ATP-Citrate Lyase Inhibitor

Aka: ATP-Citrate Lyase Inhibitor, ATP-Citrate Lyase, Bempedoic Acid, Nexletol, Nexlizet

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II. Indications

  1. Hyperlipidemia
    1. Statin Intolerant (e.g. Statin-Induced Myopathy)
    2. Second or third-line adjunct to Statin therapy if LDL not at goal

III. Contraindications

  1. Gouty Arthritis

IV. Mechanism

  1. Class prototype, Bempedoic Acid, inhibits the enzyme ATP-Citrate Lyase
    1. ATP-Citrate Lyase is an enzyme key to Fatty Acid biosynthesis
    2. ATP-Citrate Lyase cleaves citrate into oxaloacetate (and acetyl CoA, ADP and orthophosphate)
  2. Lowers LDL Cholesterol as a Statin adjunct or alternative
  3. Does NOT effect Triglycerides or HDL

V. Efficacy

  1. Limited data on longterm cardiovascular outcomes
  2. Lowers LDL Cholesterol 20%
  3. NNT 63 for high Cardiovascular Risk patients to prevent 1 cardiovascular event in 3 years

VI. Dosing

  1. Bempedoic Acid (Nexletol)
    1. Take 180 mg orally daily (typically in combination with a Statin)
  2. Bempedoic Acid 180 and Ezetimibe 10 mg (Nexlizet)
    1. Take one tablet orally daily

VII. Precautions

  1. Bempedoic Acid (Nexletol) costs $400/month in 2023

VIII. Adverse Effects

  1. Increased Uric Acid
    1. Gout flare in up to 10% of patients with gout history on Bempedoic Acid (Nexletol)
  2. Gallstones
    1. Occurs in 1% of patients on Bempedoic Acid (Nexletol)

IX. Drug Interactions

  1. Pravastatin or Simvastatin
    1. Risk of Statin-Induced Myopathy when used with Bempedoic Acid (Nexletol)
    2. Limit Simvastatin doses to 20 mg orally daily when using Bempedoic Acid
    3. Limit Pravastatin doses to 40 mg orally daily when using Bempedoic Acid

X. Resources

  1. Bempedoic Acid (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=88d06d89-a3da-40b4-b273-8f4f7d56c4c9
  2. Bempedoic Acid and Ezetimibe (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3fa2108c-0300-47b8-9d34-f762af7c93c6

XI. References

  1. (2023) Presc Lett 30(4): 19
  2. Feng (2020) Prog Lipid Res +PMID:31499095 [PubMed]

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Related Studies

Cost: Medications

nexletol (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
NEXLETOL 180 MG TABLET $12.27 each
nexlizet (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
NEXLIZET 180-10 MG TABLET $12.30 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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