Nexletol vs. Repatha for High Cholesterol: Important Differences and Potential Risks.

Nexletol

(bempedoic acid)

Repatha

(evolocumab)

Summary for Nexletol

Prescription only

Nexletol (bempedoic acid) is used treat high cholesterol in adults. This includes people with heterozygous familial hypercholesterolemia (HeFH). It can also help lower the risk of serious problems, like heart attack and stroke, in adults at risk for heart disease who aren't taking statins. Nexletol (bempedoic acid) works as an ATP-citrate lyase (ACL) inhibitor to lower cholesterol. The medication comes as a tablet that's taken by mouth once a day. Side effects can include high uric acid levels and muscle spasms.

Indications for Nexletol

High cholesterol in adults
Heterozygous familial hypercholesterolemia (HeFH) in adults
Lowers the risk of heart-related death, heart attack, stroke, and the need for procedures to improve blood flow to the heart in adults at risk for heart disease who aren't taking a statin

Pros and Cons for Nexletol

Pros

Taken by mouth once per day
An option for people who can't take statins
Can take by itself or with other cholesterol medications

Cons

Only available as a tablet that can't be crushed
Can raise uric acid levels, which can be a cause of gout
Not approved for children

Common Side Effects for Nexletol

High uric acid levels (16%)
Kidney problems (11%)
Anemia (low red blood cell count; 5%)
Higher liver enzyme levels (4%)
Muscle spasms (4%)

Warnings for Nexletol

High uric acid levels
Tendon rupture or injury

Summary for Repatha

Prescription only

Repatha (evolocumab) is a PCSK9 inhibitor that's given as an injection under the skin. It treats high cholesterol in adults and certain children. It works best with a heart-healthy diet and regular exercise. Repatha (evolocumab) also helps lower the risk of events like heart-related death, heart attack, and stroke in adults at risk. The medication is injected either once every 2 weeks or once a month. Side effects can include common cold symptoms and discomfort at the injection site.

Indications for Repatha

High cholesterol in adults
Heterozygous familial hypercholesterolemia (HeFH) in people ages 10 years and older
Homozygous familial hypercholesterolemia (HoFH) in people ages 10 years and older
Lowering the risk of heart-related death, heart attack, stroke, hospitalization for chest pain, and the need for heart procedures in adults at risk

Pros and Cons for Repatha

Pros

Taken once every 2 weeks or once a month
Can use for inherited cholesterol conditions in kids 10 years and up
Has different injection devices to choose from (prefilled syringe, autoinjector, or on-body infusor)

Cons

Must give as an injection under the skin
Might cause reactions at the injection site like redness and pain
Caution use in people with a latex allergy for syringes and autoinjectors (some have parts made with natural rubber)