Nustendi (Ezetimibe, Bempedoic Acid)

Ezetimibe, the active ingredient in Nustendi, is a lipid‑lowering agent presented as a tablet for oral use. It reduces cholesterol absorption and is used in adults with primary hypercholesterolaemia, often in combination with other therapies. GNH USA supplies Nustendi as a licensed, GDP‑compliant international pharmaceutical supplier serving hospitals and pharmacies worldwide.

Nustendi combines two lipid‑modifying agents that act on cholesterol metabolism pathways. It is indicated for: - Primary hypercholesterolaemia: helps lower LDL‑cholesterol when diet and statins alone are insufficient. - Heterozygous familial hypercholesterolaemia (HeFH): provides additional LDL‑cholesterol reduction in genetically predisposed patients. - Statin‑intolerant patients: offers an alternative LDL‑cholesterol‑lowering option for those who cannot tolerate adequate statin doses.

Side‑effect profiles reflect the actions of both components.

Common Side Effects: - Gastrointestinal discomfort: mild abdominal pain or dyspepsia. - Elevated liver enzymes: transient increases in ALT/AST. - Muscle pain: mild myalgia without weakness. - Headache: occasional tension‑type headache. - Fatigue: general tiredness reported by some patients.

Serious or Rare Side Effects: - Rhabdomyolysis: severe muscle breakdown, especially with concurrent statins. - Acute liver injury: marked elevation of transaminases with jaundice. - Severe hypersensitivity: rash, angio‑edema or anaphylaxis. - Kidney impairment: acute renal failure in rare cases. - Hyperuricaemia: gout flares in predisposed individuals.

When prescribing Nustendi, clinicians should consider several safety aspects. - Liver function monitoring: check ALT/AST before initiation and periodically thereafter. - Statin co‑administration: assess risk of myopathy and adjust statin dose if needed. - Renal function: evaluate baseline creatinine in patients with chronic kidney disease. - Pregnancy and lactation: avoid use unless the potential benefit outweighs risk. - Drug interactions: review concomitant medications for CYP‑related effects. - Store at below 25°C: keep in the original container, protect from moisture and direct sunlight.

Nustendi may interact with several medicines that share metabolic pathways or affect muscle tissue.

Major Interactions (Avoid): - Strong CYP3A4 inducers (e.g., rifampicin, carbamazepine) may reduce bempedoic‑acid exposure. - High‑intensity statins (atorvastatin >40 mg) increase risk of rhabdomyolysis. - Cyclosporine: may raise ezetimibe concentrations.

Moderate Interactions (Monitor Closely): - Fibrates (gemfibrozil, fenofibrate) – additive risk of myopathy. - Warfarin – potential alteration of INR values. - Niacin – may increase flushing and liver enzyme changes.