If you have high cholesterol, your doctor may prescribe Nexletol along with a statin medication and a low-cholesterol diet.

Nexletol is a prescription drug used in adults with heterozygous familial hypercholesterolemia (HeFH) or a type of cardiovascular (heart or blood vessel) disease.

It’s not currently known if Nexletol can lower risk of heart problems or death caused by high cholesterol. This is a limitation of Nexletol’s use. For details, see “Is Nexletol used for LDL cholesterol?” below.

Nexletol basics

Nexletol comes as a tablet that you’ll take by mouth. It contains the active ingredient bempedoic acid. This drug isn’t currently available in a generic form.

Bempedoic acid is an adenosine triphosphate-citrate lyase (ACL) inhibitor. It works by blocking a protein in the liver that makes LDL cholesterol. Bempedoic acid is the only drug in this group of medications.

In this article, we describe Nexletol’s dosage, side effects, and more.

Like most drugs, Nexletol may cause mild or serious side effects. The lists below describe some of the more common side effects it may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of Nexletol. They can also suggest ways to help manage side effects.

Mild side effects

Here’s a list of some of the mild side effects Nexletol can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Nexletol’s prescribing information.

Mild side effects of Nexletol that have been reported include:

Mild side effects of many drugs may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

* To learn more about this side effect, see the “Side effect focus” section below.

Serious side effects

Serious side effects from Nexletol can occur. If you have serious side effects from Nexletol, call your doctor right away. But if you think you’re having a medical emergency, you should call 911 or your local emergency number.

Serious side effects of Nexletol that have been reported, which are described in the “Side effect focus” section below, include:

Side effect focus

Learn more about some of the side effects Nexletol may cause.

High level of uric acid

Nexletol can increase the uric acid levels in your blood. This is called hyperuricemia.

Most people who have hyperuricemia with Nexletol don’t have any noticeable symptoms. But the following symptoms are possible:

  • severe foot pain, especially in the big toe
  • warm, red, or tender joints
  • swelling

Your uric levels may increase within 4 weeks of starting Nexletol. They may continue to remain high while you’re taking this drug. Over time, high uric acid levels can lead to gout (a type of arthritis).

Your doctor will monitor your uric acid levels with blood tests during treatment.

What might help

To help prevent hyperuricemia when taking Nexletol, your doctor may recommend drinking lots of water. Be sure to let your doctor know if you or anyone in your family has had high uric acid levels or gout.

Tell your doctor right away if you have any symptoms of hyperuricemia. They can diagnose this condition with blood tests and a physical exam.

If your uric acid is high or if you have symptoms of hyperuricemia, your doctor may prescribe medication to lower the uric acid levels in your blood. Examples include allopurinol (Zyloprim) and febuxostat (Uloric).

If you develop gout with Nexletol, your doctor may have you stop taking Nexletol. But you should not stop taking this drug without talking with your doctor first.

Ruptured tendons

Nexletol can cause tendon injury, including tendon rupture. This refers to tearing in a type of connective tissue that connects muscle to bone.

In studies, shoulder tears, bicep tears, and tears in the Achilles tendon in the ankle were most common. Symptoms of tendon problems may include swelling, inflammation, and pain in the area. A ruptured tendon can occur within weeks or months of starting Nexletol.

Your risk of a ruptured tendon with Nexletol treatment is higher if you:

  • are ages 60 years and older
  • take other medications that can also cause tendon rupture, such as corticosteroids or fluoroquinolones (a type of antibiotic)
  • have kidney failure
  • have had tendon problems in the past

What might help

If you have any of the following symptoms of tendon rupture, rest the area as much as possible and contact your doctor immediately:

  • hearing or feeling a pop in a tendon
  • bruising after injuring the area
  • inability to fully move or put weight on the body part

If you have a ruptured tendon with Nexletol, your doctor will have you stop taking the drug. They may also recommend stopping Nexletol if you have joint pain or swelling. But it’s important that you do not stop taking Nexletol unless your doctor recommends this.

Be sure to tell your doctor if you’ve had a ruptured tendon before, or if you have a tendon disorder. Your doctor will likely not prescribe Nexletol in this case.

Tell your doctor about all the medications you’re taking, in case any of them can also cause tendon rupture. These include corticosteroids and a type of antibiotic called fluoroquinolones. Also tell your doctor if you have kidney failure, because this may increase your risk of tendon rupture.

Upper respiratory infection

Upper respiratory infection (infection of the sinuses, nose, or throat) was the most common side effect in studies of Nexletol. Although these infections are common with Nexletol, they’re not typically severe.

