Gout from Bempedoic Acid: Causes, Risks, and What to Do

When you take bempedoic acid, a cholesterol-lowering drug used for people who can’t tolerate statins. Also known as Nexletol, it helps lower LDL by blocking an enzyme in the liver that makes cholesterol. But here’s the catch: it can also raise uric acid levels in your blood — and that’s where gout, a painful form of arthritis caused by uric acid crystals building up in joints. Also known as metabolic arthritis, it often hits the big toe first comes in. If you’ve started bempedoic acid and suddenly your toe feels like it’s on fire, you’re not imagining it. This isn’t rare — clinical trials showed about 2% of users developed gout, and some cases were severe enough to require stopping the drug.

Why does this happen? Bempedoic acid works by blocking ACLY, an enzyme in the liver. But that same blockage also reduces the body’s ability to clear uric acid. Think of it like a clogged drain: uric acid builds up, forms sharp crystals, and your immune system attacks them — causing swelling, redness, and pain. People with a history of gout, kidney problems, or those already on diuretics are at higher risk. And if you’re taking it for high cholesterol but also have metabolic syndrome, your body’s already struggling to manage uric acid. This isn’t just a side effect — it’s a metabolic ripple effect. You can’t ignore it. Some patients don’t realize their joint pain is drug-related until they stop bempedoic acid and the attacks vanish.

What can you do? First, don’t panic. You don’t have to quit your cholesterol medication unless your doctor says so. Talk to your provider about checking your uric acid levels every 3 months after starting bempedoic acid. If levels creep up, they might add a low-dose colchicine — a drug proven to prevent gout flares without interfering with bempedoic acid. Stay hydrated. Avoid alcohol and sugary drinks. And if you’ve had gout before, your doctor should have already considered this risk before prescribing it. If you’re already on a diuretic or have kidney disease, your risk doubles. That’s why lab monitoring calendars, structured schedules for tracking blood tests to catch side effects early. Also known as medication safety trackers, they’re not just for elderly patients — they’re essential for anyone on drugs that alter metabolism matters so much here.

The good news? Most people on bempedoic acid never get gout. But if you’re one of the ones who does, knowing the link helps you act fast. This isn’t about avoiding treatment — it’s about managing it smarter. Below, you’ll find real-world guides on how other patients handled drug-induced gout, what alternatives exist if bempedoic acid doesn’t work for them, and how to track your own risk before it turns into a hospital visit.