Is Bempedoic Acid a Diuretic?
No, bempedoic acid is not a diuretic—it is a cholesterol-lowering medication that works by inhibiting ATP citrate lyase in the liver to reduce LDL cholesterol synthesis. 1
Mechanism of Action
Bempedoic acid functions through a completely different pathway than diuretics:
- It inhibits ATP citrate lyase (ACL), a cytoplasmic enzyme that generates acetyl coenzyme A for cholesterol biosynthesis in the liver 1, 2
- It is a prodrug activated only in hepatocytes by very-long-chain acyl-CoA synthetase-1 (ACSVL1), which explains why it does not cause muscle-related side effects like statins 1, 3, 4
- It reduces endogenous cholesterol production upstream of HMG-CoA reductase (the statin target), resulting in approximately 20-25% reduction in LDL cholesterol 1, 5, 6
Clinical Indications
Bempedoic acid is FDA-approved as an adjunct to diet and maximally tolerated statin therapy for:
- Adults with heterozygous familial hypercholesterolemia requiring additional LDL-C lowering 1
- Adults with established atherosclerotic cardiovascular disease (ASCVD) who need further LDL-C reduction 1
- Statin-intolerant patients with elevated LDL-C ≥100 mg/dL, where it reduces LDL-C by approximately 24.5% as monotherapy 1, 7
Why the Confusion May Arise
The only connection to diuretic-related concerns is that bempedoic acid can increase serum uric acid levels (mean increase of 0.8 mg/dL), which may lead to hyperuricemia and gout 1, 8, 6. This is the opposite effect of what uricosuric diuretics might do, but it is not a diuretic property—it is an adverse metabolic effect requiring monitoring.