedoic acid isn't right for you, there are several other cholesterol-lowering medications your doctor might consider. The choice depends on your specific situation, other health conditions, and how you've responded to previous treatments.

Statins remain the first-line treatment for most people with high cholesterol. These include medications like atorvastatin, simvastatin, and rosuvastatin. They're generally very effective and well-studied, though some people experience muscle-related side effects.

Ezetimibe is another option that works by blocking cholesterol absorption in your intestines. It's often used in combination with statins or as an alternative for people who can't tolerate statins. PCSK9 inhibitors are newer, more powerful medications given by injection, typically reserved for people with very high cholesterol or genetic conditions.

Your doctor will work with you to find the best approach based on your cholesterol levels, risk factors, and personal preferences. Sometimes a combination of medications works better than any single drug alone.

Is Bempedoic Acid Better Than Statins?

Bempedoic acid and statins work differently and have their own advantages, so it's not necessarily a matter of one being "better" than the other. The best choice depends on your individual circumstances and treatment goals.

Statins are generally more powerful at lowering cholesterol and have decades of research showing they reduce heart attacks and strokes. They're typically the first medication doctors recommend for most people with high cholesterol because of their proven track record and effectiveness.

Bempedoic acid offers some unique advantages, particularly for people who experience muscle pain with statins. It may be less likely to cause muscle-related side effects, making it a valuable option for statin-intolerant patients. It also works well in combination with statins for people who need additional cholesterol reduction.

Your doctor will consider factors like your cholesterol levels, risk of heart disease, previous medication experiences, and other health conditions when deciding which medication or combination of medications is best for you.