I know that @AnUser mentioned this in another post somewhere, but I just wanted to pull this out and post some more links to the research.
It seems that 2.5mg of Ezetimibe is almost as good as the 10mg pill size. I just purchased some Ezetimibe from India, and the cost is fine (approx. $0.21 per 10mg tablet), but if 2.5mg is almost as effective, why not just use 2.5mg and even further lower any risk of side effects.
Conclusion: From a comparative effectiveness perspective, ezetimibe 2.5 mg, delivered by splitting an ezetimibe/simvastatin10/80 tablet into 4, provides the greatest value and delivers LDL lowering comparable to full dose ezetimibe 10 mg. This novel tablet splitting strategy may be applicable to other medications and provide significant additional cost-reduction.
Source: https://www.ahajournals.org/doi/10.1161/circoutcomes.4.suppl_1.AP62
Bempadoic Acid is a little more expensive per 180mg tablet at about $0.31 per tablet, and it seems a little unclear if you can pill split this tablet. It seems likely you can…
The manufacturer directs to swallow this medication whole. However, many similar drugs (immediate-release tablets) can be split/crushed.
Source: Bempedoic Acid/Ezetimibe - Oral | HealthLink BC
Unlike with Ezetimibe there does not seem to be any efficacy reports / papers of lower doses below 180mg daily dosing.
I will try with the full 180 tablet, and also half that level, and test after both to see what the net effect is. If others can also do that, please report your results.
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Hello, I took 1/2 tablet of Brillo EZ (Bempedoic acid and Ezetimibe) for about 4 months. Did not see any impact. My LDL was already at 50 and APOB was at 68. LDL and APO B almost no change. I added this reduce my APO B further. My cocktail included 2 mgs of Pitavastatin and about 75 mgs of Febofibrate. (Triglycerides came down from 155 to 114 - I attribute this to the fibrate). Cheers
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So that would seem to imply splitting Bempedoic Acid is a no go.
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jjrap1
#4
I’m going to try this strategy w/r/t ezetimibe to eliminate one, ahem, unpleasant personal side effect. Been trying 10mg qod which so far seems ineffective but maybe taking 1/2 or 1/4 qd would be. They are indeed difficult to split into 1/4s but 1/2 is doable.
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Rather than splitting, take the 180 BA every other day? Have been considering doing that.
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AnUser
#6
If you knew the effect at the full dose for them.
AnUser
#7
Bempedoic acid has a linear dose-response relationship from 120 mg to 240 mg.
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Thanks - I was looking for studies on partial doses and didn’t see anything. It seems we could take the approach of pill splitting or pulsed dosing on an every other day, etc. to moderate the dose. I need to check the half-life for Bempadoic Acid.
I don’t think so. Manufacturers never want you to pill split because it costs them revenue. BA is an immediate release medication (not time-released), so there should be no issues with pill splitting.
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AnUser
#10
If it’s linear it doesn’t help to split as you get half of the efficacy at half the dose. Ezetimibe is non-linear.
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It might help if you are concerned about side effects (and there is a dose-related increase in side effect risk), or you don’t need/want the full reduction in LDL.
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Agree. I have started to take half of the pill 180mg BA/ 10mg EZ - will check results in 1-2 moths.
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Might it be possible that you would see little gain by splitting Bempedoic acid and Ezetimibe tablets because your LDL-C and Apo(b) levels were already in the left tail of the distribution?
It would be helpful to see if anyone with elevated levels has tried splitting.
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By the way, ezetimibe seems to have a “mild” side effects profile. I am a bit concerned about an aging prostate and was surprised to see this study comparing ezetimibe vs finasteride in hamsters:
- Ezetimibe reduced enlarged prostates in hamsters, similar to finasteride
- Unlike finasteride, ezetimibe preserved normal glandular architecture
- Prostate enlargement was linked to dietary cholesterol
I am indeed much more concerned about bempedoic acid side effects, as it may raise serum uric acid levels and more…
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Uric acid levels can be treated with an SGLT2I like empagliflozin. I will be starting empagliflozin in a couple weeks.
I have had no problems using Bempedoic Acid over the past several months.
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Interesting synergetic impact. Was unaware about that.
Essentially you just piss out uric acid along with sugar, salt, lithium, etc…
In conclusion, SGLT2 inhibitors induce uric acid excretion, which is strongly linked to urinary glucose excretion and is attenuated during concomitant pharmacologic blockade of urate transporter 1.
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What does this mean? I take ezetimibe with Bempedoic acid.
When they look at prostatic glands of those (hamsters) who were on finasteride, there was significant atrophy (e.g. cells wasting away), whereas with ezetimibe they noted decrease in the overgrowth (hypertrophy) of the prostatic glands, but the architecture remained fairly normal.
So essentially, ezetimibe helps decrease the size of an overgrown prostate, but keeps the cells looking normal, whereas finasteride has a similar effect on decreasing prostate size - but the mechanism is due atrophy of the cells.
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@DrFraser Thank you. Any idea if a man is like a hamster in this manner? I never heard of this effect of ezetimibe before
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