Comprehensive medication guide to Nexlizet including estimated pricing, availability information, side effects, and how to find it in stock at your local pharmacy.
Estimated Insurance Pricing
$10–$60 copay for commercially insured patients; prior authorization often required; Tier 3–4 on most formularies. Eligible commercially insured patients may pay as little as $10/fill with the Esperion NEXSTEP Co-Pay Card.
Estimated Cash Pricing
$430–$595 retail for a 30-day supply (brand only, no generic available); as low as $231 with a GoodRx coupon at select pharmacies.
Medfinder Findability Score
72/100
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Nexlizet is a brand-name prescription oral tablet manufactured by Esperion Therapeutics, containing two active ingredients: bempedoic acid (180 mg) and ezetimibe (10 mg). It was first FDA-approved on February 26, 2020 — the first non-statin, fixed-dose combination cholesterol-lowering pill ever approved in the United States.
Nexlizet is indicated to reduce LDL ("bad") cholesterol in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH), alone or in combination with other cholesterol-lowering therapies. The bempedoic acid component is also approved to reduce the risk of myocardial infarction and coronary revascularization in adults who are unable to take recommended statin therapy. In March 2024, the FDA expanded the label to include both primary and secondary prevention patients regardless of statin use.
Nexlizet is not a statin and does not contain a statin. It is a once-daily oral tablet that can be taken with or without food. No generic version is currently available.
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Nexlizet lowers LDL cholesterol through two complementary mechanisms that target both the production and absorption of cholesterol.
Bempedoic acid inhibits ATP-citrate lyase (ACL), an enzyme that is two steps upstream of HMG-CoA reductase (the statin target) in the liver's cholesterol biosynthesis pathway. Bempedoic acid is a prodrug activated by the enzyme ACSVL1, which is present in the liver but not in skeletal muscle — which is why it causes far fewer muscle-related side effects than statins.
Ezetimibe inhibits the NPC1L1 (Niemann-Pick C1-Like 1) transporter in the small intestine, blocking the absorption of dietary and biliary cholesterol. The liver, receiving less cholesterol from both production and absorption, compensates by pulling more LDL from the bloodstream. Together, the two mechanisms reduce LDL by approximately 35-38% compared to placebo. Nexlizet also reduces hsCRP (a marker of inflammation) by 22-35%.
180 mg / 10 mg — tablet
One tablet once daily; this is the only available dose. Swallow whole with or without food.
As of 2026, Nexlizet is not listed on the FDA Drug Shortage Database and is generally available in the US supply chain. However, it is a brand-name-only medication with no generic equivalent, which means it is not stocked at every retail pharmacy. Patients may find it readily available at large chain pharmacies (CVS, Walgreens, Costco, Walmart) and hospital outpatient pharmacies, but less reliably at smaller independent pharmacies.
Insurance prior authorization is a common access barrier — many plans require documentation of statin intolerance or step therapy before approving Nexlizet coverage. Cost can also be a barrier at full retail ($430-$595/month), though the Esperion copay card ($10/fill) and GoodRx (~$231/month) significantly reduce patient out-of-pocket expenses.
To find Nexlizet in stock near you without spending hours calling pharmacies, medfinder calls pharmacies on your behalf and texts you results with which ones can fill your prescription.
Nexlizet is not a controlled substance and has no DEA scheduling requirements. Any licensed healthcare provider with prescribing authority can prescribe Nexlizet, including:
Cardiologists — the most common prescribers, particularly for patients with ASCVD or HeFH
Primary Care Physicians (PCPs) and Internists
Endocrinologists (for patients with HeFH or metabolic disorders)
Nurse Practitioners (NPs) and Physician Assistants (PAs)
Because Nexlizet is not a controlled substance, it can also be prescribed via telehealth in all 50 states. Platforms such as Teladoc, MDLive, and others can evaluate patients and prescribe Nexlizet through virtual visits. This is particularly useful for patients in rural areas or those needing prescription renewals without an in-person appointment.
No. Nexlizet is NOT a controlled substance and has no DEA schedule. It is a standard prescription medication that can be prescribed by any licensed healthcare provider — including physicians, nurse practitioners, and physician assistants — without DEA registration or special prescribing authority.
