Bempedoic Acid Dosing for Hyperlipidemia
The recommended dose of bempedoic acid is 180 mg taken orally once daily, with or without food, and this dose is fixed regardless of LDL-C response or patient characteristics. 1, 2, 3
Standard Dosing Regimen
- Administer 180 mg orally once daily as a single tablet, which should be swallowed whole 1, 2, 3
- The medication can be taken with or without food, as food does not affect bioavailability 1, 3
- No dose adjustment is needed based on age, including in geriatric patients 65 years and older 3
- No dose adjustment is required for patients with mild or moderate renal impairment (eGFR ≥30 mL/min/1.73 m²) 3
- No dose adjustment is necessary for patients with mild or moderate hepatic impairment (Child-Pugh A or B) 3
Expected LDL-C Reduction
- When added to maximally tolerated statin therapy, bempedoic acid provides a 17-18% placebo-corrected incremental reduction in LDL-C 1, 4
- As monotherapy, bempedoic acid reduces LDL-C by approximately 24.5% 5
- When combined with ezetimibe in a fixed-dose combination (180 mg bempedoic acid/10 mg ezetimibe once daily), the LDL-C reduction reaches 38-40% 2, 5
Critical Drug Interactions Requiring Dose Limitations
Avoid combining bempedoic acid with high-dose statins due to increased statin exposure:
- Do not exceed simvastatin 20 mg daily when used concomitantly with bempedoic acid 1, 2
- Do not exceed pravastatin 40 mg daily when used concomitantly with bempedoic acid 1, 2
When combining with bile acid sequestrants, administer bempedoic acid either 2 hours before or 4 hours after the bile acid sequestrant to avoid binding interactions 2
Common Pitfalls to Avoid
- Do not adjust the 180 mg dose based on lipid response—the dose remains fixed regardless of LDL-C levels achieved 2
- Do not titrate the dose—bempedoic acid is not available in multiple strengths and should always be given as 180 mg daily 1, 3
- Do not use in patients with severe renal impairment (eGFR <30 mL/min/1.73 m²) or end-stage renal disease on dialysis, as there is limited or no experience in these populations 3
- Do not use in patients with severe hepatic impairment (Child-Pugh C), as this population has not been studied 3
Monitoring Parameters During Treatment
While on bempedoic acid therapy, monitor the following:
- Assess serum uric acid before initiation and monitor if symptoms of hyperuricemia occur, as bempedoic acid increases uric acid by a mean of 0.8 mg/dL 1, 2
- Monitor for signs of tendinitis or tendon rupture, and discontinue immediately if tendon rupture occurs 1, 2
- Monitor liver function tests as clinically indicated, though elevated liver enzymes are a known adverse effect and mild elevations do not require discontinuation 6, 2
- Gout or gouty arthritis occurred in 3.2% of patients in the CLEAR Outcomes trial versus 2.2% with placebo 7
Special Populations
- Geriatric patients: No dose adjustment needed; 59% of patients in the CLEAR Outcomes trial were ≥65 years old with no differences in safety or effectiveness 3
- Statin-intolerant patients: Bempedoic acid is particularly well-suited for this population, as it requires hepatic activation by ACSVL1 (an enzyme absent in skeletal muscle), limiting the risk of myalgia 5, 8
- Pregnancy: Discontinue when pregnancy is recognized unless benefits outweigh potential risks to the fetus 1