Starting Dose of Nexlizet
The recommended starting dose of Nexlizet is one tablet (180 mg bempedoic acid/10 mg ezetimibe) taken orally once daily, with or without food, and this is both the starting and maintenance dose with no titration required. 1
Dosing Specifications
- Fixed-dose combination: Nexlizet contains 180 mg bempedoic acid and 10 mg ezetimibe in a single tablet 1
- Administration: Take once daily, with or without food 1
- Tablet preparation: Swallow whole—do not crush or split 1
- No dose titration needed: Unlike some lipid-lowering agents, Nexlizet has a single fixed dose with no escalation required 1
Important Timing Considerations
- Bile acid sequestrant interaction: If using in combination with bile acid sequestrants (BAS), take Nexlizet either 2 hours before or 4 hours after the BAS to avoid reduced absorption 1
Expected Efficacy
- LDL-C reduction: When added to maximally tolerated statin therapy, expect a placebo-corrected incremental reduction of approximately 38% in LDL-cholesterol 1
- Comparison to monotherapy: This represents superior efficacy compared to bempedoic acid alone (17-18% reduction) or ezetimibe alone (approximately 23% reduction) 2, 3
Pre-Treatment Assessment
Before initiating Nexlizet, assess the following:
- Uric acid level: Measure baseline serum uric acid, as bempedoic acid may increase levels and precipitate gout in susceptible patients 1
- Tendon history: Screen for history of tendon disorders or rupture, as bempedoic acid carries a risk of tendinopathy 1
- Ezetimibe hypersensitivity: Confirm no prior hypersensitivity to ezetimibe, which is the only contraindication 1
- Pregnancy status: Confirm patient is not pregnant and counsel on discontinuation if pregnancy is recognized 1
Statin Interaction Precautions
- Simvastatin limitation: Avoid concomitant simvastatin >20 mg daily when using Nexlizet 1
- Pravastatin limitation: Avoid concomitant pravastatin >40 mg daily when using Nexlizet 1
Common Pitfalls to Avoid
- Do not attempt dose titration: There is no lower or higher dose available—the single tablet formulation is the only option 1
- Do not skip bile acid sequestrant timing: Failure to separate administration by 2-4 hours will significantly reduce ezetimibe absorption 1
- Do not ignore baseline uric acid: Patients with pre-existing hyperuricemia or gout history require careful monitoring, as bempedoic acid predictably raises uric acid levels 1
- Do not overlook tendon symptoms: Advise patients to immediately report any tendon pain, swelling, or inflammation and to rest at first sign of tendinitis 1
Monitoring Requirements
After initiation:
- Uric acid monitoring: Reassess if symptoms of hyperuricemia develop (joint pain, gout flare) 1
- Tendon surveillance: Instruct patients to contact provider immediately if tendon rupture occurs or if they experience joint pain, swelling, or inflammation 1
- LDL-C response: Assess lipid panel at 8-12 weeks to evaluate therapeutic response 2, 3