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Nexletol (Bempedoic Acid): Dose, Side Effects, Cost

Nexletol (bempedoic acid) is a once-daily 180 mg pill that blocks an enzyme in the liver one step before where statins act. It lowered LDL roughly 17 to 21% more than placebo, and gout, gallstones and tendon rupture are the risks to discuss with your clinician.

What is Nexletol and how does it work?

Nexletol is the brand name for bempedoic acid. The FDA approved it to lower LDL cholesterol and to reduce the risk of heart attack and other cardiovascular events in adults who can't take recommended statin therapy. Nexlizet is its sibling, a single tablet that combines bempedoic acid and ezetimibe. Both come from Esperion.

Bempedoic acid is a prodrug. An enzyme called ACSVL1, found mainly in the liver, switches it on.

The active drug then blocks ATP citrate lyase, an enzyme upstream of the one statins block, so liver cells make less cholesterol and add more LDL receptors that pull LDL out of the blood. Skeletal muscle lacks ACSVL1, so the drug stays inactive there.

That could explain why it may cause fewer muscle effects than statins, although the label still lists muscle spasms in 4% on Nexletol and 3% on placebo in CLEAR Outcomes.

How much does Nexletol lower LDL?

The label suggests checking lipids 8 to 12 weeks after starting. Results versus placebo:

  • On top of a statin: 18% and 17% in the two main LDL trials at 12 weeks
  • In statin-intolerant people (CLEAR Outcomes): LDL-C started at 139 mg/dL and was 29.2 mg/dL lower than placebo after 6 months, a 21.1 percentage point difference
  • Nexlizet (with ezetimibe): 38% greater LDL reduction than placebo at 12 weeks

What did the CLEAR Outcomes trial show?

CLEAR Outcomes enrolled 13,970 people with, or at high risk for, cardiovascular disease who were unable or unwilling to take statins because of side effects. Over a median of 40.6 months, major cardiovascular events occurred in 11.7% on bempedoic acid and 13.3% on placebo, a 13% lower risk.

Heart attacks (fatal or nonfatal) dropped from 4.8% to 3.7%, and artery-opening procedures dropped from 7.6% to 6.2%. The trial found no significant effect on stroke, cardiovascular death or death from any cause.

What are the side effects of Nexletol?

In CLEAR Outcomes, 11% stopped because of side effects, compared with 10% on placebo. Details from that trial and the label:

  • Uric acid and gout: high uric acid was reported in 16.4% on bempedoic acid and 8.2% on placebo, and gout in 3.1% and 2.1%. Uric acid typically rises within the first 4 weeks and returns to baseline after stopping.
  • Gallstones: 2.2% vs 1.2%.
  • Tendon rupture: 1.2% vs 0.9%. The label says the risk may be higher over age 60, with corticosteroids or fluoroquinolone antibiotics, with kidney failure, or with a past tendon problem. It advises stopping the drug if a tendon ruptures.
  • Lab changes: small increases in creatinine and liver enzymes, and mild anemia, were more common than with placebo.
  • In the LDL-lowering trials, the most frequent reactions were upper respiratory infection (4.5% vs 4.0%), muscle spasms (3.6% vs 2.3%), high uric acid (3.5% vs 1.1%), back pain (3.3% vs 2.2%) and abdominal pain (3.1% vs 2.2%).

What is the Nexletol dose, and can you take it with a statin?

Nexletol is one 180 mg tablet once a day, with or without food, and many people take it alongside a statin. The label lists a few interactions:

  • Simvastatin: the label says to avoid doses above 20 mg with Nexletol.
  • Pravastatin: the label says to avoid doses above 40 mg with Nexletol.
  • Nexlizet only: it contains ezetimibe, so take it at least 2 hours before or 4 hours after a bile acid binder such as cholestyramine.

How much does Nexletol cost, and is there a copay card?

As of October 2026, Esperion's co-pay card can bring Nexletol or Nexlizet down to as little as $10 for a 30-day supply or $25 for a 90-day supply with commercial insurance. People with Medicare, Medicaid or other government coverage can't use the card. Enrollment runs for one year, and Esperion decides eligibility.

Esperion states that both medicines are covered on most insurance medication plans, though coverage and prior authorization rules vary. A current published cash price wasn't confirmed, so compare pharmacy discount prices before you fill.

If your plan asks for proof of statin intolerance, write down which statins you tried, at what doses, and what happened. Ask your clinician about gout and tendon history before you start.

Trials in this guide

Each links to a plain summary with a quote from the PubMed abstract.

Common questions

▸What is the mechanism of action of Nexletol?

Nexletol blocks ATP citrate lyase, an enzyme in the liver's cholesterol-making pathway upstream of the enzyme statins block. It's a prodrug that ACSVL1, found mainly in the liver, switches on. The liver then makes less cholesterol and builds more LDL receptors.

▸What is the difference between Nexletol and Nexlizet?

Nexletol is bempedoic acid 180 mg alone. Nexlizet is bempedoic acid 180 mg plus ezetimibe 10 mg in one tablet. Nexlizet lowered LDL by 38% more than placebo in its label trial, compared with 17 to 18% for Nexletol on top of a statin.

▸Is Nexletol safe, and what is its main side effect?

In CLEAR Outcomes, 11% stopped because of side effects, compared with 10% on placebo. The most distinctive risk is a rise in uric acid, with gout in 3.1% vs 2.1% on placebo, gallstones in 2.2% vs 1.2%, and tendon rupture in 1.2% vs 0.9%.

▸What is the Nexletol dosage?

One 180 mg tablet once a day, with or without food. The label suggests checking lipids 8 to 12 weeks after starting.

▸Is there a Nexletol or Nexlizet copay card?

Yes. As of October 2026, Esperion's co-pay card lets eligible commercially insured patients pay as little as $10 for a 30-day supply or $25 for a 90-day supply. People on Medicare, Medicaid or other government plans can't use it.

▸Can you take Nexletol with a statin?

Yes. Most people in the LDL-lowering trials took it with a statin. The label says to avoid simvastatin above 20 mg and pravastatin above 40 mg with Nexletol, since bempedoic acid raises their levels.

The full guideRead the complete, referenced version on Preval Health More detail, every study, and the date each figure was checked.

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Sources

Not medical advice. General education from published trials and drug labels, last updated October 2026. lipid.site is not a healthcare provider and cannot tell you what to take or change. Talk to your clinician before starting or stopping any treatment. If you have chest pain or other signs of a heart attack or stroke, call 911.