Bempedoic Acid

Basic bempedoic acid information

• International nonproprietary name (INN): Bempedoic acid
• Brand names available in the United Kingdom: Nilemdo (bempedoic acid 180 mg), Nustendi (bempedoic acid 180 mg/ezetimibe 10 mg)
• ATC code: C10AX15
• Forms and dosages: Film-coated tablets 180 mg; fixed-dose combination tablets with ezetimibe 180 mg/10 mg
• Manufacturers in the United Kingdom: Daiichi Sankyo
• Registration status in the United Kingdom: Prescription-only medicine (POM)
• OTC / Rx classification: Prescription-only medicine (POM)

Everyday use and best practices

Morning vs evening dosing

Bempedoic acid is taken once daily, at the same time each day.

Taking with or without meals

Bempedoic acid can be taken with or without food, which makes it easy to fit around daily routines. Swallow the tablet whole with water.

Safety priorities

Who should avoid it

The following groups should avoid bempedoic acid or use it only on medical advice.

• Known hypersensitivity to bempedoic acid or any of its excipients.
• Pregnancy and breastfeeding (it is contraindicated; women who could become pregnant need effective contraception).
• Severe renal or hepatic impairment: there is limited experience, so it should be used with caution and under medical supervision.

Monitoring is needed in people with a history of gout or high uric acid levels, as bempedoic acid can increase uric acid levels and tendon rupture has been reported.

Activities to limit

Muscle spasms, back pain or fatigue can occur in some patients.

Take care when driving or operating machinery until you know how bempedoic acid affects you.

Dosage and adjustments

General regimen

The recommended dose for adults is 180 mg orally once daily.

To support compliance:

• Establish a daily routine.
• Use reminders or alarms to ensure no doses are missed.
• Discuss with a healthcare provider if you have difficulty adhering to this regimen.

Special cases

For older adults, the standard adult dose applies, and careful monitoring is recommended to assess any potential side effects. Patients with diabetes or those who have previously experienced statin intolerance should also consult with their healthcare provider. Bempedoic acid may be combined with ezetimibe, which is also available as a fixed-dose combination tablet (Nustendi).

What’s inside and how it works

Ingredients overview

Each tablet contains 180 mg of the active ingredient, bempedoic acid. The tablets also contain excipients, including lactose monohydrate, which may be a concern for people with lactose intolerance; check the patient information leaflet if you have allergies.

Mechanism basics explained simply

Bempedoic acid works as an ATP citrate lyase (ACL) inhibitor. This unique mechanism blocks the conversion of citrate into acetyl-CoA, which is a key building block for cholesterol production in the liver. By inhibiting this pathway, bempedoic acid effectively reduces LDL cholesterol levels.

Unlike statins, which lower cholesterol by blocking HMG-CoA reductase, bempedoic acid is activated mainly in the liver and not in muscle, which is why it may be an option for people who cannot tolerate statins.

Main indications

Approved uses (MHRA listing)

Bempedoic acid is licensed in the UK for adults with primary hypercholesterolaemia (heterozygous familial and non-familial) or mixed dyslipidaemia, as an adjunct to diet. It is used with a statin (with or without ezetimibe) when LDL cholesterol targets are not reached on a maximally tolerated statin, or alone or with ezetimibe in patients who are statin-intolerant or for whom statins are contraindicated.

Off-label uses in UK clinics

Any use outside the licensed indications should only take place under the supervision of a healthcare professional, who will weigh the potential benefits against the risks.

Interaction warnings

Food interactions

Bempedoic acid can be taken with or without food. There are no specific food restrictions, but excessive alcohol is best avoided because of the risk of liver side effects.

Drug conflicts

Bempedoic acid increases blood levels of simvastatin and pravastatin, so doses of simvastatin above 40 mg daily and pravastatin above 40 mg daily should be avoided. Tell your healthcare provider about all the medicines you take, and report suspected side effects through the Yellow Card scheme.

Alternative choices

NHS alternatives to bempedoic acid include:

• Statins: Effective but can cause muscle pain in some individuals.
• PCSK9 inhibitors (such as alirocumab and evolocumab): Injectable medicines considered for people with very high LDL cholesterol, for example in familial hypercholesterolaemia.
• Ezetimibe: Often used on its own or in combination with a statin or bempedoic acid.

A discussion with a healthcare provider can help to determine the best course for managing cholesterol levels.

Regulation snapshot

Bempedoic acid is a prescription-only medicine (POM) in the UK. It is licensed by the MHRA, and the NHS (via NICE guidance) recommends it for adults with primary hypercholesterolaemia or mixed dyslipidaemia in defined circumstances, including statin intolerance.

Frequently asked questions

What are the common side effects of bempedoic acid?

Common side effects include muscle spasms, increased uric acid levels (which can lead to gout), and abdominal pain. Tell your healthcare provider about any significant discomfort.

How does bempedoic acid work?

This medication inhibits ATP citrate lyase, differentiating it from statins, by blocking a key enzyme involved in cholesterol synthesis in the liver.

Is bempedoic acid safe during pregnancy or breastfeeding?

Bempedoic acid is contraindicated during pregnancy and breastfeeding. Patients should consult their healthcare providers for alternative therapies during these life stages.

Is bempedoic acid available without a prescription?

No – in the UK bempedoic acid is a prescription-only medicine.

For further reading on bempedoic acid, see the NHS website or the British National Formulary (BNF).

Guidelines for proper use

UK pharmacist counselling style

Pharmacists can guide patients on the proper use and dosage of bempedoic acid and address concerns about potential side effects.

NHS patient support advice

Patients are encouraged to talk openly with their healthcare providers about treatment progress and any concerns.