Bempedoic Acid

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

  1. Primary Hypercholesterolemia
    • Used for lowering LDL cholesterol in patients with high cholesterol levels.
  2. Atherosclerotic Cardiovascular Disease (ASCVD)
    • Reduces the risk of cardiovascular events in high-risk patients.
  3. Familial Hypercholesterolemia
    • Treats both heterozygous forms in adults when statins alone are insufficient or not tolerated.
  4. 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 NameManufacturerFormPrice Range
NexletolEsperion TherapeuticsTablets (180 mg)~$300–$500 per month
NexlizetEsperion TherapeuticsBempedoic 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.