Bempedoic Acid Dosing with Pravastatin and Ezetimibe
Add bempedoic acid 180 mg once daily to your current regimen, but you cannot obtain it over the counter—it requires a prescription. 1, 2
Standard Dosing
- The dose of bempedoic acid is fixed at 180 mg orally once daily, regardless of your current lipid-lowering therapy or LDL-C levels. 1, 2
- This medication can be taken with or without food and should be swallowed whole. 1, 2
- There is no dose adjustment needed when adding bempedoic acid to your pravastatin 40 mg and ezetimibe 10 mg regimen. 1, 2
Critical Drug Interaction with Your Current Pravastatin
Your pravastatin dose of 40 mg is at the maximum allowed when combining with bempedoic acid. 1, 2 The American College of Cardiology specifically warns against using pravastatin doses exceeding 40 mg daily when combined with bempedoic acid due to increased drug exposure risk. 1, 2 Since you are already at this threshold, do not increase your pravastatin dose further.
Prescription Requirement
- Bempedoic acid is not available over the counter—it is a prescription medication that requires prior authorization in most cases. 1
- The medication was FDA-approved in 2020 for adults with established atherosclerotic cardiovascular disease or heterozygous familial hypercholesterolemia who need additional LDL-C lowering beyond maximally tolerated statin therapy. 1, 3
Expected LDL-C Reduction
- When added to your current statin and ezetimibe combination, bempedoic acid provides an additional 17-18% placebo-corrected reduction in LDL-C. 1
- The triple combination of statin + ezetimibe + bempedoic acid can achieve approximately 38% total LDL-C reduction compared to baseline. 1, 4
Required Safety Monitoring
Before starting bempedoic acid, your physician should check your baseline serum uric acid level. 1, 2 The American College of Cardiology recommends:
- Uric acid monitoring: Expect a mean increase of 0.8 mg/dL in serum uric acid. 1, 2, 5 Contact your physician if you develop symptoms of gout (joint pain, swelling, particularly in the big toe). 1
- Tendon monitoring: Immediately report any tendon pain, swelling, or inflammation, as bempedoic acid carries a risk of tendinitis and tendon rupture. 1, 2 Discontinue the medication immediately if tendon rupture occurs. 1
- Liver enzyme monitoring: Periodic monitoring of liver function tests is recommended as clinically indicated. 1, 2
Advantages of This Combination
- No increased muscle-related side effects: Unlike statins, bempedoic acid is a prodrug that is only activated in the liver (not skeletal muscle), so it does not increase the risk of myalgia or myopathy. 4, 5
- No diabetes risk: Bempedoic acid does not increase the risk of new-onset diabetes and may even modestly improve glycemic control. 6, 4
- Cardiovascular outcomes benefit: Recent trials show bempedoic acid reduces major adverse cardiovascular events by 13% overall, and by 30% in high-risk patients with established cardiovascular disease. 6
Common Pitfall to Avoid
Do not adjust the bempedoic acid dose based on your LDL-C response—the dose remains 180 mg daily regardless of lipid levels achieved. 2 The American College of Cardiology emphasizes this is a fixed-dose medication, not one that requires titration. 2