Nexletol side effects and hair loss is a question raised by patients taking bempedoic acid — marketed in the UK as Nilemdo or Nustendi rather than the US brand name Nexletol. Bempedoic acid is a licensed lipid-lowering medicine used to reduce LDL cholesterol in adults, particularly when statins are not tolerated. Whilst the drug has a recognised side effect profile including gout, tendon disorders, and anaemia, hair loss is not listed as an established adverse reaction. This article explains what the evidence shows, when to seek medical advice, and how to report unexpected symptoms through the MHRA Yellow Card scheme.

What Is Bempedoic Acid and How Is It Used in the UK?

Bempedoic acid is licensed in the UK as Nilemdo or Nustendi for adults with high cholesterol, particularly when statins are contraindicated or insufficient; it inhibits ATP-citrate lyase in the liver to lower LDL-C.

Bempedoic acid is a lipid-lowering medicine licensed in the UK and across Europe for use in adults with hypercholesterolaemia (high cholesterol) or mixed dyslipidaemia. In the UK and EU, it is marketed under the brand name Nilemdo (bempedoic acid alone) or Nustendi (bempedoic acid combined with ezetimibe as a fixed-dose tablet). The medicine is sometimes referred to by the US brand name Nexletol, which is not the licensed name in the UK.

The European Medicines Agency (EMA) granted marketing authorisation for Nilemdo and Nustendi, and their use in the UK is supported by NICE guidance (NICE TA694). In line with this guidance, bempedoic acid is indicated for adults whose cholesterol is not adequately controlled — particularly when statins are contraindicated or not tolerated, or when additional LDL-C lowering is needed alongside existing therapy.

Bempedoic acid works by inhibiting an enzyme called ATP-citrate lyase (ACL), which sits upstream of HMG-CoA reductase — the same pathway targeted by statins — in the liver's cholesterol synthesis process. By blocking ACL, the drug reduces the liver's ability to produce cholesterol, which in turn stimulates LDL receptors to clear more LDL-C from the bloodstream. Because bempedoic acid is activated primarily in the liver rather than in muscle tissue, the risk of muscle-related side effects is lower than with statins; however, muscle-related adverse events can still occur, particularly when bempedoic acid is taken alongside certain statins (see the interactions section below).

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Nilemdo is taken as a once-daily oral tablet (180 mg) and may be used alongside other lipid-lowering therapies. As with all prescription medicines in the UK, it should be used under medical supervision with regular monitoring of lipid levels and relevant blood markers. Patients and clinicians can find full prescribing information in the UK Summary of Product Characteristics (SmPC) available via the MHRA/electronic Medicines Compendium (eMC).

Recognised Side Effects of Bempedoic Acid (Nilemdo)

Hair loss is not a recognised side effect of bempedoic acid; common adverse effects include hyperuricaemia, gout, elevated liver enzymes, and musculoskeletal pain.

Like all medicines, bempedoic acid can cause side effects, though not everyone will experience them. The side effects listed in the Summary of Product Characteristics (SmPC) and recognised by the EMA are based on clinical trial data and post-marketing surveillance. Understanding these effects helps patients make informed decisions and recognise when to seek medical advice.

Common side effects (affecting up to 1 in 10 people) include:

• Hyperuricaemia (raised uric acid levels in the blood), which can increase the risk of gout

• Gout or gout flares, particularly in patients with a prior history

• Elevated liver enzymes (transaminases), which are usually mild and reversible

• Increased blood creatinine levels

• Musculoskeletal pain, including back pain and pain in the extremities

• Gastrointestinal symptoms such as abdominal pain, constipation, or diarrhoea

Uncommon but important side effects (affecting up to 1 in 100 people) include:

• Tendon disorders, including tendinitis and, rarely, tendon rupture — patients should be alert to tendon pain or swelling and seek prompt medical advice if this occurs (see the section below on when to contact your GP)

• Anaemia or reduction in haemoglobin — if you feel unusually tired, pale, or breathless, inform your GP

Regarding hair loss: It is important to note that hair loss (alopecia) is not a recognised or listed side effect of bempedoic acid in its official UK prescribing information or EMA documentation. Some patients searching for information about bempedoic acid side effects and hair loss may have noticed changes in their hair during treatment. This is most likely coincidental, or related to another medicine taken concurrently, or linked to an underlying condition such as thyroid dysfunction or iron deficiency anaemia. There is no established pharmacological mechanism by which bempedoic acid would cause hair loss.

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If you notice unexpected hair thinning or shedding whilst taking bempedoic acid, discuss this with your GP rather than stopping the medication abruptly. A review of all current medications and relevant blood tests can help identify the true cause. The NHS website provides helpful patient-facing information on common causes of hair loss (alopecia) and when to seek care.

When to Speak to Your GP or Pharmacist

Seek prompt medical advice for tendon pain, gout attacks, unusual fatigue, jaundice, or severe muscle pain; hair loss during treatment should be investigated for alternative causes such as thyroid dysfunction or iron deficiency.

Knowing when to seek medical advice is an important part of managing any long-term medication safely. Whilst many side effects of bempedoic acid are mild and self-limiting, certain symptoms warrant prompt attention from a healthcare professional.

