For millions of Canadians, lowering cholesterol is an important part of protecting heart health and reducing the risk of heart attack and stroke. For decades, statins have been the foundation of cholesterol treatment. Medications such as atorvastatin and rosuvastatin have helped millions of patients lower LDL (“bad”) cholesterol and reduce cardiovascular risk.
However, some patients experience muscle-related side effects with statins or are unable or unwilling to take them. A new medication called bempedoic acid (Nilemdo) provides another option. Approved by Health Canada in late 2025, bempedoic acid is a first-in-class non-statin cholesterol-lowering medication that works differently from statins.
At Centrum Pharmacy, our pharmacists can help patients understand new treatment options, review medications, monitor side effects, and work with healthcare providers to optimize cardiovascular health.
How Does Bempedoic Acid Work?
Bempedoic acid works by blocking an enzyme called adenosine triphosphate citrate lyase (ACL) in the liver. This pathway is involved in cholesterol production and occurs upstream from the pathway targeted by statins.
Unlike statins, bempedoic acid is activated primarily in the liver, is inactive in muscle tissue, and appears to have a lower risk of muscle-related side effects compared with statins. Clinical studies show bempedoic acid can reduce LDL cholesterol by approximately 17% to 28%.
Who May Benefit From Bempedoic Acid?
Bempedoic acid may be considered for adults who have high cholesterol despite lifestyle changes, have cardiovascular disease or are at increased cardiovascular risk, cannot tolerate statins because of side effects, or need additional LDL cholesterol lowering alongside other medications.
It may be used alone (monotherapy) for patients who cannot take statins, alongside statins when additional cholesterol lowering is needed, or with other cholesterol medications such as ezetimibe or PCSK9 inhibitors.
How Is It Taken?
The dose is simple: bempedoic acid 180 mg, taken once daily by mouth. No dose adjustment is generally required for mild-to-moderate kidney disease or mild-to-moderate liver impairment. However, patients with severe kidney disease or advanced liver disease were not extensively studied.
Does Bempedoic Acid Reduce Heart Attack and Stroke Risk?
The CLEAR Outcomes clinical trial studied nearly 14,000 patients who were unable or unwilling to take statins. After approximately 3.4 years, LDL cholesterol decreased by about 21%, major cardiovascular events were reduced compared with placebo, and benefits were mainly seen through fewer heart attacks and coronary procedures.
This makes bempedoic acid an important option for selected patients, especially those who cannot use statins.
Possible Side Effects
Most patients tolerate bempedoic acid well. Potential side effects include increased uric acid levels, which may trigger gout in some patients — patients with a history of gout should discuss this with their healthcare provider. Other possible effects include joint or extremity discomfort, mild increases in liver enzymes, anemia, and rare allergic reactions. Your pharmacist can help identify possible medication-related concerns.
Drug Interactions
Bempedoic acid may interact with certain statins. Special attention is needed with simvastatin (maximum recommended dose: 20 mg daily) and pravastatin (maximum recommended dose: 40 mg daily). Always provide your pharmacist with an updated medication list, including prescription medications, vitamins, supplements, and natural health products.
Bempedoic Acid vs Statins: What Is Different?
| Statins | Bempedoic Acid | |
|---|---|---|
| Main action site | Liver and muscle pathways | Liver only |
| LDL reduction | Often 30–50%+ | Approximately 17–28% |
| Muscle side effects | Possible | Lower risk |
| Cardiovascular evidence | Extensive | Positive evidence in statin-intolerant patients |
| Cost | Usually inexpensive | Approximately $140–$150/month |
The Role of Your Pharmacist
At Centrum Pharmacy, our pharmacists provide more than medication dispensing. We can help with medication reviews (reviewing cholesterol medications, identifying possible side effects, checking medication interactions, and improving adherence) and cardiovascular health support (blood pressure monitoring, diabetes medication support, lifestyle counselling, smoking cessation support, and heart health education).
Your pharmacist can communicate with your physician or nurse practitioner if cholesterol targets are not being achieved, side effects are limiting treatment, or a medication review is needed.
Key Message
For patients who cannot tolerate statins or need additional cholesterol lowering, bempedoic acid (Nilemdo) represents an important new option. It provides another tool to help reduce LDL cholesterol and protect cardiovascular health.
Talk to your Centrum Pharmacy pharmacist to learn whether this medication may be appropriate for you.
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Disclaimer: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information does not substitute for professional diagnosis and treatment. Please do not initiate, modify, or discontinue any treatment, medication, or supplement solely based on this information. Always seek the advice of your healthcare provider first. Full Disclaimer.
