[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › ATP-citrate lyase (ACL) inhibitors

# ATP-citrate lyase (ACL) inhibitors

Oral cholesterol-lowering drugs that block an enzyme one step before the statin target, inside liver cells only.

Updated Nov 1, 2026

## What they are

A new class of LDL-lowering drugs. Bempedoic acid is the only member; it is used with or instead of a statin, often with ezetimibe.

## Mechanism of action

ATP-citrate lyase turns citrate into acetyl-CoA in the cytoplasm, the raw material for cholesterol synthesis, upstream of HMG-CoA reductase. Bempedoic acid is a prodrug activated only in the liver, so it cuts hepatic cholesterol synthesis; the liver then makes more LDL receptors and clears LDL from the blood.

Target: ATP-citrate lyase (ACLY), in liver cells

## Key points

- Acts upstream of the statin target, so the effects add to those of statins.
- The prodrug is activated in the liver but not in skeletal muscle, which explains the low rate of muscle pain.
- Raises uric acid and can trigger gout; tendon rupture is a rare warning.
- An option for statin-intolerant patients.

## Drugs in this class

- [**Bempedoic acid** An oral LDL-lowering prodrug that blocks ATP-citrate lyase in the liver; an option when statins are not tolerated or… ATP-citrate lyase (ACLY)](https://durgical.com/en/pharmacology/bempedoic-acid/)

## Others in the class

- bempedoic acid + ezetimibe (fixed combination)

## Test yourself

Think of the answer, then tap the question to see it.

## Which enzyme do ACL inhibitors block, and how does it relate to the statin target?

ATP-citrate lyase, which makes acetyl-CoA for cholesterol synthesis; it is upstream of HMG-CoA reductase, the statin target.

## Why do ACL inhibitors cause fewer muscle symptoms than statins?

Bempedoic acid is activated by a liver enzyme that is not present in skeletal muscle, so the active drug does not form there.

## Which lab value can rise with bempedoic acid and cause a joint problem?

Uric acid, which can lead to gout.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/classes/atp-citrate-lyase-inhibitors/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

[← All of pharmacology](https://durgical.com/en/pharmacology/)

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).

## **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/classes/atp-citrate-lyase-inhibitors/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/classes/atp-citrate-lyase-inhibitors/