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ATP-citrate lyase inhibitor + cholesterol absorption inhibitor

Bempedoic acid with ezetimibe

Brand names: Nustendi

A fixed-dose oral combination of bempedoic acid and ezetimibe used as an adjunct to diet to lower LDL-cholesterol, particularly where statins are not tolerated or do not achieve target.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

Bempedoic acid inhibits ATP-citrate lyase upstream of cholesterol synthesis, upregulating LDL receptors, while ezetimibe inhibits the intestinal cholesterol transporter NPC1L1 to reduce cholesterol absorption; together they lower circulating LDL-cholesterol.

Prescribing in practice

  • Bempedoic acid can raise serum uric acid and precipitate gout and has been associated with tendon rupture, so review patients with hyperuricaemia, gout or tendon disorders.
  • Avoid concurrent high-intensity simvastatin and use caution with statins generally, as bempedoic acid increases statin exposure and the risk of myopathy.
  • It is an option for statin intolerance or inadequate response, not a routine first-line lipid-lowering choice.

Monitoring

Monitor lipid profile to assess response, with review of uric acid and gout symptoms where relevant.

Counselling the patient

  • Report joint pain or swelling suggestive of gout, or tendon pain or swelling.
  • Continue dietary and lifestyle measures alongside the tablet.
  • Tell your prescriber about any statin you are also taking.

Evidence & guidelines

NICE recommends bempedoic acid with ezetimibe as an option for primary hypercholesterolaemia or mixed dyslipidaemia when statins are contraindicated or not tolerated, supported by cardiovascular outcome data for bempedoic acid.

Reference: NICE TA729; ESC/EAS; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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