Complete Guide with FAQs
Introduction
- Bempedoic Acid is a lipid-lowering medication used to manage high cholesterol, particularly in patients who are intolerant to or need additional cholesterol reduction beyond what statins provide.
- It works by inhibiting ATP-citrate lyase, a key enzyme in cholesterol synthesis in the liver.
- Commonly prescribed in combination with statins or ezetimibe for patients with atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia.
Class and Mechanism of Action
- Drug Class: ATP-citrate lyase inhibitor.
- Mechanism of Action:
- Reduces cholesterol production in the liver by inhibiting ATP-citrate lyase, a key enzyme upstream of HMG-CoA reductase (targeted by statins).
- Lowers LDL (“bad cholesterol”) and complements the action of other cholesterol-lowering drugs.
Indications
- Primary Hypercholesterolemia
- Used for lowering LDL cholesterol in patients with high cholesterol levels.
- Atherosclerotic Cardiovascular Disease (ASCVD)
- Reduces the risk of cardiovascular events in high-risk patients.
- Familial Hypercholesterolemia
- Treats both heterozygous forms in adults when statins alone are insufficient or not tolerated.
- Statin Intolerance
- Alternative for patients who cannot tolerate statins due to side effects like muscle pain.
Dosage and Administration
Standard Dose:
- 180 mg orally once daily.
Administration Guidelines:
- Can be taken with or without food.
- Swallow the tablet whole; do not crush, chew, or split.
- Ensure adherence to a lipid-lowering diet alongside medication.
Forms, Brand Names, Manufacturers, and Prices
Brand Name | Manufacturer | Form | Price Range |
---|---|---|---|
Nexletol | Esperion Therapeutics | Tablets (180 mg) | ~$300–$500 per month |
Nexlizet | Esperion Therapeutics | Bempedoic acid + ezetimibe | ~$400–$600 per month |
Contraindications and Precautions
Contraindications:
- Known hypersensitivity to bempedoic acid or any excipients.
- Severe liver disease or significant elevations in liver enzymes.
Precautions:
- Use cautiously in patients with moderate liver impairment.
- Monitor uric acid levels, as it may increase the risk of gout.
- Adjust treatment if severe joint pain or tendon rupture occurs.
Side Effects
Common Side Effects
- Upper respiratory tract infections.
- Muscle spasms.
- Back pain.
- Elevated liver enzymes.
Less Common Side Effects
- Increased uric acid levels (may trigger gout).
- Abdominal discomfort.
Rare but Serious Side Effects
- Tendon rupture.
- Severe allergic reactions (e.g., rash, swelling, breathing difficulty).
Drug Interactions
- Statins: Safe to use with low-to-moderate dose statins but monitor for potential additive effects.
- Ezetimibe: Often combined for enhanced LDL-lowering effects.
- Cyclosporine: Monitor closely, as bempedoic acid may increase its levels.
- Anticoagulants (e.g., Warfarin): Monitor INR levels as anticoagulant effects may be altered.
Monitoring Parameters
- Lipid Profile: Measure LDL, HDL, and triglycerides at baseline, 4–12 weeks after starting treatment, and periodically.
- Liver Function Tests (LFTs): Monitor at baseline and periodically for liver enzyme elevations.
- Uric Acid Levels: Check in patients with a history of gout.
- Signs of Tendonitis or Tendon Rupture: Educate patients to report symptoms promptly.
Patient Counseling Points
- Take bempedoic acid exactly as prescribed; do not skip doses.
- Continue following a heart-healthy diet and exercise routine.
- Report any symptoms of muscle pain, severe joint discomfort, or tendon injury.
- Avoid activities that stress tendons excessively while on this medication.
- Inform your healthcare provider about all other medications or supplements you’re taking.
Use in Children
- Safety and efficacy in pediatric populations have not been established.
Use in Pregnancy
- Not recommended; limited data on its use in pregnancy. Discuss potential risks and alternatives with a healthcare provider.
Use in Elderly
- Generally well-tolerated; monitor for side effects like muscle pain or elevated uric acid levels.
FAQs About Bempedoic Acid
Q1: What is bempedoic acid used for?
- Bempedoic acid is used to lower LDL cholesterol, particularly in patients with high cardiovascular risk or statin intolerance.
Q2: How does bempedoic acid differ from statins?
- Bempedoic acid works upstream of statins in the cholesterol synthesis pathway and is less likely to cause muscle-related side effects.
Q3: Can bempedoic acid be combined with other cholesterol-lowering medications?
- Yes, it is often combined with statins or ezetimibe for enhanced LDL reduction.
Q4: How long does it take for bempedoic acid to work?
- Significant reductions in LDL cholesterol are seen within 4–12 weeks of starting treatment.
Q5: Can bempedoic acid cause gout?
- Yes, it may increase uric acid levels and trigger gout in susceptible individuals.
Q6: Is bempedoic acid safe for patients with liver disease?
- Use cautiously in moderate liver impairment; avoid in severe cases.
Q7: What should I do if I miss a dose?
- Take the missed dose as soon as you remember unless it’s close to the next dose. Do not double up.
Q8: Does bempedoic acid cause muscle pain?
- Muscle pain is less common with bempedoic acid compared to statins.
Q9: Can bempedoic acid prevent heart attacks?
- While it lowers cholesterol and cardiovascular risk, direct evidence for heart attack prevention is still being studied.
Q10: Is bempedoic acid safe during pregnancy?
- It is not recommended due to limited data; consult your doctor for alternatives.
Q11: Can bempedoic acid be used in patients with statin intolerance?
- Yes, it is a valuable option for those who cannot tolerate statins.
Q12: How is bempedoic acid different from ezetimibe?
- Bempedoic acid inhibits cholesterol synthesis in the liver, while ezetimibe reduces cholesterol absorption in the intestines.
Q13: What are the signs of tendon rupture?
- Sudden, sharp pain, swelling, bruising, or difficulty moving the affected area.
Q14: Are there natural alternatives to bempedoic acid?
- Diet and lifestyle changes can help lower cholesterol but may not be sufficient for high-risk patients.
Q15: Does bempedoic acid interact with statins?
- It is safe with low-to-moderate dose statins but requires monitoring to avoid side effects.