Nexletol (Bempedoic Acid) - Oral

What Is Nexletol?

Nexletol (bempedoic acid) is an oral prescription tablet used to treat high cholesterol (hyperlipidemia). It is usually used along with other cholesterol-lowering medications, such as HMG-CoA reductase inhibitors or statins.

Cholesterol is an important part of the body and serves as a structure for your cells. However, too much cholesterol in your blood can put you at risk for heart disease, heart attack, high blood pressure, or stroke. High cholesterol can be caused by many reasons, including conditions that increase your blood vessels' fat levels. One common cause of high cholesterol is a diet of excessive amounts of fatty meat, dairy, or fast food.

Nexletol works well if you have not met your goal of therapy since it completely stops the liver from making low-density lipoprotein (LDL), commonly referred to as the "bad" type of cholesterol. The way it works also makes it effective when added to statin therapy since statins inhibit another enzyme involved in making cholesterol, HMG-CoA reductase. The use of both these medications may be necessary to manage your medical condition effectively.

Drug Facts

Generic Name: Bempedoic acid

Brand Name(s): Nexletol

Administration Route(s): Oral

Drug Availability: Prescription

Therapeutic Classification: Antihyperlipidemic

Available Generically: No

Controlled Substance: N/A

Active Ingredient: Bempedoic acid

Dosage Form(s): Tablet

What Is Nexletol Used For?

The Food and Drug Administration (FDA) approved Nexletol as an additional therapy if you have:

Nexletol (Bempedoic Acid) Drug Information - Illustration by Zoe Hansen

Verywell / Zoe Hansen

How to Take Nexletol

Only take Nexletol with the guidance of your prescribing healthcare provider.

Generally, you can take Nexletol with or without food and with water. You should continue to take this medication and any other cholesterol treatments you are taking, even if you are feeling well. You may not have any signs or symptoms of high cholesterol. It is important that you take your medication as instructed to avoid any unwanted health problems, such as a heart attack.

Storage

Store Nexletol in a cool and dry place. Generally, medications should be kept away from areas with a lot of heat, such as your kitchen, or in places with high humidity, such as your bathroom. Environments such as these can impact how well medications work. Keep your medication away and out of reach of children and pets to avoid accidental consumption.

It is always important to contact your pharmacy or prescribing healthcare provider before you run out to clarify any details when wanting to refill medications.

How Long Does Nexletol Take to Work?

Generally, Nexletol may take at least a week to have an effect on your cholesterol with its maximum effect taking up to 12 weeks. This will vary from person to person and can change due to many factors, such as gender, age, weight, taking it with meals or without meals, and others.

What Are the Side Effects of Nexletol?

It is generally always important to follow directions from your prescriber or pharmacist on any medication that you may receive to avoid interactions or worsening side effects of Nexletol.

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.

Common Side Effects

Common side effects of Nexletol include:

Severe Side Effects

Call your healthcare provider right away if you are experiencing any of the side effects below:

  • Increased uric acid, with which you may experience joint stiffness or severe joint pain
  • Tendon rupture

You should also call 911 if your symptoms feel life-threatening or if you think you are experiencing a medical emergency.

Long-Term Side Effects

One long-term effect, even once you’re no longer taking Nexletol, is increased liver proteins. Specifically, this drug may increase proteins that are produced by your liver called transaminases. Elevated transaminases can often indicate liver damage or that something may be wrong with your liver, but other times it may not indicate anything. Your provider will monitor your lab regularly as indicated and necessary.

Report Side Effects

Nexletol may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Nexletol Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablets):
    • For heterozygous familial hypercholesterolemia (HeFH) and patients with heart disease who need additional lowering of their bad cholesterol (LDL) levels:
      • Adults—180 milligrams (mg) once a day together with a statin medicine.
      • Children—Use and dose must be determined by your doctor.

Modifications

There are no special changes that would be made if you are an older adult, pregnant or nursing, or if you are younger. Nexletol will generally be dosed the same.

Missed Dose

If you miss a dose of Nexletol, you should take it as soon as you remember. If you are close to the next scheduled dose when you remember, you should just take that dose and not the one you missed. It is essential not to take more than one dose at a time. If you miss a dose, it is more likely that it will be harder to control your high cholesterol.

Overdose: What Happens If I Take Too Much Nexletol?

There is no specific dose indicating that you have taken too much Nexletol. The effects of a Nexletol overdose will be similar to its side effects and can include:

  • Cough symptoms associated with a cold
  • Muscle spasms
  • Back pain
  • Abdominal pain
  • Inflammation of your airways
  • Increased liver proteins

There is no clinical experience with an overdose of Nexletol.

What Happens If I Overdose on Nexletol?

If you think you or someone else may have overdosed on Nexletol, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses, has a seizure, has trouble breathing, or can’t wake up after taking too much Nexletol, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood and urine tests may be needed to check for unwanted effects.

This medicine may increase the uric acid levels in the blood (hyperuricemia), which can lead to gout. This can occur within 4 weeks of using this medicine. Check with your doctor right away if you have joint pain, stiffness, or swelling, lower back, side, or stomach pain, or swelling of the feet or lower legs.

