Compound Physician required

Bempedoic Acid

Statin alternative for statin-intolerant patients. Same pathway, one step upstream.

Approved Verified 27 August 2026

What it does

Hits the cholesterol-synthesis pathway one step upstream of statins. A narrow but real role: patients who can't tolerate statins, or who need an additional layer when stacked therapy still falls short.

Inhibits ATP-citrate lyase, upstream of HMG-CoA reductase. It is activated specifically in the liver, which avoids the muscle metabolism behind statin myalgia.

  • ApoB
  • LDL-C

What the evidence shows

Overall evidence strength: Moderate certainty

Who it's for, who should skip

Statin-intolerant patients, or an adjunct when stacked lipid therapy still misses ApoB target. The ApoB effect is meaningful but smaller than high-intensity statin therapy.

Running it

Form
oral
Dose
180 mg · daily

Measuring it

Retest ApoB — 4–12 weeks after starting or changing the dose, then every 6–12 months — ApoB follows the lipid-panel schedule..

  • LDL-C baseline
  • LDL-C annual
  • ApoB baseline
  • ApoB annual

Safety

  • hyperuricemia and gout flares uncommon
  • tendon rupture rare

Stacking & alternatives

Access & cost

Prescription or clinician order — typically via cardiology or primary care.

Last reviewed 27 August 2026. Regulatory status verified 27 August 2026.