Symptoms of an upper respiratory infection may include a fever, stuffy nose, cough, or fatigue (low energy).

What might help

To prevent upper respiratory infections, it helps to:

  • wash your hands often with soap and water
  • avoid touching your face with unwashed hands
  • avoid contact with people who are sick

If you have symptoms that are severe, last longer than 7 to 10 days, or get worse after about a week, talk with your doctor. They may recommend treatment.

If you have an infection of your sinuses, nose, or throat, you should stay home from work or school. Coughing or sneezing into a tissue or your sleeve can help limit the spread of germs.

Allergic reaction

Some people may have an allergic reaction to Nexletol. While allergic reaction wasn’t reported in studies of Nexletol, it can still happen.

Symptoms of a mild allergic reaction can include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include swelling under your skin, typically in your eyelids, lips, hands, or feet. They can also include swelling of your tongue, mouth, or throat, which can cause trouble breathing.

Call your doctor right away if you have an allergic reaction to Nexletol. But if you think you’re having a medical emergency, call 911 or your local emergency number.

Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use. To find current prices for Nexletol in your area, visit GoodRx.com.

If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. And you can visit the Nexletol manufacturer’s website to see if they have support options.

You can also check out this article to learn more about saving money on prescriptions.

Find answers to some commonly asked questions about Nexletol.

How does Nexletol work?

Nexletol is an adenosine triphosphate-citrate lyase (ACL) inhibitor. It works by inhibiting (blocking) the ACL enzyme. This is a type of protein in the liver that makes LDL cholesterol.

By blocking this enzyme, Nexletol lowers the amount of LDL cholesterol that your liver makes. This is Nexletol’s mechanism of action (how the drug works in your body).

When the liver makes less LDL cholesterol, the body produces more LDL receptors. LDL receptors are a type of protein on cells that moves LDL cholesterol from your blood into your cells. This lowers the amount of cholesterol in your blood.

Talk with your doctor or pharmacist if you have questions about how Nexletol works.

What should I know about Nexletol and the alternative drug Repatha?

Nexletol and Repatha are both cholesterol-lowering medications. Repatha contains the active ingredient evolocumab. Nexletol’s active ingredient is bempedoic acid. Repatha works in a slightly different way than Nexletol.

Repatha works by blocking an enzyme called PCSK9. PCSK9 breaks down LDL receptors on liver cells, which keeps your body from removing extra cholesterol from your blood. By blocking this enzyme, Repatha allows LDL receptors to remove cholesterol from your blood, which lowers your LDL cholesterol.

Your doctor or pharmacist can provide more information about how Nexletol compares with Repatha and similar drugs.

Is Nexletol a statin?

No, Nexletol isn’t a statin.

Similar to statins, Nexletol is used to lower cholesterol. But Nexletol works in a different way than statins. It’s a type of drug called an ACL inhibitor. See “How does Nexletol work?” just above for details.

Examples of statin drugs include:

Your doctor will recommend the dosage of Nexletol that’s right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.

Form and strength

Nexletol comes as a tablet that you take by mouth. It comes in a strength of 180 milligrams (mg).

Recommended dosage

You’ll take Nexletol once daily, with or without food.

Questions about Nexletol’s dosage

  • What if I miss a dose of Nexletol? If you miss a dose of Nexletol, take it as soon as you remember. But if you’re close to your next scheduled dose, skip it and take your next dose at your regularly scheduled time. If you miss a dose, and you’re unsure when to take your next dose, talk with your doctor or pharmacist.
  • Will I need to use Nexletol long term? Heterozygous familial hypercholesterolemia (HeFH) and atherosclerotic cardiovascular disease (ASCVD) are long-term conditions. Nexletol is used to manage these two conditions. So you may need to take Nexletol long term. Whether you take Nexletol long term may depend on whether you have side effects. Talk with your doctor to find out how long you’ll likely take Nexletol.

Nexletol is used to lower low-density lipoprotein (LDL) cholesterol in people who have:

  • Established atherosclerotic cardiovascular disease (ASCVD). This refers to narrowing of your blood vessels due to plaque buildup. This makes it harder for blood to flow through your blood vessels. “Established” means that the condition has been diagnosed.
  • Heterozygous familial hypercholesterolemia (HeFH). This is a genetic condition that causes high levels of certain types of cholesterol.

