Nexletol (bempedoic acid) alternatives: What can I take instead of Nexletol?

In this article:

• Compare Nexletol alternatives
• Statins
• Repatha
• Praluent
• Zetia
• Leqvio
• Natural alternatives
• How to switch meds

In this article

• Compare Nexletol alternatives
• Statins
• Repatha
• Praluent
• Zetia
• Leqvio
• Natural alternatives
• How to switch meds

Nexletol (bempedoic acid) is a prescription medication used to lower cholesterol and reduce the risk of heart attack and heart procedures, such as stent placement or bypass surgery, in people who have heart disease or are at risk of heart disease. Nexletol is currently only available as a brand-name medication. This medication is an antilipemic drug meaning it treats hyperlipidemia, an excess of lipids in the blood, such as cholesterol. Specifically, Nexletol decreases low-density lipoprotein cholesterol (LDL-C), also known as bad cholesterol. This medicine comes as a tablet taken by mouth once per day.

While an effective treatment for some people, Nexletol may not be the best and safest treatment for everyone, lowering cholesterol or trying to reduce cardiovascular events. Nexletol may cause hyperuricemia (an excess of uric acid in the blood) and lead to gout. People with a history of gout have a higher risk of developing gout while taking Nexletol. Additionally, Nexletol can increase the risk of tendon rupture. Some people may experience better cholesterol control with other treatment options.

What can I take in place of Nexletol?

There are other options available to lower bad cholesterol that do not improve with Nexletol. These alternative prescription medications include statins, PCSK9 inhibitors, and Zetia. According to the American Heart Association (AHA), statins are the preferred treatment for lowering bad (LDL) cholesterol along with healthy lifestyle changes. Other statin alternatives like PCSK9 inhibitors and Zetia can be used for additional LDL cholesterol-lowering therapy. These options may be more suitable for certain individuals due to their different uses, side effect profiles, dosages, and costs.

Other alternatives to Nexletol

Other alternative cholesterol-lowering drugs, such as fibrates and bile acid sequestrants, can be used as additional treatment as they are not as preferred as the above alternatives.

• Colestid (colestipol)
• Fibricor (fenofibrate)
• Lopid (gemfibrozil)
• Niacin
• Prevalite (cholestyramine)
• Questran (cholestyramine)
• Tricor (fenofibrate)
• Trilipix (fenofibrate)
• Welchol (colesevelam)

Top 5 Nexletol alternatives

The following are some of the most common alternatives to Nexletol.

1. Statins

Statins are a group of medications that are the preferred treatment for lowering bad (LDL) cholesterol along with healthy lifestyle changes. Additionally, statins reduce the risk of heart attack, stroke, and heart procedures, such as stent placement or bypass surgery, in people who have heart disease or are at risk of heart disease. Depending on the intensity of the statin, certain statins can lower LDL-C by at least 50%. Most statins are taken once a day and are available as tablets or capsules. The most common side effects of statins include nausea, diarrhea, joint pain, and fatigue. More serious side effects of statins include liver toxicity and myopathy (muscle pain or weakness). 

Examples of statins include Lipitor (atorvastatin), Lescol (fluvastatin), Altoprev (lovastatin), Livalo (pitavastatin), pravastatin, Crestor (rosuvastatin), and Zocor (simvastatin). 

RELATED: When is the best time to take statins?

2. Repatha

Repatha (evolocumab) is a PCSK9 inhibitor that is currently only available as a brand-name medication. PCSK9 inhibitors are a relatively newer class of drugs that are powerful LDL-lowering medications and are generally well tolerated, but long-term safety remains to be proven. The American Heart Association (AHA) supports the use of a PCSK9 inhibitor like Repatha to be combined with a statin to further reduce LDL-C levels by 43% to 64%. Repatha can also be used for those with a statin intolerance. Repatha can also reduce the risk of myocardial infarction (heart attack), stroke, and coronary revascularization in adults with established cardiovascular disease. Unlike Nexletol, which is a tablet, Repatha comes as an auto-injector or syringe that is used to inject the medication subcutaneously (under the skin). Repatha does not need to be injected daily; rather, it should be either 140 mg every two weeks or 420 mg every four weeks. It’s important to review proper administration techniques with the healthcare provider or pharmacist prior to starting this alternative.

RELATED: How much is Repatha without insurance?

