Nexlizet Side Effects: What to Expect and When to Call Your Doctor

Starting a new medication always raises questions about what side effects to watch for. With Nexlizet (bempedoic acid and ezetimibe), most patients tolerate the medication well — but there are several side effects worth knowing about before you start. This guide covers the full spectrum from minor annoyances to serious warnings, so you know what to monitor and when to contact your doctor.

How Common Are Side Effects with Nexlizet?

In clinical trials, about 8% of patients treated with Nexlizet discontinued due to adverse reactions, compared with 5% on placebo. The medication is generally well-tolerated, and most side effects are mild to moderate. One important advantage of Nexlizet over statins is that bempedoic acid — one of its two active ingredients — is activated in the liver rather than in skeletal muscle, which means it causes fewer muscle-related side effects than high-dose statins.

Common Side Effects of Nexlizet

The following side effects were reported in clinical trials at a rate of 2% or higher and more frequently than placebo:

Urinary tract infection (UTI): Reported in 5.9% of Nexlizet patients vs. 2.4% on placebo. Contact your doctor if you have burning with urination, frequent urination, or pelvic pain.

Nasopharyngitis (cold-like symptoms): Reported in 4.7% of patients on Nexlizet vs. 0% on placebo in some trials.

Constipation: Reported in 4.7% of patients on Nexlizet. Staying well-hydrated and maintaining adequate dietary fiber can help manage this.

Muscle spasms: Reported in 3.6% of Nexlizet patients vs. 2.3% on placebo. While less severe than statin-related muscle pain, report painful or persistent muscle spasms to your doctor.

Back pain and pain in extremities: Reported in some trials at a rate modestly higher than placebo.

Anemia: A decrease in red blood cell counts has been observed. Your doctor may order periodic blood tests to monitor this.

Elevated liver enzymes: Lab tests may show elevated liver transaminases. Clinically significant liver inflammation is rare but possible.

Diarrhea and abdominal pain: Gastrointestinal symptoms are possible with the ezetimibe component; these usually improve as your body adjusts.

Serious Side Effects: What to Watch For

1. Hyperuricemia and Gout

Bempedoic acid inhibits a renal transporter (OAT2) that normally helps excrete uric acid. As a result, 26% of patients with normal baseline uric acid experienced elevated levels during Nexlizet treatment (vs. 9.5% on placebo). Clinically significant gout was reported in 3.5% of patients.

Gout can develop within 4 weeks of starting Nexlizet. Call your doctor if you experience: sudden, severe joint pain (especially in the big toe), warm or swollen joints, redness around a joint, or pain when urinating. If you have a history of gout, tell your doctor before starting Nexlizet.

2. Tendon Rupture

Bempedoic acid is associated with an increased risk of tendon rupture, particularly of the Achilles tendon and shoulder tendons. Tendon rupture occurred in 0.5% of Nexlizet-treated patients in primary hyperlipidemia trials and 1.2% in the cardiovascular outcomes trial (vs. 0.9% placebo).

Risk is higher if you are: over age 60, taking corticosteroids or fluoroquinolone antibiotics, have kidney failure, or have a prior history of tendon problems.

Stop taking Nexlizet immediately and get medical attention if you: hear or feel a snap or pop in a tendon area, notice bruising after an injury to a tendon, or cannot move or put weight on an affected limb.

3. Serious Allergic Reactions

Rare but serious allergic reactions — including anaphylaxis and angioedema — have been reported with ezetimibe and bempedoic acid. Go to the nearest emergency room immediately if you experience: swelling of the face, lips, tongue, or throat; difficulty breathing; wheezing; hives or rash; dizziness; or a rapid heartbeat.

Nexlizet vs. Statins: How Do the Side Effects Compare?

Many patients are prescribed Nexlizet specifically because they couldn't tolerate statins. Compared to statins, Nexlizet has a better muscle safety profile — because bempedoic acid is activated primarily in the liver, not in skeletal muscle, the classic statin-related myalgia is much less common. However, Nexlizet introduces its own unique risks (gout, tendon problems) that statins don't typically cause.

Drug interactions can also increase the risk of side effects. See our guide on Nexlizet drug interactions: what to avoid and what to tell your doctor to make sure you're taking Nexlizet as safely as possible.

Having trouble finding Nexlizet at a pharmacy? medfinder can call pharmacies near you to locate your prescription.