An oral cholesterol-lowering medicine
Bempedoic acid
An oral medicine that lowers LDL (bad) cholesterol, used when statins are not tolerated or are not enough on their own.
What is Bempedoic acid?
Bempedoic acid is a tablet that lowers LDL (bad) cholesterol. It is mainly used for people who cannot take or cannot tolerate statins, or who need extra cholesterol lowering on top of a statin. It works in the liver to reduce how much cholesterol the body makes, and is often combined with ezetimibe. It can raise uric acid, which may trigger gout, and rarely affects the tendons. In the UK it is sold as Nilemdo, and as Nustendi when combined with ezetimibe.
Education and reference only. This is a plain-language guide to Bempedoic acid — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Bempedoic acid is a prescription tablet that lowers LDL cholesterol, the type linked to furring of the arteries and to heart attacks and strokes. It belongs to a class called ACL inhibitors and is a relatively recent option in the UK. It is mainly used for people who cannot take statins, who get muscle side effects from them, or who need their cholesterol brought down further despite a statin. It is taken once a day and is often combined with another cholesterol medicine, ezetimibe.
How it works
Bempedoic acid blocks an enzyme in the liver that the body uses to make cholesterol, which is one step earlier than where statins act. As the liver makes less cholesterol, it pulls more LDL out of the blood, so LDL levels fall. Because it is mainly switched on inside the liver rather than in muscle, it is less likely to cause the muscle aches that some people get with statins, which is why it is useful when statins are not tolerated.
Company & origin
Originated / developed by: Daiichi Sankyo.
A newer oral cholesterol-lowering medicine used in the UK for people who cannot tolerate statins or need extra LDL lowering on top of them.
What it treats
Conditions Bempedoic acid is used for
Practical use
How to take Bempedoic acid
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take one tablet once a day, with or without food, at a time you will remember.
- Keep taking it every day even though you will not feel any difference, as the benefit is in lowering your long-term risk.
- Tell your prescriber if you have ever had gout, as this medicine can raise uric acid and trigger an attack.
- Report any new tendon pain, swelling or stiffness, particularly in the heel, and stop and seek advice if it occurs.
- Keep up healthy eating, regular activity and other heart-protective habits alongside the tablet.
Weighing it up
Advantages & disadvantages of Bempedoic acid
Advantages
- Lowers LDL cholesterol in people who cannot take or tolerate statins.
- Acts mainly in the liver, so it is less likely to cause the muscle aches some people get with statins.
- Available combined with ezetimibe in a single daily tablet for a greater effect.
Disadvantages
- Can raise uric acid and bring on gout in people who are prone to it.
- Rarely affects the tendons, causing pain or, very rarely, a tear.
- Lowers cholesterol but does not make you feel any different, so it is easy to forget.
Practical use
Good to know
Bempedoic acid is most useful when a statin cannot be taken or is not enough, and it is often paired with ezetimibe (as Nustendi) for a bigger effect from one tablet. A key thing to know is that it can raise the level of uric acid in the blood, which can bring on a gout attack in people who are prone to it, so tell your prescriber if you have ever had gout. It can also, rarely, affect the tendons, so report any new tendon pain or swelling, especially in the heel. Like other cholesterol medicines it works best alongside a healthy diet, regular activity and not smoking, and the benefit comes from taking it steadily over the long term rather than from feeling any day-to-day difference.
Who should not take it / use with caution
- It should not be used in pregnancy or while breastfeeding.
- People with a history of gout should use it with caution and tell their prescriber.
- It is used carefully in those with significant liver or kidney problems, or a history of tendon disorders.
Monitoring
- Blood tests to check that LDL cholesterol is falling as expected.
- Checking uric acid and watching for gout symptoms, especially early on.
- Reviewing for any tendon or muscle symptoms and overall heart risk.
Side effects
- Raised uric acid, which may trigger gout, is one of the more notable effects.
- Tummy upset, back or limb pain, and raised liver enzymes or uric acid seen on blood tests in some people.
- Rarely, tendon problems such as pain or swelling, especially around the heel.
Key interactions
- Taken with certain statins (such as simvastatin or pravastatin) it can raise their levels, so doses may be limited.
- It can interact with some medicines handled by the same body pathways, so tell your prescriber what you take.
- It is often used alongside ezetimibe, either as separate tablets or combined as Nustendi.
Available as: Tablets taken by mouth, alone or combined with ezetimibe.
Answers
Bempedoic acid: frequently asked questions
Why might I be given bempedoic acid instead of a statin?
It is mainly used for people who cannot take statins or get muscle side effects from them, or who need extra cholesterol lowering on top of a statin.
Will it give me the muscle aches I had with statins?
It acts mainly in the liver rather than in muscle, so it is less likely to cause the muscle aches some people get with statins, though any new pain should be reported.
Can it cause gout?
Yes, it can raise uric acid in the blood, which may bring on gout in people who are prone to it, so tell your prescriber if you have ever had gout.
What is Nustendi?
Nustendi is bempedoic acid combined with ezetimibe in a single tablet, giving a greater cholesterol-lowering effect than either alone.
Will I feel any different on it?
No. Like other cholesterol medicines it does not make you feel different; the benefit is in lowering your long-term risk of heart attack and stroke.
Authoritative sources
- BNF
- NICE CKS
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