Nexletol is prescribed along with a low-cholesterol diet and a statin* medication (another type of cholesterol-lowering drug). Specifically, it’s prescribed to further lower LDL cholesterol if you’re taking the highest statin dose that you can tolerate.

It’s not currently known if Nexletol can lower risk of heart problems or death caused by high cholesterol. This is a limitation of Nexletol’s use.

* See “Taking Nexletol with other drugs” in “How is Nexletol taken?” just below for details about statins that may be prescribed with Nexletol.

Your doctor will explain how you should take Nexletol. They will also explain how much to take and how often. Be sure to follow their instructions.

Taking Nexletol

Nexletol comes as a tablet that you’ll take by mouth. You should take it once daily, with or without food.

Accessible medication containers and labels

If it’s hard for you to read the label on your prescription, tell your doctor or pharmacist. Certain pharmacies may provide medication labels that:

  • have large print
  • use braille
  • contain a code you can scan with a smartphone to change the text into audio

Your doctor or pharmacist may be able to recommend a pharmacy that offers these options if your current pharmacy doesn’t.

Also, if you’re having trouble opening your medication bottles, let your pharmacist know. They may be able to put Nexletol in an easy-open container. Your pharmacist may also recommend tools to help make it simpler to open the drug’s container.

Taking Nexletol with other drugs

You’ll take Nexletol with a statin, which is another type of cholesterol-lowering drug. Nexletol is prescribed if you’re taking a high dose of your statin and eating a low-cholesterol diet.

But it’s important to note that some statins can interact with Nexletol. If you’re taking simvastatin (Zocor) or pravastatin (Pravachol), your doctor may lower your statin dose if you start taking Nexletol.

Another drug your doctor may prescribe with Nexletol is ezetimibe (Zetia). Ezetimibe is a cholesterol-lowering medication that works differently than statins and Nexletol. It lowers how much cholesterol your intestines absorb after a meal.

In some cases, instead of Nexletol, your doctor may prescribe Nexlizet. This drug contains both bempedoic acid (Nexletol’s active ingredient) and ezetimibe. You can talk with your doctor to find out if the Nexlizet combination pill is right for you.

Questions about taking Nexletol

  • Can Nexletol be chewed, crushed, or split? It’s unknown if it’s safe to chew, crush, or split Nexletol tablets. You should swallow the tablets whole. If you have trouble swallowing Nexletol tablets, talk with your doctor or pharmacist. They can recommend ways to help with swallowing pills. Or they may recommend a different drug that’s easier for you to swallow.
  • Can I take Nexletol with food? You can take Nexletol tablets with or without food. But you should take your dose the same way (either with or without food) every day.
Questions for your doctor

You may have questions about Nexletol and your treatment plan. It’s important to discuss all your concerns with your doctor.

Here are a few tips that might help guide your discussion:

  • Before your appointment, write down questions such as:
    • How will Nexletol affect my body, mood, or lifestyle?
  • Bring someone with you to your appointment if doing so will help you feel more comfortable.
  • If you don’t understand something related to your condition or treatment, ask your doctor to explain it to you.

Remember, your doctor and other healthcare professionals are available to help you. And they want you to get the best care possible. So, don’t be afraid to ask questions or offer feedback on your treatment.

Some important things to think about when considering Nexletol include your overall health and any medical conditions you may have. Tell your doctor if you’re taking other medications. This is important since some drugs can interfere with how Nexletol works.

These and other considerations to discuss with your doctor are described below.

Interactions

Taking a medication with certain vaccines, foods, and other things can affect how the medication works. These effects are called interactions.

Before taking Nexletol, be sure to tell your doctor about all the medications you take, including prescription and over-the-counter types. Also describe any vitamins, herbs, or supplements you use. Your doctor or pharmacist can tell you about any interactions these items may cause with Nexletol.

Interactions with drugs or supplements

Nexletol is known to interact with certain statins (other cholesterol-lowering drugs), specifically:

If you’re taking simvastatin or pravastatin, your doctor may lower your statin dose when you start taking Nexletol. This lowers your risk of an interaction.

This list does not contain all types of drugs that may interact with Nexletol. Your doctor or pharmacist can tell you more about these interactions and any others that may occur with use of Nexletol.

Warnings

Nexletol may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Nexletol. Factors to consider include those in the list below.

