Can you take Nexlizet (bempedoic acid) with a history of gout?

Taking Nexlizet with a History of Gout

Patients with a history of gout can take Nexlizet (bempedoic acid and ezetimibe), but should be closely monitored for hyperuricemia and gout flares, as bempedoic acid increases blood uric acid levels and may trigger gout attacks in susceptible individuals.

Mechanism and Risk

• Bempedoic acid (a component of Nexlizet) inhibits renal tubular OAT2, which increases blood uric acid levels, typically within the first 4 weeks of treatment 1
• In clinical trials, 26% of patients with normal baseline uric acid developed hyperuricemia with bempedoic acid (vs 9.5% with placebo), and 3.5% experienced clinically significant hyperuricemia (vs 1.1% with placebo) 1
• Gout was reported in 1.5% of patients treated with bempedoic acid compared to 0.4% with placebo in hyperlipidemia trials, and in 3.2% vs 2.2% in cardiovascular outcome trials 1, 2

Monitoring and Management Recommendations

• For patients with a history of gout taking Nexlizet:
  • Assess serum uric acid levels before starting therapy and monitor periodically during treatment 1
  • Watch for signs and symptoms of hyperuricemia and gout flares 1
  • Consider prophylactic treatment with urate-lowering therapy (ULT) if the patient has:
    • Frequent gout flares (≥2/year) 3
    • Tophi 3
    • Radiographic damage attributable to gout 3
    • Chronic kidney disease stage ≥3 3

Gout Management While on Nexlizet

• For acute gout flares while on Nexlizet:

  • Treat flares as early as possible with appropriate medications 3
  • First-line options include colchicine (within 12 hours of flare onset), NSAIDs, or oral corticosteroids 3
  • Avoid colchicine in patients with severe renal impairment or those receiving strong P-glycoprotein/CYP3A4 inhibitors 3

• For long-term management:

  • Consider urate-lowering therapy (ULT) such as allopurinol (first-line) or febuxostat to maintain serum uric acid <6 mg/dL 3
  • Start ULT at a low dose and titrate upward until target uric acid level is reached 3
  • Provide prophylaxis against flares during the first 6 months of ULT, typically with colchicine 0.5-1 mg/day 3

Risk Mitigation Strategies

• Lifestyle modifications to help manage gout while on Nexlizet:
  • Weight loss if appropriate 3
  • Limit alcohol consumption (especially beer and spirits) 3
  • Avoid sugar-sweetened drinks and foods rich in fructose 3
  • Reduce intake of meat and seafood 3
  • Encourage low-fat dairy products 3
  • Regular exercise 3

Special Considerations

• If gout becomes difficult to control on Nexlizet, consider:
  • Adjusting the urate-lowering therapy dosage 3
  • Adding a uricosuric agent if allopurinol alone is insufficient 3
  • In severe cases with poor quality of life, discussing with the prescriber whether the benefits of Nexlizet outweigh the risks 4

Conclusion

While Nexlizet can increase uric acid levels and potentially trigger gout flares, patients with a history of gout can still take the medication with appropriate monitoring and management. The decision should balance cardiovascular risk reduction benefits against the potential for worsened gout symptoms, with proactive monitoring and treatment strategies in place.