Bempedoic acid

Pronunciation: bem-pe-DOE-ik acid.

Generic name
bempedoic acid
Drug class
ATP-citrate lyase (ACL) inhibitor
Form
Tablet (180 mg)
Route
Oral
Legal status
Prescription-only

Availability and supply rules vary by country

Trade names by country: United States · United Kingdom · Canada

Australia: · Full directory

What bempedoic acid is and how it works

Bempedoic acid is a prescription-only tablet that lowers LDL ('bad') cholesterol. It works through a different pathway than statins, so it is often used by people who cannot tolerate statins, or added to other cholesterol treatments. (1)

Take bempedoic acid exactly as prescribed, once a day. Your prescriber will check your cholesterol levels after a couple of months and may monitor your uric acid levels, since this medicine can raise them.

Mechanism of action: how bempedoic acid works

Bempedoic acid inhibits ATP-citrate lyase (ACL), an enzyme upstream of the target of statins in the cholesterol-synthesis pathway, reducing LDL cholesterol via a mechanism distinct from statins. (1)

What bempedoic acid is used for

Reducing cardiovascular risk

Used in adults at increased cardiovascular risk who are unable to take recommended statin therapy, to lower the risk of cardiovascular death, heart attack, stroke, or a coronary revascularisation procedure. (1)

Lowering LDL cholesterol

Used alongside diet and exercise, combined with other cholesterol-lowering medicines or alone when that is not possible, to lower LDL cholesterol in adults with high cholesterol, including the inherited condition heterozygous familial hypercholesterolemia (HeFH). (1)

Before taking bempedoic acid

Do not take / not appropriate for

  • Do not take bempedoic acid if you have had a serious allergic reaction to it or any of its ingredients. (all countries) (1)

Tell your clinician about

  • Any history of gout or high uric acid levels.
  • Any tendon problems in the past, and your age (tendon rupture risk is higher over age 60).
  • Whether you take corticosteroids (like prednisone) or fluoroquinolone antibiotics, or have kidney problems -- these increase tendon rupture risk.
  • All other cholesterol medicines you take, especially simvastatin, pravastatin, or fibrates.
  • Pregnancy, plans for pregnancy, or breastfeeding.
(1)

How to take bempedoic acid

  • Take one tablet by mouth once a day, with or without food.
  • Your prescriber will usually check your cholesterol levels 8-12 weeks after you start, to see how well it is working.
  • Your uric acid levels may also be checked periodically, since this medicine can raise them.
(1)

Procedures and treatment changes

Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4)

Missed dose

If you miss a dose, take it as soon as you remember unless it is almost time for your next dose -- in that case, skip the missed dose and continue your normal schedule. Do not take a double dose.

Overdose

Seek urgent medical attention or contact your prescriber if too much bempedoic acid has been taken. (1)

Side effects

Side effects and their urgency vary; report severe, persistent, or concerning symptoms.

Upper respiratory infections and muscle spasms.

What to notice: Upper respiratory infections and muscle spasms.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Raised uric acid levels, back pain, and stomach pain.

What to notice: Raised uric acid levels, back pain, and stomach pain.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Kidney function changes, low red blood cell count (anaemia), and raised liver enzymes have also been reported.

What to notice: Kidney function changes, low red blood cell count (anaemia), and raised liver enzymes have also been reported.

What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)

Serious warnings

Signs of a tendon injury — high caution

Symptoms: Sudden pain, swelling, bruising, or difficulty moving a joint, especially in the ankle, shoulder, or wrist -- signs of a possible tendon tear or rupture.

Action: Rest the affected joint and contact your prescriber promptly. Risk is higher over age 60, or with corticosteroid use, fluoroquinolone antibiotic use, kidney problems, or a past tendon injury. Your prescriber will decide whether to stop the medicine. (1)

Signs of gout — high caution

Symptoms: Sudden, severe joint pain, redness, and swelling, often starting in the big toe.

