11 Nexlizet Side Effects and How to Manage Them

If you can’t take a statin, or if your statin doesn’t meet your cholesterol treatment goals, your prescriber may recommend Nexlizet. It’s a combination pill that contains bempedoic acid (Nexletol) and ezetimibe (Zetia). It’s also used to lower the risk of heart attack in certain adults.

Nexlizet can be an effective option, but side effects are possible. So it’s a good idea to familiarize yourself with possible Nexlizet side effects and steps to take if they happen to you.

Nexlizet side effects at a glance

Below is a summary of side effects that people taking Nexlizet reported during clinical trials. This list doesn’t include all possible Nexlizet side effects. Tell your prescriber if you think you might be experiencing side effects, even if your symptoms aren’t listed below.

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Common Nexlizet side effects (reported by at least 2% of people) include:

• High uric acid levels

• Kidney problems

• Muscle spasms

• Back pain

• Abdominal pain

• Upper respiratory tract infection (URTI), including the common cold

• Bronchitis

• Abnormal liver tests

• Pain in the arms or legs

• Joint pain

• Diarrhea

• Constipation

• Low red blood cells

• Gout

• Gallstones

• Urinary tract infection

Less common Nexlizet side effects include:

• Tendon rupture

• Elevated creatine kinase (an indicator of muscle damage)

Let’s review 11 Nexlizet side effects in more detail below.

1. High uric acid levels

Nexlizet can raise uric acid levels in your blood. This is because bempedoic acid blocks a transporter in the kidneys that removes uric acid from the blood. Your uric acid levels may rise within 4 weeks of starting Nexlizet. And they may continue to rise throughout treatment.

High uric acid levels can lead to a painful condition of the joints called gout. Symptoms of high uric acid levels or gout include:

• Tender or painful joints

• Joint redness

• Swelling

• Joints that feel warm to the touch

• Severe foot pain, especially in the big toe

If left untreated, gout can lead to permanent damage in your joints. Your prescriber will check your uric acid levels regularly through blood tests while you’re taking Nexlizet. But make sure to tell them if you experience any symptoms listed above.

If your uric acid levels are too high, your prescriber may recommend treatment to lower them. Or they may switch you to a different cholesterol-lowering medication.

2. Muscle spasms

During clinical trials, some people taking Nexlizet reported muscle spasms, which can be painful. But it’s important to note that trial participants were also taking statins, which can cause muscle-related side effects.

For some people, muscle spasms may go away over time. But if they’re happening often, tell your prescriber. They may recommend gently stretching or massaging the muscle or applying heat to relax it. Make sure to drink plenty of water to stay hydrated and maintain a balanced diet to prevent muscle spasms.

Tell your prescriber right away about any worsening muscle pain or weakness. This is especially the case if you’re taking a statin. It could be a sign of serious muscle damage.

3. Back pain

Back pain is another potential Nexlizet side effect. But it’s important to note that, like muscle spasms, back pain is also possible while taking statins.

Using hot or cold compresses may help relieve back pain. There are also many over-the-counter (OTC) pain relievers if they’re safe for you to take. Call your prescriber if your back pain is persistent, is severe, or isn’t getting better with home care.

4. Upper respiratory tract infection

People taking Nexlizet during clinical trials reported URTIs during treatment. Examples of URTIs include sinus infections and the common cold. Signs you might be coming down with a URTI can include sinus pressure, a sore throat, and a runny nose.

Home remedies are the cornerstone of URTI treatment. Plenty of rest, fluids, and OTC medications (if needed) should get you through. But if your symptoms become more severe or aren’t going away, contact your prescriber for further guidance.

5. Diarrhea

You may experience diarrhea while taking Nexilet. It should get better with time, but try to avoid foods that can worsen diarrhea in the meantime. Hydration is also important since you’re losing fluids. Your healthcare team may recommend taking an OTC antidiarrheal to relieve your symptoms.

Because there are many causes of diarrhea, be sure to contact your primary care provider if it is severe or not getting better. They’ll want to evaluate you to determine if it’s a side effect of Nexilet.

6. Joint pain

Joint pain has been reported by people taking Nexlizet. But it’s possible that it could be from a statin, since that can also cause joint pain. Arthritis is another potential cause.

Similar to muscle spasms, joint pain may get better with time. But tell your prescriber about it so they can watch to see if it gets better. They may suggest taking an OTC pain reliever for relief. They may also consider adjusting your medication regimen.

7. Tendon rupture

Less commonly, Nexlizet may increase the risk of tendon rupture or injury. This has been linked to bempedoic acid. It can happen within weeks to months of starting the medication. Certain factors that may increase the risk of tendon rupture, including:

• Age over 60 years old

• Taking Nexlizet with certain antibiotics, such as fluoroquinolones, or steroids

• History of tendon problems

• Kidney problems

Symptoms to watch for include pain and swelling in the tendon. This may be most likely to happen in your shoulder or upper arm or on the back of your ankle.

If you hear a popping sound in a tendon area, have any bruising, or aren’t able to put weight on or move the area, call your care team right away. These are signs of a tendon rupture. Avoid exercising or moving the affected area until they’re able to see you.

8. Elevated liver enzymes

People taking Nexlizet have developed elevated liver enzymes, which can be a sign of liver inflammation or damage. Most of the time, you won’t have noticeable symptoms if this happens. And liver enzyme tests usually go back to normal as you continue taking the medication.

Still, your prescriber may check your liver health through blood tests while you’re taking Nexlizet. In some cases, they may have you stop taking it if your liver enzymes get too high.

9. Kidney problems

Kidney problems are also listed as a potential Nexlizet side effect. This has been linked to the bempedoic component.

Tell your prescriber if you have a history of kidney problems. They’ll want to monitor your kidney labs closely. Tell them right away if you notice any signs of kidney damage. These may include not peeing as much, feeling more tired than usual, or having swollen ankles or feet.

10. Anemia

Anemia, or low red blood cell counts, is another reported side effect of Nexlizet. This doesn’t happen to everyone, and your prescriber can watch out for it through blood tests. They’ll monitor the amount of red blood cells and hemoglobin — a protein on red blood cells that carries oxygen.

Contact your prescriber if you notice any symptoms of anemia, including:

• Weakness

• Feeling tired

• Shortness of breath

• Racing heart

• Pale skin

• Chest pain

• Dizziness

11. Pain in the arms or legs

Some people taking Nexlizet have reported experiencing pain in their arms and/or legs during clinical trials. This could be related to muscle pain, which is commonly caused by cholesterol medications.

Tell your prescriber if you notice muscle pain, especially if you’re also taking a statin. These symptoms may go away on their own. But they can sometimes be dangerous and cause kidney problems.

How to save on Nexlizet

There are ways to save on Nexlizet, which is available as a brand-name medication. GoodRx can help you navigate between GoodRx coupons and copay savings cards to save money on your prescription.

• Save with GoodRx: Anyone with a valid prescription, regardless of insurance status, can use GoodRx to purchase a 30-day supply of Nexlizet at an exclusive cash price of $231.

• Save with a copay savings card: If you have commercial insurance, you may be eligible to pay as little as $10 per month for Nexlizet using a savings card from the manufacturer.

Why trust our experts?

Written by:

Kristianne Hannemann, PharmD

Kristianne Hannemann, PharmD, is a licensed pharmacist in California. She has been a retail pharmacy manager and staff pharmacist for over 7 years and has contributed drug information content to different health companies.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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