Tendon problems, including swelling, inflammation, or rupture can occur in the shoulder (rotator cuff), upper arm (biceps tendon), or Achilles tendon at the back of the ankle, within days or months after starting treatment with bempedoic acid. If you hear or feel a snap or pop, have bruising right after an injury, or are unable to move or put weight in an affected tendon area, check with your doctor right away. Avoid using and exercising the affected area.

Using this medicine together with simvastatin or pravastatin may increase your risk of developing muscle pain or weakness. Talk to your doctor if you have any concerns.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Nexletol?

There are no contraindications that the FDA lists for Nexletol. Generally, if you are allergic to Nexletol, bempedoic acid, or any of the ingredients in the tablet you are given, you should not take Nexletol. If you are experiencing an allergic reaction, it can look like the symptoms mentioned below:

  • Hives
  • Difficulty breathing
  • Itchiness
  • Redness
  • Swelling

You should always tell your healthcare provider if you have experienced the symptoms associated with an allergic reaction. Other treatment options may be better for you.

​​This medication should be used with caution if you have a history of gout. The use of Nexlizet has been shown to increase your uric acid levels, which can cause a gout flare-up. If you are already taking this medication, it is important to monitor your uric acid levels.

Nexletol can also increase the risk of tendon ruptures in people:

Avoid taking this medication if you have a history of tendon disorders or tendon rupture.

What Other Medications Interact With Nexletol?

Your healthcare provider will usually only add Nexletol to your treatment regimen if they think it is necessary. To be eligible for Nexletol, you must already be taking a statin medication. Statins are generally the first treatment option for high cholesterol. Although statins should be used, they can still interact with Nexletol.

These specific statins have been identified by the FDA to have an interaction with Nexletol:

  • Simvastatin: It is recommended to avoid Nexletol if you are taking a dose over 20 milligrams of simvastatin.
  • Pravastatin: If you are taking over 40 milligrams of pravastatin, it is recommended to avoid Nexletol.

Taking Nexletol with the above statin medications can increase the risk that you develop a side effect associated with statins known as myopathy. Myopathy, or muscle pain, can indicate that your liver may not be functioning properly.

What Medications Are Similar?

Nexletol is a unique drug. It is currently the only FDA-approved ACL inhibitor.

Nexletol isn't the only treatment used for high cholesterol, and it is often not even the first choice. Usually, the treatments used initially will be statins, such as:

  • Lipitor (atorvastatin)
  • Crestor (rosuvastatin)
  • Pravacahol (pravastatin)
  • Livalo (pitavastatin)

Your healthcare provider will prescribe Nexletol if you aren't achieving your therapy goals with statins alone. Other potential cholesterol-lowering options include:

  • Zetia (ezetimibe): Zetia works differently than Nexletol or statins. It reduces how much cholesterol you absorb from food.
  • Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors: PCSK9 inhibitors also work differently than other cholesterol-lowering drugs. They lower cholesterol by allowing the liver to remove more from the blood than usual.

This is a list of drugs also prescribed for high cholesterol. This is NOT a list of drugs that should be taken with Nexletol unless recommended by your prescriber. It is always important to ask your pharmacist or healthcare provider if you have any questions.

Frequently Asked Questions

  • How can I manage the side effects of Nexletol?

    Cough drops can help manage cough related to Nexletol. If you are experiencing a cough, it is important to ensure that it is due to the medication. If you also have a fever or if you are producing phlegm, then it is likely that your cough is not caused by Nexletol. Other side effects like stomach pain can be managed by eating before or after taking your dose. Muscle spasms and back pain associated with Nexletol can be reduced by stretching or taking a pain reliever recommended by your healthcare provider.

  • How expensive is Nexletol? Is there a way I can get help paying for it?

    Nexletol is an expensive medication that can range between $350 to $400, and it may be difficult to pay for it if your insurance does not cover it. If you have trouble affording your medication, you may be eligible for savings cards available through the manufacturer.

  • What else can I do to manage my high cholesterol?

    Apart from regularly taking your medication, one of the best things you can do for high cholesterol is to maintain a healthy diet. You may be advised to follow a DASH diet, which will generally consist of low daily amounts of salt and a larger amount of green, leafy vegetables. You can also try to get in 30 minutes of moderate-intensity exercise per day.

How Can I Stay Healthy While Taking Nexletol?

To stay healthy while taking Nexletol, it is important to take it exactly as directed by your healthcare provider. While it can be difficult to remember to regularly keep up with your medications, it is important for keeping your cholesterol under control. Living a healthy lifestyle by maintaining a healthy diet, active lifestyle, and staying well hydrated is also necessary for managing your condition.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Food and Drug Administration. Nexletol label.

  2. Grundy SM, Stone NJ, Bailey AL, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNa guideline on the management of blood cholesterol: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3168-3209. doi:10.1016/j.jacc.2018.11.002

  3. Stancu C, Sima A. Statins: mechanism of action and effects. J Cell Mol Med. 2001;5(4):378-387. doi:10.1111/j.1582-4934.2001.tb00172.x

  4. Food and Drug Administration. Zetia label.