3. Praluent

Praluent (alirocumab) is another PCSK9 inhibitor that is also currently only available as a brand-name drug. Like Repatha, Praluent is a powerful LDL-lowering medication that also reduces the risk of heart attack, stroke, and coronary revascularization in adults with established cardiovascular disease. Common PCSK9 inhibitor side effects include injection site reactions like itching, swelling, redness, or pain. Praluent is available as an auto-injector injected under the skin at doses of 75 mg to 150 mg every two weeks or 300 mg every 4 weeks. Learning proper administration with the healthcare provider or pharmacist is important prior to starting this alternative.

RELATED: Praluent vs. Repatha: Differences, similarities, and which is better for you

4. Zetia

Zetia (ezetimibe) is a cholesterol absorption inhibitor that is available as a generic medication. This medication can be used to lower LDL-C and reduce the risk of ASCVD (atherosclerotic cardiovascular disease). Zetia is the most commonly used non-statin medicine as it lowers LDL-C levels by 13% to 20% and has a low incidence of side effects. Potential side effects include joint pain and upper respiratory tract infection. Zetia is available as a 10 mg tablet taken once a day. Additionally, ezetimibe is available as a combination tablet with Nexletol called Nexlizet (bempedoic acid and ezetimibe).

RELATED: Ezetimibe side effects and how to avoid them

5. Leqvio

Leqvio (inclisiran) is a lipid-lowering medication that inhibits PCSK9 and is currently only available as a brand medication. Leqvio lowers LDL-C and can lower LDL-C by up to 52% in combination with a maximally tolerated statin. This medication is administered at a doctor’s office by a healthcare professional as an injection under the skin in either the abdomen, upper arm, or thigh. After the initial dose and a follow-up 3-month dose, Leqvio is administered only every six months. Leqvio is well-tolerated, and injection site reactions, such as redness or pain, are the most common side effects. People who have difficulty giving themselves injections at home or who have adherence issues with taking medication may benefit from a healthcare professional-administered medication like Leqvio.

Natural alternatives to Nexletol

Alternative remedies to lower bad cholesterol levels and maintain a healthy cholesterol range include supplements, lifestyle changes, and diet modifications.

The American Heart Association supports eating a heart-healthy diet, which can help lower bad cholesterol and lead to a healthy weight and blood pressure. The heart-healthy diet includes a variety of fruits and vegetables, fish, nuts, whole grains, lean meats, and beans. Foods that should be limited include red and fatty meats, fried foods, foods high in sodium, full-fat dairy products, saturated fats, and trans fats. Along with diet, the American Heart Association encourages regular exercise to achieve a healthy body weight and overall heart health.

Red yeast rice is a supplement that has been used for centuries in Chinese medicine to lower cholesterol, improve digestion, and enhance blood circulation. Red yeast rice contains substances known as monacolins that are believed to have a similar chemical makeup to statins, specifically the similarity of monacolin K to lovastatin. A study published in the American Journal of Cardiology found that red yeast rice modestly decreased total and LDL cholesterol, was well-tolerated and was an acceptable alternative in patients intolerant of other lipid-lowering medications (such as statin-intolerance). There are certain people who should not use red yeast rice to treat high cholesterol, such as those with liver disease, kidney disease, thyroid problems, musculoskeletal disorders, or those at higher risk of cancer.

RELATED: 10 natural remedies for high cholesterol

How to switch to a Nexletol alternative

1. Discuss all health conditions with a healthcare provider

Before switching from Nexletol to an alternative, it’s important the prescribing healthcare provider has reviewed all health conditions. Alternatives may have serious side effects or drug interactions that need to be avoided. It’s best to seek medical advice prior to changing medication therapy.

2. Do not suddenly stop taking Nexletol

Before stopping Nexletol, make a treatment plan with the prescribing healthcare provider to avoid increases in cholesterol levels and further risk for cardiovascular events such as heart attack or stroke. Once a plan has been established, Nexletol can be safely discontinued, and the new treatment can start.

3. Discuss all prescription and over-the-counter medications with a healthcare provider

Before switching from Nexletol to an alternative, it’s important the healthcare provider reviews a complete medication list, including prescription drugs and over-the-counter medication (OTC). Some alternatives have dangerous drug interactions that must be avoided.

4. Keep up with routine lab appointments

Staying up to date with routine lab appointments for cholesterol tests can help determine whether treatment is working or help guide healthcare providers to change therapy. Cholesterol tests usually measure high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, and triglyceride levels, along with total blood (or serum).

5. Be aware of high-risk factors for heart disease

In addition to unhealthy blood cholesterol levels, there are several important health conditions people taking cholesterol-lowering medication should be familiar with and discuss with their healthcare provider to learn more about. These conditions include high blood pressure (hypertension), diabetes mellitus, and obesity.