[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [ATP-citrate lyase (ACL) inhibitors](https://durgical.com/en/pharmacology/classes/atp-citrate-lyase-inhibitors/) › Bempedoic acid # Bempedoic acid ## ATP-citrate lyase (ACL) inhibitors? ATP-citrate lyase (ACL) inhibitors ## Pregnancy: contraindicated? Not recommended: because it blocks cholesterol synthesis, it may harm the fetus; it is usually stopped when pregnancy is found. An oral LDL-lowering prodrug that blocks ATP-citrate lyase in the liver; an option when statins are not tolerated or not enough. Updated Nov 1, 2026 Also called: ETC-1002 ## Quick facts **Group** [ATP-citrate lyase (ACL) inhibitors](https://durgical.com/en/pharmacology/classes/atp-citrate-lyase-inhibitors/) **Target** ATP-citrate lyase (ACLY) **Used for** High LDL cholesterol **Key effects** Muscle spasms · Back pain · Pain in the hands or feet **Monitor** LDL cholesterol after starting · Uric acid **ATC** C10AX15 No doses: the clinician sets them by the current guideline. On this page - The basics Mechanism of action - Indications - Adverse effects - Pharmacokinetics - Memory aid - Clinical What the labels mean - Safety Contraindications - Key interactions - What is monitored - Administration and safety - Pregnancy and breastfeeding - Nursing care - Study Test yourself - Connections Connections ## Mechanism of action Bempedoic acid is a prodrug. In liver cells an acyl-CoA synthetase (very-long-chain acyl-CoA synthetase 1) turns it into bempedoyl-CoA, which competitively inhibits ATP-citrate lyase. Less acetyl-CoA reaches the cholesterol pathway, hepatic cholesterol falls, LDL receptors increase and LDL is cleared from the blood. Skeletal muscle lacks the activating enzyme, so the drug is not active there. - Activated to bempedoyl-CoA in liver cells - Inhibits ATP-citrate lyase, upstream of HMG-CoA reductase - Less cholesterol is made; LDL receptors increase - LDL cholesterol falls in the blood ## Indications - High LDL cholesterol, added to diet and other lipid-lowering drugs, or alone when statins are not tolerated, to lower LDL and reduce heart attack and stroke [Atherosclerosis and dyslipidaemia →](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/) - Heterozygous familial hypercholesterolaemia needing extra LDL lowering [Familial hypercholesterolemia →](https://durgical.com/en/conditions/familial-hypercholesterolemia/) ## Adverse effects ### Common - Muscle spasms - Back pain - Pain in the hands or feet - Raised uric acid - Raised creatine kinase, creatinine or liver enzymes ### Serious (rare, important) - Gout attacks from hyperuricaemia - Tendon rupture (rare) - Allergic reactions ## Contraindications - Hypersensitivity to the drug - Pregnancy: it blocks a step needed for cholesterol synthesis and may harm the fetus ## Key interactions **Simvastatin or rosuvastatin at higher doses** Their levels rise and myopathy risk increases, so high doses are avoided with bempedoic acid. **Other statins and ezetimibe** LDL lowering adds up; it is designed to be combined with them. **Drugs that raise uric acid (thiazides, loop diuretics)** Possible further rise in uric acid and gout risk. ## What is monitored - LDL cholesterol after starting - Uric acid, especially with a history of gout - Symptoms of gout or tendon pain - Liver enzymes when clinically indicated ## Administration and safety - Oral tablet, once a day, with or without food. - Can be given with a statin or alone; a fixed combination with ezetimibe exists. - Not to be confused with other lipid drugs with similar names on prescriptions. ## Pregnancy and breastfeeding Not recommended: because it blocks cholesterol synthesis, it may harm the fetus; it is usually stopped when pregnancy is found. ## Nursing care - Before: history of gout, tendon problems and current statin dose. - During: ask about joint pain (especially the big toe) and sudden tendon pain or a 'pop'. - Teach that the drug does not replace diet and exercise. - Report pregnancy promptly. ## Pharmacokinetics **Absorption** Oral, with or without food. **Metabolism** Activated in the liver; the prodrug and active form are glucuronidated (UGT2B7). **Elimination** Mostly in urine as glucuronides. **Half-life** About 21 hours, allowing once-daily use (G&G). ## Memory aid Bempedoic acid works BEfore the statin step and only in the liver: 'liver-only, before-statin'. Its price is uric acid (gout) and, rarely, a snapped tendon. ## Test yourself Think of the answer, then tap the question to see it. ## Why does bempedoic acid cause fewer muscle symptoms than statins? It is a prodrug activated by a liver enzyme that skeletal muscle lacks, so the active drug forms only in the liver. ## A patient on bempedoic acid develops a hot, swollen big toe. What is the likely cause? Gout, because bempedoic acid raises serum uric acid. ## Where in the cholesterol pathway does bempedoic acid act compared with statins? Upstream: it blocks ATP-citrate lyase, which supplies acetyl-CoA, before HMG-CoA reductase. ## Which statins need dose limits with bempedoic acid? Simvastatin and rosuvastatin, whose levels rise and increase the risk of myopathy at higher doses. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/pharmacology/bempedoic-acid/) [More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology) ## What the labels mean **Pregnancy: contraindicated** Not recommended: because it blocks cholesterol synthesis, it may harm the fetus; it is usually stopped when pregnancy is found. ## Connections ## Related drugs 2 - [Ezetimibe](https://durgical.com/en/pharmacology/ezetimibe/) - [Atorvastatin](https://durgical.com/en/pharmacology/atorvastatin/) ## Related conditions 2 - [Atherosclerosis and dyslipidaemia](https://durgical.com/en/conditions/atherosclerosis-and-dyslipidaemia/) - [Familial hypercholesterolemia](https://durgical.com/en/conditions/familial-hypercholesterolemia/) [← Back to the class: ATP-citrate lyase (ACL) inhibitors](https://durgical.com/en/pharmacology/classes/atp-citrate-lyase-inhibitors/) Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given. Sources: [Bempedoic Acid: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a620020.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=C10AX15) (WHO Collaborating Centre for Drug Statistics Methodology, 2026). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/pharmacology/bempedoic-acid/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/bempedoic-acid/