Action: Contact your prescriber -- this medicine can raise uric acid levels, and gout treatment may be needed. (1)

Interactions

  • If you take simvastatin, your prescriber will generally keep your dose at 20 mg or lower while taking bempedoic acid. (1)
  • If you take pravastatin, your prescriber will generally keep your dose at 40 mg or lower while taking bempedoic acid. (1)
  • Combining with fibrate medicines may need extra monitoring of your triglycerides and HDL cholesterol. (1)

Pregnancy, breastfeeding, kidney/liver function, age

Pregnancy

If you become pregnant while taking bempedoic acid, your prescriber will usually advise stopping it unless the benefits clearly outweigh the risks to the developing baby. (1) (2) (3) (4)

Breastfeeding

Bempedoic acid passes into breast milk. Discuss the risks and benefits of breastfeeding with your prescriber. (1) (2) (3) (4)

Children

Not established as safe/effective in children in the source reviewed. (1) (2) (3) (4)

Elderly

Tendon rupture risk is higher in people over 60 -- your prescriber will weigh this when deciding whether this medicine is right for you. (1) (2) (3) (4)

Hepatic_impairment

Not established in the source reviewed for this dossier. (1) (2) (3) (4)

Renal_impairment

Kidney problems increase the risk of tendon rupture -- tell your prescriber about any kidney issues. (1) (2) (3) (4)

Monitoring

Before starting

  • Baseline cholesterol/LDL levels
  • Uric acid level
  • Tendon injury history

During treatment

  • Cholesterol/LDL levels checked 8-12 weeks after starting.
  • Uric acid levels checked periodically.
  • Ongoing awareness of tendon pain/swelling symptoms.
(1)

Storage

Store as directed on the product label supplied with your specific medicine; keep out of the reach of children.

Professional information

Clinician-facing context only, sourced from the current US FDA prescribing information; verify against the current full label before prescribing.

United States

Indication: CV risk reduction / hypercholesterolemia / HeFH

Dose summary: 180 mg orally once daily, with or without food. Assess lipid levels 8-12 weeks after initiation. Avoid simvastatin >20mg or pravastatin >40mg concomitantly (myopathy risk). Monitor uric acid; initiate urate-lowering therapy as needed.

Renal context: Not established in the source reviewed for this dossier; renal impairment is a tendon-rupture risk factor to weigh. (1)

Mechanism of action

Hepatic guidance

Not established in the source reviewed for this dossier.

Overdose note

No specific antidote described in the source reviewed; manage supportively and seek prescriber guidance for suspected overdose. (1)

Frequently asked questions

Is bempedoic acid (Nexletol/Nilemdo) available in the US, UK, Europe, and Canada?

Yes, it is approved in all of these regions. Its status in Australia and New Zealand is less clear -- a commercial licensing deal was announced in 2025, but confirmed regulatory approval in those countries was not established in this review. (1) (2) (3) (4)

Is bempedoic acid a statin?

No. It lowers cholesterol through a different pathway than statins, which is why it's often an option for people who can't tolerate statins. (1)

What tendon-related symptoms should I watch for with bempedoic acid?

Tendon rupture has been reported with bempedoic acid, more often in people over 60, those taking corticosteroids or fluoroquinolone antibiotics, those with kidney failure, or those with a prior tendon problem. Rest and seek prompt medical attention if you notice sudden pain, swelling, bruising, or weakness in a tendon area (such as the Achilles tendon, shoulder, or hand), and tell your clinician about this medicine if it happens. (1)

What is the mechanism of action of bempedoic acid?

Bempedoic acid inhibits ATP-citrate lyase (ACL), an enzyme upstream of the target of statins in the cholesterol-synthesis pathway, reducing LDL cholesterol via a mechanism distinct from statins. (1)

What is the generic name of Bempedoic acid?

The generic name is bempedoic acid. (1)

What class of drug is bempedoic acid?

Bempedoic acid is classed as: ATP-citrate lyase (ACL) inhibitor. (1)

References

  1. NEXLETOL (bempedoic acid) tablets -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information, Esperion Therapeutics, Inc. · United States · accessed 2026-07-29 · source 1
  2. European Commission approval of NILEMDO (bempedoic acid)Esperion Therapeutics press releases / European Commission approval record · European Union / United Kingdom · accessed 2026-07-29 · source 2
  3. Health Canada approval of NILEMDO (bempedoic acid)HLS Therapeutics press releases (Health Canada licensee) · Canada · accessed 2026-07-29 · source 3
  4. Mixed evidence on Australian/New Zealand regulatory statusCSL Seqirus/Esperion press release (commercial licensing) and a TGA prescription-medicines-under-evaluation listing · Australia / New Zealand · accessed 2026-07-29 · source 4

Brand names by country

Single-ingredient bempedoic acid names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.

Priority countries

United States

  • Nexletol180 mg · esperion therapeutics, inc.

United Kingdom

  • Nilemdo (2)licensed via Daiichi Sankyo Europe confirmed · 180 mg · Daiichi Sankyo Europe

Canada

  • Nilemdo (3)Health Canada approved 2025-11 available 2026-03 · not specified in fetched source · HLS Therapeutics
View brands in additional countries.

European Union

Nilemdo (2)