What is Nexletol and What Does It Treat?
Nexletol, also known by its generic name bempedoic acid, is a medication prescribed to lower LDL cholesterol levels in adults [1]. It is used in individuals with primary hyperlipidemia or mixed hyperlipidemia who require additional LDL-C lowering beyond diet and maximally tolerated statin therapy [1]. It can also be used in patients with established atherosclerotic cardiovascular disease or multiple cardiovascular risk factors who require additional lowering of LDL-C [1].
How Does Nexletol Work?
Nexletol functions by inhibiting ATP citrate lyase (ACL), an enzyme found in the liver [1]. This inhibition reduces the synthesis of cholesterol in the liver, which in turn leads to an increase in LDL receptors on the surface of liver cells [1]. These increased LDL receptors help to remove more LDL cholesterol from the bloodstream [1].
What Are the Alternatives to Nexletol for Lowering Cholesterol?
Several classes of medications serve as alternatives to Nexletol for managing high cholesterol, often used in combination with lifestyle modifications such as diet and exercise [2].
Statin Medications
Statins are a primary class of drugs used to lower LDL cholesterol [2]. They work by blocking a different enzyme in the cholesterol production pathway, HMG-CoA reductase [2]. Examples include atorvastatin (Lipitor), rosuvastatin (Crestor), simvastatin (Zocor), and pravastatin (Pravachol) [2]. Statins are typically the first-line treatment for individuals needing cholesterol reduction [2].
Ezetimibe (Zetia)
Ezetimibe is another option that works differently from statins and Nexletol [3]. It reduces the absorption of cholesterol from the small intestine [3]. Ezetimibe is often prescribed alongside statins when statins alone are not sufficient to reach target LDL cholesterol levels [3]. It can also be used as monotherapy for patients who cannot tolerate statins [3].
PCSK9 Inhibitors
PCSK9 inhibitors are injectable medications that significantly lower LDL cholesterol [4]. They work by increasing the number of LDL receptors in the liver that are available to clear cholesterol from the blood [4]. Examples include evolocumab (Repatha) and alirocumab (Praluent) [4]. These are generally reserved for individuals with very high cholesterol or those who have not responded adequately to other treatments [4].
Bile Acid Sequestrants
These medications, such as cholestyramine (Questran) and colesevelam (Welchol), bind to bile acids in the intestine, prompting the liver to use cholesterol to make more bile acids [5]. This process removes cholesterol from the bloodstream [5].
Fibrates and Niacin
Fibrates, like fenofibrate and gemfibrozil, are primarily used to lower triglycerides and can have a modest effect on raising HDL cholesterol, with some LDL-lowering capacity [6]. Niacin (vitamin B3) can lower LDL and triglycerides while raising HDL, but its use has been limited by side effects and evidence of not providing additional cardiovascular benefit when added to statin therapy in some studies [6].
Can I Combine Nexletol with Other Cholesterol Medications?
Nexletol can be used in combination with other cholesterol-lowering medications, including statins [1]. It is indicated for patients who require additional LDL-C lowering beyond diet and maximally tolerated statin therapy [1]. It has also been studied and used in combination with ezetimibe [1].
What Are the Side Effects of Nexletol?
Common side effects associated with Nexletol include upper respiratory tract infections, muscle spasms, gout, and hyperuricemia (elevated uric acid levels) [1].
How Long Does It Take for Nexletol to Work?
The LDL cholesterol-lowering effects of Nexletol are typically observed within four weeks of starting treatment [1].
Are There Any Drugs Like Nexletol?
Nexletol is unique in its mechanism of action as an inhibitor of ATP citrate lyase (ACL) [1]. While other drugs target cholesterol synthesis or absorption, the specific inhibition of ACL distinguishes Nexletol [1]. Drugs like statins inhibit HMG-CoA reductase, and ezetimibe inhibits cholesterol absorption [1, 3]. PCSK9 inhibitors work by affecting LDL receptor degradation [4].