Nustendi (Ezetimibe, Bempedoic Acid)

Ezetimibe, the active ingredient in Nustendi, is a combination lipid‑lowering agent presented as a tablet for oral use. It helps lower elevated cholesterol levels in adults with primary hyperlipidemia, particularly when diet and statin therapy alone are insufficient. GNH USA supplies Nustendi as a licensed, GDP‑compliant international pharmaceutical supplier serving hospitals, pharmacies and clinics worldwide.

GNH USA supplies Nustendi as a licensed, GDP‑compliant international pharmaceutical supplier serving hospitals, pharmacies and clinics worldwide.

Nustendi is a combination lipid‑lowering agent that acts on cholesterol metabolism pathways. It is indicated for: - Primary hyperlipidemia: reduces low‑density lipoprotein cholesterol (LDL‑C) when added to statin therapy. - Heterozygous familial hypercholesterolemia (HeFH): helps achieve LDL‑C targets in patients who are statin‑intolerant or need additional lowering. - Secondary prevention of cardiovascular events: used as part of a regimen to lower LDL‑C after myocardial infarction or stroke. - Statin‑intolerant patients: provides an alternative mechanism to lower cholesterol when statins cannot be used. - Patients with mixed dyslipidemia: lowers non‑HDL‑C and triglycerides in addition to LDL‑C.

Nustendi may cause a range of adverse reactions. Monitoring and reporting are recommended.

Common Side Effects: - Headache: mild to moderate intensity. - Upper respiratory tract infection: symptoms such as sore throat or nasal congestion. - Diarrhea: loose stools that are usually self‑limiting. - Muscle pain (myalgia): occasional discomfort without severe weakness. - Elevated liver enzymes: mild increases in ALT/AST. - Abdominal discomfort: mild pain or cramping.

Serious or Rare Side Effects: - Rhabdomyolysis: severe muscle breakdown, often with marked CK elevation. - Acute liver injury: significant rise in liver enzymes with jaundice. - Severe hypersensitivity: rash, angioedema or anaphylaxis. - Tendon rupture: rare but serious musculoskeletal event. - Kidney injury: acute renal impairment in susceptible individuals. - Hyperuricemia: elevated uric acid levels leading to gout flares.

Before prescribing Nustendi, clinicians should consider several safety aspects.

- Liver function monitoring: assess baseline ALT/AST and repeat periodically. - Renal function assessment: evaluate eGFR in patients with chronic kidney disease. - Pregnancy and lactation: avoid use unless benefits outweigh risks. - Concomitant statin therapy: monitor for muscle‑related symptoms. - Drug interactions: review patient’s medication list for potential interactions. - Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

Nustendi can interact with several medicines, requiring attention to dosing and monitoring.

Major Interactions (Avoid): - Strong CYP3A4 inhibitors (e.g., itraconazole, clarithromycin): may increase bempedoic‑acid levels. - Cyclosporine: raises ezetimibe concentrations, increasing risk of liver enzyme elevation. - High‑intensity statins (e.g., rosuvastatin >20 mg): heightened risk of myopathy.

Moderate Interactions (Monitor Closely): - Bile‑acid sequestrants (e.g., cholestyramine): may reduce ezetimibe absorption.\n- Fibrates (gemfibrozil, fenofibrate): increase risk of muscle toxicity when combined with statins. - Anticoagulants (warfarin): may require INR monitoring adjustments. - Niacin (nicotinic acid): additive effect on liver enzymes. - Antidiabetic ​