#2

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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#3

So that would seem to imply splitting Bempedoic Acid is a no go.

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#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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#5

Rather than splitting, take the 180 BA every other day? Have been considering doing that.

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#6

If you knew the effect at the full dose for them.

#7

Bempedoic acid has a linear dose-response relationship from 120 mg to 240 mg.

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#8

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.

#9

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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#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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#11

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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#12

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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#13

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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#14

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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Exploring Strategies for Prostate Health and Cancer Prevention
#15

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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#16

Interesting synergetic impact. Was unaware about that.

#17

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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#18

What does this mean? I take ezetimibe with Bempedoic acid.

#19

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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#20

@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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#21

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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