What is the typical dosing of bempedoic acid for hyperlipidemia?

Bempedoic Acid Dosing

Bempedoic acid is dosed at 180 mg orally once daily, with or without food, and requires no dose adjustments for renal or hepatic impairment in most patients. 1, 2

Standard Dosing Regimen

• The FDA-approved dose is 180 mg taken orally once daily 1, 2
• Can be taken with or without food - food does not affect bioavailability 2
• Steady-state is achieved after 7 days of daily dosing 2
• The tablet should be swallowed whole 1

Combination Therapy Dosing

• When using the fixed-dose combination with ezetimibe: one tablet (180 mg bempedoic acid/10 mg ezetimibe) once daily 1
• If combining with bile acid sequestrants: take bempedoic acid either 2 hours before or 4 hours after the bile acid sequestrant 1

Special Population Considerations

Renal Impairment

• No dose adjustment needed for mild or moderate renal impairment 2
• Limited experience in severe renal impairment (eGFR <30 mL/min/1.73 m²) - use with caution 2
• Not studied in end-stage renal disease requiring dialysis 2

Hepatic Impairment

• No dose adjustment needed for mild or moderate hepatic impairment (Child-Pugh A or B) 2
• Not studied in severe hepatic impairment (Child-Pugh C) 2

Elderly Patients

• No dose adjustment required - 58% of trial participants were ≥65 years old with no differences in safety or efficacy 2

Critical Drug Interactions Affecting Dosing

• Avoid concomitant simvastatin >20 mg daily 1
• Avoid concomitant pravastatin >40 mg daily 1

Monitoring Parameters During Treatment

• Assess serum uric acid before initiation and monitor if symptoms of hyperuricemia occur (mean increase 0.8 mg/dL expected) 1, 3
• Monitor for signs of tendinitis or tendon rupture - discontinue immediately if tendon rupture occurs 1
• Monitor liver function tests as clinically indicated 1

Common Pitfalls to Avoid

• Do not adjust dose based on LDL-C response - the dose is fixed at 180 mg daily regardless of lipid levels 1, 2
• Do not split, crush, or chew tablets - must be swallowed whole 1
• Do not assume dose adjustments are needed in elderly patients - the same 180 mg dose applies across all age groups 2
• Do not combine with high-dose simvastatin or pravastatin due to increased exposure risk 1