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ATP-citrate lyase inhibitor (lipid-lowering)

Bempedoic acid

Brand names: Nilemdo

Bempedoic acid is an oral lipid-lowering agent used to reduce LDL-cholesterol, either alone or with a statin and/or ezetimibe, in patients with hypercholesterolaemia or mixed dyslipidaemia.

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

It is a prodrug that inhibits ATP-citrate lyase in the cholesterol biosynthesis pathway, upregulating LDL receptors and lowering circulating LDL-cholesterol.

Prescribing in practice

  • It can raise serum uric acid and may precipitate gout, so use with caution in patients with a history of gout or hyperuricaemia.
  • Tendon rupture has been reported, so consider discontinuation if tendinitis or tendon rupture occurs.
  • Activation occurs in the liver via an enzyme largely absent from skeletal muscle, which may account for a low incidence of muscle-related effects.

Monitoring

Monitor the lipid profile for response, and check uric acid and assess for gout symptoms where clinically indicated.

Counselling the patient

  • Report joint pain or swelling, which could indicate gout, and any tendon pain or swelling.
  • Continue dietary measures and any other cholesterol-lowering medicines alongside this treatment.

Evidence & guidelines

The CLEAR Outcomes trial demonstrated cardiovascular risk reduction with bempedoic acid in statin-intolerant patients.

Reference: NICE TA694; 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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