If you REALLY can’t take a statin (and recent work suggests that this is much rarer than most people think) then Bempedoic acid (Nilemdo) could be the solution. At present the alternative is an injectable drug taken 2x per month. Now this new tablet will be easier to take, and cheaper – about £600 per year rather than over £3000. Statins are £30 per year and with the best evidence base. They remain 1st line in all patients.
Lowering cholesterol lowers risk of heart attack and stroke. You will find many cardiologists recommending statins strongly – as like Dr Malik, taking them themselves- prevention is better than cure.
Nilemdo contains bempedoic acid, which is inactive until it enters the liver where it is changed to its active form. Bempedoic acid decreases the production of cholesterol in the liver and increases the removal of LDL-cholesterol from the blood by blocking an enzyme (ATP citrate lyase) needed for the production of cholesterol.
What you need to know before you take Nilemdo
Do not take Nilemdo:
• if you are allergic to bempedoic acid or any of the other ingredients of this medicine (listed in section 6);
• if you are pregnant;
• if you are breast-feeding;
• if you take more than 40 mg of simvastatin daily (another medicine used to lower cholesterol).
Warnings and precautions
Talk to your doctor before taking Nilemdo:
• if you ever had gout;
• if you have severe kidney problems;
• if you have severe liver problems. Your doctor may do a blood test before you start taking Nilemdo. This is to check how well your liver is functioning.
Other medicines and Nilemdo
Tell your doctor if you are taking medicine(s) with any of the following active substances:
• atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin (used to lower cholesterol and known as statins).The risk of muscle disease may increase when taking both a statin and Nilemdo. Tell your doctor immediately about any unexplained muscle pain, tenderness or weakness.
• bosentan (used to manage a condition called pulmonary artery hypertension).
• fimasartan (used to treat high blood pressure and heart failure).
• asunaprevir, glecaprevir, grazoprevir, voxilaprevir (used to treat hepatitis C).
Pregnancy and breast-feeding
Do not take this medicine if you are pregnant, trying to get pregnant, or think you may be pregnant, as there is a possibility that it could harm an unborn baby. If you get pregnant while taking this medicine, call your doctor immediately and stop taking Nilemdo. Do not take Nilemdo if you are breast-feeding because it is not known if Nilemdo passes into milk.
Nilemdo contains lactose and sodium
If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.
This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.
How to take Nilemdo
The recommended dose is one tablet once daily. Swallow the tablet whole with food or between meals. If you take more Nilemdo than you should
Contact your doctor or pharmacist immediately. If you forget to take Nilemdo
• a dose late in a day, take the missed dose and take the next dose at your regular time the next day.
• the previous day’s dose, take your tablet at the regular time and do not make up for the forgotten dose.
Possible side effects
Like all medicines, this medicine can cause side effects, although not everybody gets them. Side effects can occur with the following frequencies:
Common (may affect up to 1 in 10 people)
• lower number of red blood cells (anaemia)
• increased levels of uric acid in blood, gout
• pain in shoulders, legs, or arms
• blood test results indicating liver abnormalities
Uncommon (may affect up to 1 in 100 people)
• decreased haemoglobin (a protein in red blood cells that carries oxygen)
• raised creatinine and blood urea nitrogen (laboratory tests of kidney function)
• decreased glomerular filtration rate (a measure of how well your kidneys are working