bempedoic acid at a glance
Medicine class
ATP citrate lyase inhibitor
Main role
Lowers LDL cholesterol and, in eligible adults, cardiovascular risk
Administration
Swallow the film-coated tablet whole, with or without food
Important caution
May raise uric acid and trigger or worsen gout
What is bempedoic acid used for?
UK-licensed uses in adults include:
Primary hypercholesterolaemia, including heterozygous familial and non-familial disease, or mixed dyslipidaemia, alongside diet.
Use with a statin and potentially other lipid-lowering treatments when LDL cholesterol remains above the agreed goal.
Use alone or with other lipid-lowering treatments when statins are not tolerated or are contraindicated.
Reduction of cardiovascular risk through LDL lowering in adults with established or high-risk atherosclerotic cardiovascular disease, alongside management of other risk factors.
How does bempedoic acid work?
Bempedoic acid is activated mainly in the liver. It blocks ATP citrate lyase, reducing liver cholesterol production and increasing LDL receptors that remove LDL cholesterol from the blood. The activating enzyme is not expressed in skeletal muscle.
bempedoic acid preparations and strengths
Tablet
Route: Oral
Strengths: 180 mg
How to take bempedoic acid
Take it as prescribed. Swallow the tablet whole, with or without food.
Do not stop treatment without discussing it with the prescriber, because cholesterol may rise again.
Ask a pharmacist before crushing, splitting or otherwise altering the tablet.
bempedoic acid side effects
Common or expected effects
- Raised uric acid or gout
- Pain in an arm or leg
- Anaemia
- Changes in liver blood tests
- Reduced estimated kidney filtration on blood testing
Get urgent medical advice
- Unexplained muscle pain, tenderness or weakness when also taking a statin requires urgent assessment.
bempedoic acid in pregnancy
Bempedoic acid is contraindicated during pregnancy because reducing cholesterol synthesis may harm fetal development. Effective contraception is advised during treatment; contact the prescriber and stop treatment if pregnancy is planned or occurs.
bempedoic acid while breastfeeding
Very small amounts enter human milk. Breastfeeding may be considered after the prescriber weighs its benefits against the woman's need for treatment; information about effects on infants remains limited.
bempedoic acid interactions
A clinician or pharmacist should review other treatments before bempedoic acid is started.
Statins, particularly simvastatin
Bempedoic acid can increase statin exposure and the risk of muscle toxicity; concurrent simvastatin above the product's permitted limit is contraindicated.
Fibrates, including fenofibrate
The combination may raise triglycerides, lower HDL cholesterol and increase anaemia or hyperuricaemia, so laboratory monitoring is needed.
OATP1B1 or OATP1B3 substrates, including bosentan and certain hepatitis C antivirals
Their blood concentrations may increase, requiring an interaction review.
Common questions about bempedoic acid
Answers are fully visible for fast scanning and source review.
Is bempedoic acid a statin?
No. It inhibits ATP citrate lyase, an earlier step in liver cholesterol synthesis than the enzyme targeted by statins.
Why is it prescribed when a statin is not enough?
It can provide additional LDL lowering when the maximum tolerated statin treatment has not achieved the agreed cholesterol goal.
Can it be used if statins cause side effects?
Yes. It is licensed for adults who cannot tolerate statins or for whom statins are contraindicated, alone or with other lipid-lowering treatments.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.