  • Gout (a type of arthritis) or hyperuricemia (high uric acid level). Tell your doctor if you (or anyone in your family) have had hyperuricemia or gout. Increased uric acid levels in the blood is a possible side effect of Nexletol. This can increase your risk of gout, especially if you have a personal or family history of this condition. If you have symptoms of hyperuricemia or gout during Nexletol treatment, tell your doctor right away. If your uric acid levels rise or if you develop gout, your doctor may have you stop taking Nexletol. But you should not stop taking the drug without talking with your doctor first.
  • Allergic reaction. If you’ve had an allergic reaction to Nexletol or any of its ingredients, your doctor will likely recommend that you don’t take Nexletol. Ask your doctor what other medications are better options for you.
  • Kidney failure. If you have kidney failure, talk with your doctor about whether it’s safe for you to use Nexletol. Having kidney failure can increase your risk of a tendon rupture (tear) with Nexletol.
  • Severe liver problems. Nexletol may cause high levels of liver enzymes (a type of protein). This can be a sign that your liver isn’t functioning correctly. Be sure to talk with your doctor about whether it’s safe for you to take Nexletol if you have severe liver problems.
  • Risk factors for tendon rupture. If you’ve had a tendon rupture in the past, your doctor will likely not prescribe Nexletol. This is because tendon rupture is a possible side effect of the drug. You have a higher risk of tendon rupture if you’re ages 60 years or older, or if you have kidney failure. Your risk is also higher if you take other medications that can cause tendon rupture. These include corticosteroids and fluoroquinolones (a type of antibiotic). Be sure to tell your doctor about your medical history and all the medications you’re taking before you start Nexletol.

Nexletol and alcohol

Nexletol and alcohol aren’t known to interact. But before starting Nexletol, ask your doctor if it’s safe for you to drink alcohol.

Drinking alcohol may affect your heart health. Drinking a lot of alcohol over time can negatively affect your heart health.

Talk with your doctor about how much and which types of alcohol they recommend, if any, for you.

Pregnancy and breastfeeding

Nexletol may harm a fetus if taken during pregnancy, based on how the drug works. Your doctor will likely not prescribe Nexletol if you’re pregnant or planning to become pregnant.

Tell your doctor if you’re pregnant or considering pregnancy before starting Nexletol. They can recommend which treatments are safe for your high cholesterol during pregnancy.

If you’re exposed to Nexletol during pregnancy, tell your doctor about any side effects you experience. Your doctor could report these side effects to the Bempedoic Acid Pregnancy Surveillance Program. Bempedoic acid is Nexletol’s active ingredient. Reporting side effects through this program helps researchers better understand the drug’s risks.

Breastfeeding is not recommended with Nexletol. It isn’t known if Nexletol passes into breastmilk if taken while breastfeeding. Tell your doctor if you’re breastfeeding or considering breastfeeding before taking Nexletol. They’ll likely recommend that you do not take Nexletol.

Do not take more Nexletol than your doctor prescribes. Using more than this can lead to serious side effects. There’s no information on the symptoms of overdosing on Nexletol.

What to do in case you take too much Nexletol

Call your doctor if you think you’ve taken too much Nexletol. You can also call 800-222-1222 to reach the American Association of Poison Control Centers or use its online resource. However, if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.

If you have questions about taking Nexletol, talk with your doctor or pharmacist. They can help answer questions you have about your condition or treatment plan. You might also find these articles helpful:

Some questions to ask your doctor about Nexletol may include:

  • Do you recommend adjusting my Nexletol dose if I’m eating a meal that’s high in fat?
  • Can I take Nexletol and my statin at the same time?
  • Which natural medicines could help reduce LDL cholesterol?
  • Do I have to stop eating eggs if I have high cholesterol?

Q:

Can I have grapefruit or grapefruit juice with Nexletol?

Anonymous

A:

It depends. Nexletol by itself isn’t known to interact with grapefruit or grapefruit juice. But Nexletol is prescribed along with a statin (another type of cholesterol-lowering drug). And some statins do interact with citrus fruits, such as grapefruit.

Specifically, you should avoid grapefruit if you’re taking atorvastatin (Lipitor), simvastatin (Zocor), or lovastatin (Altoprev, Mevacor). If you’re taking a different statin, you may not need to avoid grapefruit. Be sure to follow your doctor’s recommendations about whether grapefruit is safe for you.

Grapefruit can cause your liver to take longer to break down certain statins. This can be dangerous because if too much of the drug builds up in your bloodstream, it can lead to serious side effects.

If you accidentally have grapefruit while taking Nexletol with atorvastatin, simvastatin, or lovastatin, call your doctor right away. If you think you’re having a medical emergency, call 911 or your local emergency number. Or go to the nearest emergency room.

Tanya Kertsman, PharmDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.