You’ll hear buzz about bempedoic acid (Nilemdo), a new oral non-statin cholesterol med.
It’ll be an option to ADD to a statin (rosuvastatin, etc) in patients with high cholesterol. It may also be used alone or together with other non-statin meds in patients who don’t tolerate a statin.
But don’t expect bempedoic acid to fly off your shelves.
Bempedoic acid costs about $140/month and it may increase the risk of statin-induced muscle pain when added to a statin.
Plus it can bump up uric acid levels. About 1 in 100 patients on bempedoic acid report a gout attack...however most of these patients have a history of gout or prior elevated uric acid levels.
Expect to see statins used first for cholesterol lowering...based on established benefits, safety and tolerability, and low cost.
If further cholesterol lowering is needed, a non-statin may be added, such as ezetimibe (Ezetrol), a PCSK9 inhibitor (alirocumab, evolocumab), icosapent ethyl (Vascepa), or bempedoic acid.
If you get an Rx for bempedoic acid, ensure their profile is current with medical conditions since patients with a history of gout may need extra monitoring due to the increased risk of a flare.
Expect patients on bempedoic acid to take one 180 mg tablet by mouth once daily...with or without food.
Don’t override drug interaction alerts. For example, simvastatin should be limited to a daily dose of 20 mg or less when combined with bempedoic acid since it may increase simvastatin levels and the risk of muscle pain.
Compare bempedoic acid to other meds in our chart, Non-Statin Lipid-Lowering Agents.
- Nissen SE, Lincoff AM, Brennan D, et al. Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients. N Engl J Med. 2023 Apr 13;388(15):1353-1364.
- Pearson GJ, Thannassoulis G, Anderson TJ, et al. 2021 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults. Can J Cardiol. 2021 Aug;37(8):1129-1150.