Contact your GP or pharmacist promptly if you experience:

• Sudden or severe joint pain, swelling, or redness — particularly in the big toe, ankle, or knee — which may indicate a gout attack

• Tendon pain, swelling, or stiffness (for example, in the Achilles tendon or shoulder) — rest the affected area and contact your GP promptly, as treatment may need to be paused or stopped

• Unusual fatigue, pallor, or breathlessness, which could suggest anaemia

• Persistent or worsening abdominal pain

• Yellowing of the skin or eyes (jaundice), dark urine, or significant upper abdominal discomfort, which may indicate liver involvement

• Muscle pain, tenderness, or weakness — particularly if severe or accompanied by dark-coloured urine, which requires urgent assessment; this risk is heightened if you are also taking simvastatin or pravastatin (see below)

Regarding hair loss specifically: If you notice significant or progressive hair shedding whilst taking bempedoic acid, raise this with your GP. Although there is no established link between bempedoic acid and alopecia, your doctor can arrange blood tests to rule out other causes — including thyroid disorders and iron deficiency anaemia — which are common and treatable causes of hair loss in adults.

You should seek urgent medical attention if you develop signs of a serious allergic reaction, such as facial swelling, difficulty breathing, or a widespread rash. Do not stop taking bempedoic acid without first consulting your prescriber, as abrupt discontinuation may affect your cardiovascular risk management. Your GP or pharmacist can advise on whether a dose adjustment, temporary pause, or switch to an alternative therapy is appropriate based on your individual circumstances.

Managing Side Effects and Continuing Treatment Safely

Most side effects are manageable with monitoring; simvastatin must not exceed 20 mg/day and pravastatin 40 mg/day when used alongside bempedoic acid to reduce myopathy risk.

For most patients, the side effects of bempedoic acid are manageable and do not require discontinuation of treatment. The key is regular monitoring and open communication with your healthcare team.

Drug interactions — important dose limits: Before starting bempedoic acid, your GP or specialist should review your full medication list. Bempedoic acid can increase plasma concentrations of simvastatin and pravastatin, raising the risk of muscle-related side effects. If you are taking either of these statins alongside bempedoic acid:

• Simvastatin should not exceed 20 mg per day

• Pravastatin should not exceed 40 mg per day Your prescriber should monitor for signs of myopathy (muscle pain, weakness, or dark urine) if these combinations are used.

Practical steps for managing common side effects:

• Gout: Stay well hydrated, reduce alcohol intake, and follow dietary advice to limit purine-rich foods (such as red meat and shellfish). Your GP may prescribe urate-lowering therapy if gout attacks are recurrent. The NHS website provides further patient guidance on managing gout.

• Anaemia: Ensure adequate dietary intake of iron and vitamin B12. Your GP may arrange repeat full blood counts to monitor haemoglobin levels over time.

• Gastrointestinal symptoms: Bempedoic acid can be taken with or without food. If symptoms persist, speak to your pharmacist about suitable remedies.

• Elevated liver enzymes: These are usually transient. Your GP will monitor liver function tests periodically and will advise if levels become clinically significant.

• Tendon problems: If you develop tendon pain or swelling, avoid strenuous activity involving the affected area and contact your GP promptly.

Special populations — important cautions: Bempedoic acid is generally not recommended during pregnancy or breastfeeding due to limited safety data. Caution is also required in patients with severe renal impairment (eGFR below 30 mL/min/1.73 m²) or moderate to severe hepatic impairment — your prescriber should consult the SmPC for full guidance on these situations.

If hair loss is a concern and no clear cause is identified through initial blood tests, your GP may refer you to a dermatology (hair and scalp) clinic for further assessment. In the meantime, gentle hair care practices — avoiding excessive heat styling and harsh chemical treatments — can help minimise further breakage. Full prescribing details, including interactions and monitoring requirements, are available in the Nilemdo SmPC on the MHRA/eMC website and in the BNF.

MHRA Guidance and Reporting Adverse Reactions

Any suspected side effect from bempedoic acid, including hair loss, should be reported to the MHRA via the Yellow Card scheme online, by app, or through a healthcare professional.

The Medicines and Healthcare products Regulatory Agency (MHRA) is the UK body responsible for ensuring that medicines, including bempedoic acid (Nilemdo/Nustendi), are safe and effective for their intended use. The MHRA continuously monitors the safety profile of licensed medicines through post-marketing surveillance, which includes analysis of spontaneous adverse event reports submitted by both healthcare professionals and patients.

If you believe you have experienced a side effect from bempedoic acid — including hair loss, even though it is not currently listed as a recognised adverse reaction — you are encouraged to report it through the Yellow Card scheme, the UK's pharmacovigilance reporting system. Reports can be submitted:

• Online at yellowcard.mhra.gov.uk

• Via the Yellow Card app, available on iOS and Android

• Through your GP, pharmacist, or nurse, who can submit a report on your behalf

Yellow Card reports from patients and clinicians are invaluable. They help the MHRA identify previously unrecognised side effects, update prescribing information, and issue safety communications where necessary. Even if a causal link is uncertain, reporting is encouraged — the MHRA uses statistical analysis across large datasets to detect genuine signals.

Healthcare professionals prescribing bempedoic acid should refer to the current UK SmPC (available via the MHRA/eMC), which is regularly updated in line with EMA and MHRA reviews. Patients should be counselled at the point of prescribing about the known side effect profile and advised to report any unexpected symptoms. Staying informed through reputable sources — including the NHS website, NICE TA694, the EMA European Public Assessment Report (EPAR) for Nilemdo, and the BNF — ensures that both patients and clinicians can make evidence-based decisions about the ongoing use of bempedoic acid as part of a comprehensive cardiovascular risk reduction strategy.

Frequently Asked Questions