What is the interaction between bempedoic acid (Esperion's Nexletol) and testosterone?

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Last updated: March 25, 2025View editorial policy

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From the Guidelines

There is no known significant interaction between bempedoic acid and testosterone therapy, so they can generally be used together safely. Bempedoic acid (brand name Nexletol) is a cholesterol-lowering medication that works by inhibiting ATP citrate lyase, reducing cholesterol production in the liver, while testosterone replacement therapy addresses hormone deficiency [ 1 ]. When using both medications, standard dosing applies: bempedoic acid is typically taken as a 180mg tablet once daily, and testosterone dosing varies by formulation (injections typically 50-100mg weekly, gels 50-100mg daily, patches 2-6mg daily).

Key Considerations

  • Patients should monitor lipid levels regularly, as testosterone therapy can sometimes affect cholesterol profiles.
  • Some patients may experience mild side effects from either medication, including muscle pain with bempedoic acid or mood changes with testosterone.
  • It's essential to inform all healthcare providers about all medications being taken, as this combination may require monitoring of both lipid panels and testosterone levels to ensure optimal therapy.

Important Warnings and Precautions

  • Bempedoic acid may increase serum uric acid, and patients should be advised to contact their clinician if symptoms of hyperuricemia occur [ 1 ].
  • Testosterone therapy can have various effects on the body, and patients should be monitored for any changes in their condition.

Conclusion is not needed, and the answer is based on the most recent evidence available [ 1 ].

From the Research

Interaction between Bempedoic Acid and Testosterone

There are no research papers to assist in answering this question, as the provided studies do not mention the interaction between bempedoic acid (Esperion's Nexletol) and testosterone.

Key Points about Bempedoic Acid

  • Bempedoic acid is an oral adenosine triphosphate citrate lyase (ACL) inhibitor that lowers low-density lipoprotein cholesterol (LDL-C) blood levels 2, 3, 4, 5, 6
  • It is approved to reduce cardiovascular (CV) risk in statin-intolerant patients who are at high risk for, or have, CV disease 3, 6
  • Bempedoic acid was generally well tolerated and, unlike statins, was associated with a low incidence of musculoskeletal adverse events (AEs) 3, 5, 6
  • It provides an effective tool to further reduce LDL-cholesterol as add-on therapy in patients unable to reach the target despite maximally tolerated lipid-lowering therapy 4, 6

Adverse Events Associated with Bempedoic Acid

  • Myalgia (4.7%) 6
  • Anemia (3.4%) 6
  • Increased aminotransferases (0.3%) 6
  • Gout or gouty arthritis (3.2% in bempedoic acid and 2.2% in placebo patients) 2
  • Cholelithiasis (2.2% in bempedoic acid and 1.2% in placebo patients) 2

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Bempedoic Acid: A Review in Cardiovascular Risk Reduction in Statin-Intolerant Patients.

American journal of cardiovascular drugs : drugs, devices, and other interventions, 2025

Research

Bempedoic Acid: for Whom and When.

Current atherosclerosis reports, 2022

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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