Bempedoic Acid
Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026
Bempedoic acid is an oral, once-daily ATP-citrate lyase (ACL) inhibitor used to lower LDL cholesterol, typically as an add-on to maximally tolerated statins or in statin-intolerant patients. It is a prodrug activated primarily in the liver, which limits muscle-related side effects seen with statins. It can be combined with ezetimibe in a fixed-dose product and has been shown to reduce major cardiovascular events in statin-intolerant patients.
Exploratory record, not a reviewed medical publication.
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What the research says.
A quick, data-only summary. The full evidence, dosing, and sources are below.
Bempedoic acid is an oral, once-daily ATP-citrate lyase (ACL) inhibitor used to lower LDL cholesterol, typically as an add-on to maximally tolerated statins or in statin-intolerant patients. NutriStack rates the supporting evidence as strong. Common adult dosing is 180 mg orally once daily, with or without food. Available alone or as a fixed-dose combination with ezetimibe 10 mg., though a prescriber sets the actual dose. This profile indexes 3 sources.
- Lowering LDL cholesterol in adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia)1,2
- Add-on therapy to maximally tolerated statins when additional LDL lowering is needed2
- LDL lowering in patients who are statin-intolerant1,2
- Reducing the risk of major adverse cardiovascular events in statin-intolerant patients with or at high risk for cardiovascular disease1,3
- Elevated uric acid (hyperuricemia) and gout flares
- Upper respiratory tract infection
- Muscle spasms
- Known hypersensitivity to bempedoic acid or any component of the formulation1,2
- Use caution and consider statin dose limits because bempedoic acid increases plasma concentrations of simvastatin and pravastatin (avoid simvastatin doses above 20 mg and pravastatin doses above 40 mg when used together)1,2
The bottom line
Evidence rating strong. Most-documented uses: lowering ldl cholesterol in adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia), add-on therapy to maximally tolerated statins when additional ldl lowering is needed, ldl lowering in patients who are statin-intolerant. 3 sources indexed (2016–2023), with 0 interaction records on file.
How it works, mechanistically.
Core mechanism
Bempedoic acid is a prodrug that is converted to its active form (bempedoyl-CoA) by the enzyme very long-chain acyl-CoA synthetase 1 (ACSVL1), which is expressed in the liver but not in skeletal muscle. The active metabolite inhibits ATP-citrate lyase (ACL), an enzyme that acts upstream of HMG-CoA reductase in the cholesterol biosynthesis pathway. Inhibiting ACL reduces hepatic cholesterol synthesis, leading to upregulation of LDL receptors and increased clearance of LDL particles from the blood. Because the activating enzyme is essentially absent in muscle tissue, bempedoic acid does not produce active drug in muscle, which accounts for its low rate of myalgia compared with statins.3,1
Dosing & protocol.
Can be taken with or without food at any time of day; food does not meaningfully affect efficacy. It is a prodrug activated in the liver. Bile-acid sequestrants and some other drugs may affect absorption if dosed together, so separate administration is generally advised.
Full safety detail.
Side effects
- Elevated uric acid (hyperuricemia) and gout flares
- Upper respiratory tract infection
- Muscle spasms
- Back pain
- Abdominal pain or discomfort
- Increased liver enzymes (transaminase elevations)
- Increased blood creatinine and decreased estimated GFR
- Tendon rupture (uncommon; higher risk with concurrent fluoroquinolones, corticosteroids, renal impairment, or in patients over 60)
- Anemia and elevated platelet counts (reported in trials)
Contraindications
- Known hypersensitivity to bempedoic acid or any component of the formulation1,2
- Use caution and consider statin dose limits because bempedoic acid increases plasma concentrations of simvastatin and pravastatin (avoid simvastatin doses above 20 mg and pravastatin doses above 40 mg when used together)1,2
- Pregnancy and breastfeeding are generally not recommended for lipid-lowering therapy of this type2
- History of gout or hyperuricemia warrants caution due to risk of elevated uric acid2
- History of tendon disorders or tendon rupture warrants caution
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Randomized controlled trials
2- 1Bempedoic Acid and Cardiovascular Outcomes in Statin-Intolerant Patients (CLEAR Outcomes trial)PMIDNissen SE, Lincoff AM, Brennan D, et al. · New England Journal of Medicine · 2023
In statin-intolerant patients, bempedoic acid lowered LDL cholesterol and significantly reduced the risk of a composite of major adverse cardiovascular events compared with placebo.
- 2Safety and Efficacy of Bempedoic Acid to Reduce LDL Cholesterol (CLEAR Harmony trial)PMIDRay KK, Bays HE, Catapano AL, et al. · New England Journal of Medicine · 2019
Bempedoic acid reduced LDL cholesterol by approximately 18 percent compared with placebo when added to maximally tolerated statin therapy, with a safety profile generally similar to placebo aside from higher rates of gout and elevated uric acid.
Reference material
1- 3Bempedoic acid: mechanism of action and clinical pharmacologyPMIDPinkosky SL, Newton RS, Day EA, et al. · Nature Communications · 2016
Bempedoic acid requires activation by very long-chain acyl-CoA synthetase 1, an enzyme absent from skeletal muscle, so it inhibits cholesterol synthesis in the liver via ATP-citrate lyase without generating active drug in muscle.
Common questions.
Quick answers about Bempedoic Acid, drawn from the data on this page.
What is Bempedoic Acid?
Bempedoic acid is an oral, once-daily ATP-citrate lyase (ACL) inhibitor used to lower LDL cholesterol, typically as an add-on to maximally tolerated statins or in statin-intolerant patients. It is a prodrug activated primarily in the liver, which limits muscle-related side effects seen with statins. It can be combined with ezetimibe in a fixed-dose product and has been shown to reduce major cardiovascular events in statin-intolerant patients.
What is Bempedoic Acid used for?
Commonly cited benefits of Bempedoic Acid include: Lowering LDL cholesterol in adults with primary hyperlipidemia (including heterozygous familial hypercholesterolemia); Add-on therapy to maximally tolerated statins when additional LDL lowering is needed; LDL lowering in patients who are statin-intolerant; Reducing the risk of major adverse cardiovascular events in statin-intolerant patients with or at high risk for cardiovascular disease. NutriStack rates the overall evidence as strong.
What is a typical dose of Bempedoic Acid?
A typical adult dose of Bempedoic Acid is 180 mg orally once daily, with or without food. Available alone or as a fixed-dose combination with ezetimibe 10 mg.. The commonly recommended form is Oral tablet (180 mg), taken once daily. These are general ranges, not personalized advice; confirm the right dose with a clinician.
What are the side effects of Bempedoic Acid?
Reported side effects include elevated uric acid (hyperuricemia) and gout flares, upper respiratory tract infection, muscle spasms, back pain, abdominal pain or discomfort, increased liver enzymes (transaminase elevations). This is educational information; check with a healthcare professional before use.
How strong is the evidence for Bempedoic Acid?
NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.
Use this with your stack
Bempedoic Acid in NutriStack.
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