What is Bempedoic acid used for?

Bempedoic acid is an innovative pharmaceutical agent that has garnered significant attention in the medical community for its role in managing cholesterol levels. Marketed under trade names such as Nexletol and Nilemdo, Bempedoic acid targets specific enzymes involved in cholesterol biosynthesis. Developed by Esperion Therapeutics, this drug belongs to the ATP citrate lyase (ACL) inhibitors class and is primarily indicated for the treatment of hypercholesterolemia, particularly in patients who are statin-intolerant or require additional lipid-lowering therapy. Research and clinical trials have shown promising results, with ongoing studies aimed at further elucidating its efficacy and safety profile.

The mechanism of action of Bempedoic acid is distinct from other lipid-lowering agents, particularly statins. Bempedoic acid inhibits the enzyme ATP citrate lyase, a key player in the cholesterol biosynthesis pathway upstream of HMG-CoA reductase, the enzyme targeted by statins. By inhibiting ATP citrate lyase, Bempedoic acid reduces the amount of acetyl-CoA available for cholesterol synthesis, thereby lowering low-density lipoprotein cholesterol (LDL-C) levels in the blood. This mode of action is particularly beneficial for patients who cannot tolerate statins due to muscle-related side effects, as Bempedoic acid does not directly affect muscle cells.

Administering Bempedoic acid is straightforward, making it a convenient option for patients. The drug is taken orally, usually in the form of a tablet, once a day. This daily regimen simplifies adherence to the treatment plan, increasing the likelihood of achieving optimal therapeutic outcomes. The onset of action of Bempedoic acid is relatively rapid, with significant reductions in LDL-C levels observed within weeks of initiating therapy. However, as with most lipid-lowering treatments, the full effect may take several months, and continued use is necessary to maintain the benefits.

Like all medications, Bempedoic acid is associated with a range of side effects, although not all individuals will experience them. Common side effects include respiratory tract infections, muscle spasms, hyperuricemia, and gastrointestinal symptoms such as abdominal pain and diarrhea. While these side effects are generally mild to moderate in severity, they can be bothersome and may necessitate medical attention. More serious, but less common, side effects include tendon rupture and elevations in liver enzymes, which warrant closer monitoring and possibly discontinuation of the drug.

Contraindications for using Bempedoic acid include known hypersensitivity to the drug or any of its components, as well as severe renal or hepatic impairment. Due to its potential to increase uric acid levels, Bempedoic acid is not recommended for patients with gout. Additionally, caution is advised when prescribing this medication to individuals with a history of tendon disorders or those concurrently taking corticosteroids or fluoroquinolones, as these factors may further elevate the risk of tendon rupture.

Bempedoic acid can interact with other drugs, potentially altering its efficacy or increasing the risk of adverse effects. For instance, co-administration with simvastatin or pravastatin can lead to elevated blood levels of these statins, increasing the likelihood of muscle-related side effects such as myopathy or rhabdomyolysis. Therefore, when Bempedoic acid is prescribed alongside these statins, it is crucial to use the lowest effective doses of the statins and monitor the patient closely for signs of muscle damage.

Additionally, Bempedoic acid may affect the metabolism of drugs that are substrates of specific transporters such as OATP1B1 and OATP1B3. Patients should inform their healthcare provider of all medications they are currently taking, including over-the-counter drugs and supplements, to avoid potential drug interactions. Adjustments to dosages or alternative therapies may be necessary to minimize risks and ensure the safe use of Bempedoic acid.

In conclusion, Bempedoic acid represents a significant advancement in the management of hypercholesterolemia, particularly for patients who are intolerant to statins. Its unique mechanism of action, relatively straightforward administration, and promising efficacy make it a valuable addition to the therapeutic arsenal against high cholesterol. However, like all medications, it comes with potential side effects and drug interactions that must be carefully managed. Ongoing research and clinical experience will continue to refine our understanding of this drug, ultimately enhancing its role in improving cardiovascular health.