Nilemdo, a new non statin lipid-lowering drug, was approved by the US FDA in 2020 and is mainly used to treat hypercholesterolemia and atherosclerotic cardiovascular diseases.

1、 Drug name

1. Common name: Bempedoic Acid

2. Product Name: NEXLETOL (Nilemo)

2、 Indications

1. Reduce the risk of cardiovascular events: Used for adults who cannot receive recommended statin treatment (including those who have not used statins) to reduce the risk of major adverse cardiovascular events (cardiovascular death, myocardial infarction, stroke, or coronary revascularization).

2. Lowering low-density lipoprotein cholesterol (LDL-C): As an adjunct therapy to diet and exercise, combined with other LDL-C lowering therapies or used alone (when other LDL-C lowering therapies cannot be combined), for the reduction of LDL-C in adult hypercholesterolemia (including heterozygous familial hypercholesterolemia).

3、 Specifications

Specification: Each tablet contains 180mg of beperidic acid.

4、 Main components

Active ingredient: Betamethasone.

5、 Usage and dosage

1. Recommended dosage: 180mg orally once daily, can be taken with food or on an empty stomach.

2. Blood lipid levels should be tested 8-12 weeks after starting treatment.

6、 Dose adjustment

1. No special dosage adjustment instructions.

2. Mild or moderate liver dysfunction (Child Pugh A or B grade) patients do not require dose adjustment; Severe liver dysfunction (Child Pugh C grade) patients have not been studied.

7、 Medication precautions

1. Before and after meals: can be taken with food or on an empty stomach without special requirements.

2. Omission: Not clearly stated, it is recommended to take medication according to daily routine, and there is no need to take double the dose after omission.

3. Vomiting: Not explicitly stated. If vomiting occurs after taking medication, it is not recommended to take it again.

4. Other precautions:

During the treatment period, there may be an increase in blood uric acid or tendon rupture, and relevant symptoms need to be monitored.

Avoid combination therapy with simvastatin exceeding 20mg or pravastatin exceeding 40mg.

Combination therapy with beta drugs may increase triglycerides and decrease high-density lipoprotein cholesterol, and blood lipids should be monitored after 4 weeks of combination therapy.

8、 Medication for special populations

1. Pregnancy period: Based on the mechanism of action, it may cause fetal damage. If pregnancy is detected, medication should be discontinued unless the treatment benefits outweigh the potential risks.

2. Breastfeeding period: Betamethasone can be secreted with breast milk and may cause harm to breastfed infants. It is necessary to weigh the pros and cons before deciding whether to use medication or breastfeed.

3. Children: Safety and effectiveness have not yet been established.

4. There is no overall difference in safety and efficacy between patients aged 65 and above and young adults.

5. Liver injury: Patients with mild or moderate liver injury do not need to adjust the dosage; Patients with severe liver injury have not been studied.

9、 Adverse reactions

1. Common adverse reactions (primary hypercholesterolemia test): upper respiratory tract infection, muscle spasms, hyperuricemia, back pain, abdominal pain or discomfort, bronchitis, limb pain, anemia, elevated liver enzymes.

2. Common adverse reactions (cardiovascular outcome tests): hyperuricemia, renal impairment, anemia, elevated liver enzymes, muscle spasms, gout, gallstones.

3. Serious adverse reactions:

Hyperuricemia (which may progress to gout) may occur and persist within 4 weeks of treatment.

Tendon rupture (common in the shoulder, biceps, Achilles tendon) often occurs within weeks to months of treatment.

10、 Contraindications

Individuals with a history of severe hypersensitivity reactions to any excipients in beperidic acid or NEXLETOL are prohibited from use.

11、 Drug interactions

1. Simvastatin: Avoid using simvastatin in combination with doses exceeding 20mg.

2. Pravastatin: Avoid using pravastatin in combination with doses exceeding 40mg.

3. Betrate drugs: Combination use may increase triglycerides and decrease high-density lipoprotein cholesterol, and blood lipids need to be monitored.

4. Other: There is no significant interaction with warfarin, metformin, or oral contraceptives.

12、 Storage method

1. Store at room temperature ranging from 68 ° F to 77 ° F (20 ° C to 25 ° C), with short-term exposure allowed at 59 ° F to 86 ° F (15 ° C to 30 ° C).

2. It needs to be stored and distributed in its original packaging.

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