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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If you look at the article … the urologists think this is a pretty good model for humans. Anyway, if there is a reason to be on ezetimibe, potentially, it might also stop the prostate from being hypertrophied.
Might be a good thing to include in the lipid management for men as they get 45+ years old … note to self.
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Would be interesting to know if ezetimibe provided a similar protection from prostate cancer. If yes, that would be a potent combination to avoid it altogether.
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The thought by this group was probably so on the cancer. They had a follow up article - including pictures of the prostate cells treated with ezetimibe (Zetia) vs. Finasteride in Figure 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4051281/
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Thank you for follow-up, @DrFraser
Although we were not the first to use this hamster strain in preclinical experiments on BPH, the last published studies using this model in this context were reported in the early 1980s106. Our results suggest that ezetimibe might be effective as an alternative to standard medical BPH therapy and, further, that dysregulation of cholesterol metabolism may be an important, and neglected, component of disease etiology113. These results also strongly suggest that the original findings described above with polyene macrolides, published over 30 years ago, were likely correct and that reducing intestinal cholesterol absorption is a viable approach to controlling LUTS in men. Our preclinical data provide support for prospective studies on ezetimibe in men as a novel approach to treating BPH.
Interesting findings/hypotheses. I am still a bit concerned about the possible side effects of finasteride. Therefore, it is good to know that there is some likelihood that a medication with a “low-risk profile”, such as ezetimibe, could have this beneficial secondary effect 
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I have been taking ezetimibe for 1.5 years with no benefit to BPH so far. It can’t be a huge effect. Or “everybody is different”… again. (Or a man is not a hampster). I’ll keep taking ezetimibe for the apoB benefits and hope for more.
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I guess the issue is … for a condition that is generally progressive … if just staying the same, that is a win … if getting worse despite being on ezetimibe … then I’d agree would be a fail.
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Ezetimibe may be a good secondary treatment when combined with alpha blockers and 5ar inhibitors.
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What about start it earlier as part of lipid treatment before there is disease and hope nothing becomes symptomatic. I have older men come in several times per month in urinary retention from their prostates - having to leave with a catheter in place. I’d rather avoid that situation myself … and a preventive drug (which this might be) that has another reason I could be on it … might not be a bad choice.
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