Common Side Effects of Bempedoic Acid
Patients taking bempedoic acid (Nexletac or Nexlizet) most often report upper respiratory tract infections, back pain, high uric acid levels (hyperuricemia), muscle spasms, diarrhea, abdominal pain, nausea, bronchitis, pain in extremities, and increased liver enzymes.[1][2]
Serious Side Effects and Risks
Tendon rupture or injury can occur, especially in those over 60 or with kidney/gout history—stop the drug if suspected.[1] Elevated uric acid raises gout flare risk; monitor levels.[1][2] Possible allergic reactions include rash, itching, swelling, or breathing trouble—seek emergency care.[1] Liver enzyme increases need monitoring; rare severe liver damage reported.[2]
How Side Effects Compare to Statins
Bempedoic acid causes fewer muscle-related issues (myalgia in ~4-5% vs. 5-10% with statins) since it activates only in the liver, not muscles.2 However, it has higher hyperuricemia (1.2-1.5 mg/dL rise) and tendon risks not typical with statins.3
Who Experiences Side Effects Most?
Older adults, those with kidney impairment, or gout history face higher tendon and uric acid risks.[1] Combination with ezetimibe (Nexlizet) slightly increases gallstones.[2] Clinical trials showed 10-15% discontinuation due to adverse events, similar to placebo in some studies.3
Managing and Monitoring Side Effects
Check uric acid and liver enzymes before starting and periodically.[1] Stay hydrated to reduce gout risk; report muscle pain or tendon issues immediately.[2] No routine muscle enzyme monitoring needed, unlike statins.3
[1]: https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/211616s000lbl.pdf (Nexletac prescribing information)
[2]: https://www.nexlizet.com/ (official patient site with side effects data)