Rankings / Metabolic Health

Bempedoic acid

Metabolic Health · ACL inhibitor

Also known as: Nexletol

Tier B-

Reviewed by Read Off Label · Last reviewed · How we grade

statinprescription
5.9 / 10
Tier B-
Ev 7 Bn 5 Sf 5

Bottom line

Read Off Label grades Bempedoic acid as B- (5.9/10) based on moderate-strong evidence, moderate benefit magnitude, and a med-risk safety profile.

CLEAR Outcomes 2023 finally gave statin-intolerant patients a non-statin oral with CV outcome data.

Studied, labeled, or reported-use context: 180 mg PO daily — Rx; not individualized guidance.

What the evidence says

CLEAR Outcomes 2023 finally gave statin-intolerant patients a non-statin oral with CV outcome data. Gout flares are a documented adverse effect; baseline hyperuricemia increases their relevance. Expensive relative to ezetimibe with similar LDL reduction. A 2026 post hoc age-stratified analysis of the phase 3 program (JAHA, n=16,979 pooled) found LDL-C reduction (~18-25%) and CV event reduction were statistically comparable across age bands including patients >=75 years, with a similar adverse-event profile (modestly higher overall AE frequency in the oldest group, as expected) -- reassuring for older readers considering it.

Mechanism

ATP-citrate lyase inhibitor; blocks cholesterol synthesis upstream of HMG-CoA reductase; prodrug activated only in liver (bypasses muscle → less myalgia); ~20% LDL reduction monotherapy; CLEAR Outcomes trial showed CV benefit

Studied, labeled, or reported dose & route

180 mg PO daily

This records doses and routes described in studies, approved labeling, clinical practice, or documented use. It is not individualized guidance and does not establish safety; context changes with indication, formulation, health history, monitoring, and other medicines.

Citations

A link means the source informed this entry; it does not mean every claim on the page comes from that source. If a citation looks wrong or you want a claim re-checked, send a correction.

Common questions

What does the evidence show about Bempedoic acid's effects?
Read Off Label rates the evidence for Bempedoic acid as Moderate-Strong and the benefit magnitude as moderate, producing an overall grade of B- (5.9/10). CLEAR Outcomes 2023 finally gave statin-intolerant patients a non-statin oral with CV outcome data.
What safety findings are reported for Bempedoic acid?
Bempedoic acid has a med risk profile in the database. Med (hyperuricemia — gout risk; modest LFT elevations; tendon rupture reports) Legal status: Rx (Nexletol; combo with ezetimibe = Nexlizet).
What doses or routes are reported for Bempedoic acid?
180 mg PO daily This is context from studies, approved labeling, clinical practice, or documented use; it is not individualized guidance and does not establish safety.
How does Bempedoic acid work?
ATP-citrate lyase inhibitor; blocks cholesterol synthesis upstream of HMG-CoA reductase; prodrug activated only in liver (bypasses muscle → less myalgia); ~20% LDL reduction monotherapy; CLEAR Outcomes trial showed CV benefit

This is an independent synthesis of published research by a non-clinician. Scores are opinions supported by citations, not prescriptions. See the full disclaimer and methodology for how this score was produced and what it does and doesn't mean.