Nexlizet (Bempedoic Acid and Ezetimibe) for Heart Disease

Nexlizet (bempedoic acid and ezetimibe) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) for use with diet and exercise to lower low-density lipoprotein (LDL) cholesterol in adults with high cholesterol, including inherited high cholesterol.

How Nexlizet Works and How It’s Taken

Nexlizet contains two cholesterol-lowering medicines, bempedoic acid and ezetimibe. Bempedoic acid reduces cholesterol production in the liver, while ezetimibe reduces cholesterol absorption in the small intestine. Together, they lower LDL cholesterol, also called “bad” cholesterol, in the blood.

Doctors prescribe Nexlizet for:

Lowering bad cholesterol — Nexlizet is used with diet and exercise to lower LDL cholesterol in adults with high cholesterol, including an inherited form called heterozygous familial hypercholesterolemia (HeFH).
Lowering the risk of major heart and blood vessel problems — Bempedoic acid, one of the ingredients in Nexlizet, is approved to lower the risk of heart attack, stroke, death from heart or blood vessel disease and procedures such as stent placement or bypass surgery to restore blood flow to the heart. This use is for adults at increased risk of these problems who cannot take recommended statin treatment, including those not taking a statin.

Nexlizet comes as a tablet taken by mouth once daily, with or without food. Swallow the tablet whole. Do not cut, chew, or crush it.

Typical Dosing for Heart Conditions

The recommended dose of Nexlizet is one tablet by mouth once daily. Each tablet contains 180 milligrams of bempedoic acid and 10 milligrams of ezetimibe.

If you take a medicine that binds bile acids, such as colesevelam or cholestyramine, take Nexlizet at least two hours before or four hours after that medicine.

Your healthcare provider should check your cholesterol levels within eight to 12 weeks after you start taking Nexlizet.

This information is based on the prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Nexlizet Side Effects

In clinical studies of Nexlizet and its individual ingredients, the most common side effects occurred in about 2 percent to 16 percent of people. These include:

Side effects in people with high cholesterol:

Upper respiratory tract infection (coldlike symptoms)
Muscle spasms
Hyperuricemia (high uric acid levels in the blood)
Back pain
Abdominal (stomach) pain or discomfort
Bronchitis
Pain in an arm or leg
Anemia (low red blood cell levels)
Elevated liver enzymes (changes in liver blood tests)
Diarrhea
Arthralgia (joint pain)
Sinusitis (swelling of the sinuses)
Fatigue
Influenza (flu)

Side effects in people with heart disease or high risk for heart disease:

Hyperuricemia (high uric acid levels in the blood)
Kidney problems
Anemia (low red blood cell levels)
Elevated liver enzymes (changes in liver blood tests)
Muscle spasms
Gout
Cholelithiasis (gallstones)

Serious Side Effects and Warnings

Nexlizet can cause serious side effects that may require immediate medical attention. These include:

Hyperuricemia and gout — High uric acid levels can lead to gout.
Tendon rupture — A tendon tear can occur, most often in the shoulder, upper arm, or back of the ankle.
Serious allergic reactions (hypersensitivity) — These reactions can include anaphylaxis and angioedema, which can cause swelling of the face, lips, mouth, or tongue and trouble breathing.

Get medical help right away if you think you are having a serious reaction.

If you experience serious side effects, you can report them to the FDA online or by calling 1-800-FDA-1088. You can also contact the drug's manufacturer.

How to Save on Nexlizet

Esperion Therapeutics, Inc, the manufacturer of Nexlizet, offers the Nexlizet Co-Pay Card. Eligible people with commercial insurance may pay as little as $10 for a 30-day supply or $25 for a 90-day supply of Nexlizet.

The Nexstep Patient Support Program also provides representatives who can help eligible people activate and use their copay card.

To learn more, visit the Nexstep Patient Support Program website or call 855-699-8814.

What To Know Before Taking Nexlizet

Before taking Nexlizet, tell your doctor if you:

Have or have had gout (a painful type of arthritis caused by high uric acid levels)
Have or have had tendon problems, including tendon tears
Have moderate or severe liver problems
Have any allergies to bempedoic acid and ezetimibe or any ingredients in Nexlizet

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Be sure to tell your doctor, if you take:

Simvastatin or pravastatin (other cholesterol-lowering medicines)
Cyclosporine (often used for people who’ve had an organ transplant)
Fibrates (triglyceride-lowering medicines)
Cholestyramine (used to lower cholesterol)

Do not take Nexlizet if you have had a serious allergic reaction to bempedoic acid, ezetimibe, or any of the ingredients in Nexlizet.

If you miss a dose of Nexlizet, take it as soon as you remember. If it is time for your next dose, skip the missed dose and return to your regular schedule. Do not take two doses at the same time.

If you are pregnant or planning to become pregnant while taking Nexlizet, talk with your doctor before taking Nexlizet.

Nexlizet may harm a developing baby. Tell your doctor right away if you become pregnant while taking it. Your doctor will usually stop Nexlizet during pregnancy unless the benefits outweigh the possible risks to your baby.

If you become pregnant during treatment, you are encouraged to report your pregnancy to Esperion at 833-377-7633.

If you are breastfeeding or planning to breastfeed, while taking Nexlizet, talk with your doctor before taking Nexlizet. Both ingredients in Nexlizet pass into breast milk. It is not known how they affect a breastfed baby, but they may cause harm. Talk with your doctor about whether to take Nexlizet or breastfeed.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Nexlizet for heart disease?

In a 12-week study of adults with heart disease, inherited high cholesterol, or several risk factors for heart disease, Nexlizet lowered LDL (bad) cholesterol by 38 percent more than placebo (a treatment with no active medicine). People were receiving their highest tolerated dose of statin treatment.

In a separate study of bempedoic acid, one of the ingredients in Nexlizet, adults with heart and blood vessel disease or at high risk for it had fewer major cardiovascular events. Over a median follow-up of 3.4 years, these events occurred in 11.7 percent of people taking bempedoic acid compared with 13.3 percent taking placebo.

How long does Nexlizet take to work for heart disease?

In a 12-week study, Nexlizet reached its greatest LDL cholesterol-lowering effect by week 4. Your doctor should check your cholesterol levels within eight to 12 weeks after you start treatment.

In a separate cardiovascular outcomes trial, bempedoic acid lowered LDL cholesterol by 20 percent more than placebo at month 6.

Does Nexlizet interact with other medications?

Yes. Nexlizet can interact with certain medicines, including:

Simvastatin and pravastatin — Taking these cholesterol-lowering medicines with Nexlizet may increase the risk of muscle pain or weakness. Avoid taking Nexlizet with more than 20 milligrams of simvastatin or 40 milligrams of pravastatin daily.
Cyclosporine — Taking cyclosporine with Nexlizet may increase the levels of both cyclosporine and ezetimibe in the blood. Your doctor may monitor your cyclosporine levels.
Fibrates — Taking these medicines with Nexlizet may raise triglycerides and lower high-density lipoprotein (HDL) cholesterol, often called “good” cholesterol. Taking fenofibrate with Nexlizet may also increase the risk of gallstones.
Cholestyramine — This medicine may reduce how well Nexlizet works. Take Nexlizet at least two hours before or four hours after cholestyramine.

Tell your doctor about all medicines and supplements you take before starting Nexlizet.