Can Bempedoic Acid/Ezetimibe Be Taken With Pramipexole (Mirapex)?
Yes, bempedoic acid 180 mg/ezetimibe 10 mg fixed-dose combination can be safely taken with pramipexole (Mirapex), as there are no known drug-drug interactions between these medications.
Drug Interaction Profile
The American College of Cardiology identifies only two specific drug interactions requiring dose restrictions with bempedoic acid: simvastatin >20 mg daily and pravastatin >40 mg daily must be avoided. 1, 2
Pramipexole (Mirapex), a dopamine agonist used primarily for Parkinson's disease and restless legs syndrome, does not appear in any contraindication or drug interaction warnings for the bempedoic acid/ezetimibe combination. 1, 3
The only absolute contraindication to the fixed-dose combination is documented hypersensitivity to ezetimibe. 3
Additional agents to avoid with this combination include cyclosporine and fibrates, but pramipexole is not among these. 3
Mechanism Considerations
Bempedoic acid works by inhibiting ATP-citrate lyase in the liver's cholesterol synthesis pathway and is activated only in hepatic tissue (not skeletal muscle), making systemic drug interactions less likely. 4, 5
Ezetimibe acts locally in the intestinal brush border to inhibit cholesterol absorption, further limiting potential for systemic drug interactions. 1
Pramipexole is primarily renally excreted and acts on dopamine receptors in the central nervous system, with no overlapping metabolic pathways with either bempedoic acid or ezetimibe.
Monitoring Recommendations When Using Both Medications
Measure serum uric acid before initiating bempedoic acid/ezetimibe and monitor for hyperuricemia symptoms, as bempedoic acid raises uric acid by approximately 0.8 mg/dL. 3, 2
Monitor for tendon-related symptoms (pain, swelling, inflammation) and discontinue immediately if tendon rupture occurs; this occurred in 0.5% of patients versus 0% with placebo. 3, 2
Check hepatic transaminases periodically, especially given the ezetimibe component. 3
While not related to the pramipexole interaction, be aware that atrial fibrillation occurred in 1.7% versus 1.1% with placebo in bempedoic acid trials. 3
Clinical Pitfalls to Avoid
Do not confuse the statin dose restrictions (simvastatin/pravastatin) with other medications—pramipexole has no such restriction. 1, 2
If the patient is taking bile acid sequestrants, administer the bempedoic acid/ezetimibe combination ≥2 hours before or ≥4 hours after the sequestrant. 3, 2
Do not overlook baseline uric acid measurement before starting therapy, as this is essential for monitoring hyperuricemia risk. 3