Because it is not controlled, Nexlizet can also be prescribed via telehealth in all 50 states, and refills can be transmitted electronically without the in-person visit requirements associated with controlled substances. Prescriptions can typically be written for 90-day supplies through mail-order pharmacies.
The most commonly reported adverse reactions include:
Urinary tract infection (5.9%)
Nasopharyngitis / cold-like symptoms (4.7%)
Constipation (4.7%)
Muscle spasms (3.6%)
Back pain and pain in extremities
Anemia (decreased red blood cell counts)
Elevated liver enzymes
Diarrhea and abdominal pain
Hyperuricemia/Gout: Elevated uric acid in 26% of treated patients (vs 9.5% placebo); clinically significant gout in 3.5%. Can begin within 4 weeks.
Tendon rupture: Rare but serious (0.5-1.2% in trials). Risk higher in patients >60 years, on corticosteroids/fluoroquinolones, or with renal failure. Discontinue immediately if tendon snap or pop occurs.
Severe allergic reactions: Anaphylaxis, angioedema, urticaria — seek emergency care immediately.
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Nexletol (bempedoic acid)
Contains only the bempedoic acid component of Nexlizet (same 180 mg dose), without ezetimibe. Lowers LDL ~17-21%. Brand-name only, similar price.
Ezetimibe (generic Zetia)
The intestinal absorption component of Nexlizet, available as a widely stocked generic. Lowers LDL 15-20%. Very affordable at $10-30/month.
Repatha (evolocumab)
PCSK9 inhibitor injection every 2 or 4 weeks; lowers LDL 45-60%. Superior efficacy but injectable, expensive, and requires robust prior authorization.
Praluent (alirocumab)
PCSK9 inhibitor injection biweekly or monthly; lowers LDL 45-60%. Similar to Repatha in efficacy and access profile.
Leqvio (inclisiran)
siRNA-based PCSK9 inhibitor; twice-yearly injection after initial doses. 50% LDL reduction; excellent adherence profile but injectable and limited formulary coverage.
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Simvastatin (>20 mg/day)
majorBempedoic acid inhibits OAT2 transport, raising simvastatin plasma levels and increasing myopathy risk. Avoid simvastatin doses exceeding 20 mg/day with Nexlizet.
Pravastatin (>40 mg/day)
majorSame mechanism as simvastatin interaction. Avoid pravastatin doses exceeding 40 mg/day with Nexlizet.
Cyclosporine
moderateCo-administration increases both cyclosporine and ezetimibe blood levels. Monitor cyclosporine concentrations closely, especially in patients with renal insufficiency.
Fibrates (non-fenofibrate)
moderateIncreased risk of cholelithiasis (gallstones). Coadministration with fibrates other than fenofibrate is not recommended.
Bile acid sequestrants (cholestyramine, colestipol)
moderateReduces ezetimibe absorption by up to 55%. Take Nexlizet at least 2 hours before or 4 hours after bile acid sequestrants.
Grapefruit juice (with concurrent statin)
minorGrapefruit does not interact directly with Nexlizet, but significantly raises levels of co-administered CYP3A4-metabolized statins. Avoid grapefruit with atorvastatin or simvastatin.
Nexlizet represents a significant advance in non-statin cholesterol management. As the first fixed-dose non-statin combination approved in the US, it offers patients who can't tolerate statins a meaningful, evidence-based option for LDL reduction (35-38%) and cardiovascular risk reduction. The 2024 FDA label expansion further broadened its eligibility to both primary and secondary prevention patients, with or without statin use.
Patients should be aware of the key monitoring needs — uric acid levels, signs of gout, and any tendon symptoms — and should always inform their doctor of all medications they take, particularly simvastatin (dose limit: 20 mg/day) and pravastatin (dose limit: 40 mg/day). Cost management through the Esperion copay card or GoodRx can make Nexlizet significantly more affordable for eligible patients.
If you're having trouble finding Nexlizet at a pharmacy near you, medfinder calls pharmacies in your area and texts you which ones can fill your prescription — saving you hours of calling.
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Our medication guides are researched and written to help patients make informed decisions. All content is reviewed for accuracy and updated regularly. Learn more about our standards
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