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Apr 13, 2023



Nexletol vs Statins: Which is better at lowering cholesterol?

What is Nexletol?

On February 21, 2020, a drug called Nexletol was approved by the FDA (Food and Drug Administration) as a non-statin cholesterol lowering agent. The drug is approved as an adjunct therapy along with diet or other cholesterol medications like a statin.

In clinical trials Nexleton has shown to lower LDL-C levels by between 18-28% when taken alone and up to 38% when taken in combination with a statin.

For treating high-cholesterol, statins are still considered the first-line therapy. In general, statinas lower LDL-C levels by 30-50% and by up to 60% when used in combination with other medications such as ezetimibe.

Nexletol is generally recommended for patients who cannot tolerate or are not responding well to statin therapy. It may also be used in combination with other cholesterol-lowering medications for patients who require additional LDL-C lowering.

Nexletol vs statins: How do they work?

While both medications are effective at lowering cholesterol levels, they work by targeting different steps in the cholesterol-making process.

The process of making cholesterol in the body involves several steps, and enzymes are involved in each step. Cholesterol synthesis starts with a molecule called acetyl-CoA, which gets converted into another molecule called HMG-CoA, and then into mevalonate, which finally becomes cholesterol.

Statins vs Nexletol

Nexletol blocks an enzyme called ATP-citrate lyase (ACL) that is involved in the early stages of cholesterol synthesis. ACL helps convert a molecule called citrate to acetyl-CoA, which is the starting molecule in the cholesterol-making process. By blocking ACL, Nexletol interrupts the earlier stage to reduce choesterol production.

Statins, on the other hand, work by blocking an enzyme called HMG-CoA reductase that is involved in a later stage of cholesterol synthesis. This enzyme helps convert acetyl-CoA into HMG-CoA, which is a critical step in the cholesterol-making process. By blocking this step, statins help reduce the amount of cholesterol produced in the liver.

Nexletol vs Statins: Which is better at lowering cholesterol?

Studies have shown that statins are generally more effective than Nexletol at lowering cholesterol.

Statins are the first-line cholesterol therapy since they have been extensively studied and proved to be effective and safe. Statins lower LDL-C levels by up to 50%. In addition to lowering LDL-C, they have also been shown to have other beneficial effects on heart health, such as reducing inflammation and stabilizing plaques in the arteries.

Nexletol, on the other hand, is a newer medication that has been shown to lower LDL-C levels by around 18-30%. While this is still a significant reduction, it is not as much as what is typically achieved with statins. Nexletol has been approved as an adjunct therapy in conjunction with diet or other cholesterol medications such as a statin or ezetimibe to lower LDL-C.

If you are taking Nexletol along with a statin, note that Nexletol can be taken any time of the day, even at the same time as your statin medication.

Despite that, some statins may interact with Nexiletol. If you start taking Nexletol while taking simvastatin or pravastatin, your physician may reduce your statin dose. It's recommended that you use caution while using Nexletol with simvastatin dosages larger than 20 mg or pravastatin doses greater than 40 mg. This can raise the amount of statins level and aggravate or induce myopathy.

Nexletol may be a good option for people who cannot tolerate statins or who have not achieved their target LDL-C levels with statin therapy alone. It may also be used in combination with a statin for people who need additional LDL-C lowering.

Doses and administration


Nexletol is approved for use in individuals as young as 18 years old and is available as a 180 mg tablet that can be taken by mouth (swallowed whole, not crushed or chewed), once daily, with or without a meal.

Keep in mind that although this medication may start working right away. You may start to see your LDL-C levels decrease after 4 weeks, however, you might not get the full benefits of this medication for up to 12 weeks after starting treatment.

Nexletol should be taken exactly as prescribed by your doctor. If you're unsure about how to take this medication, ask your doctor or pharmacist for advice.


Although Nexletol is safe and effective for many individuals, it does cause some negative effects, including the following:

Side effects

Nexletol: common side effects

  • Anemia (decreased levels of red blood cells)
  • Increased levels of liver enzymes
  • Muscle spasms
  • Back, shoulder, leg, and/or arm pain and/or joint pain
  • Abdominal pain or back pain
  • Cold-like symptoms, including sore throat, stuffy nose, and/or sneezing
  • Respiratory infections, including the common cold or flu-like symptoms, such as runny or stuffy nose, and sneezing.

Nexletol: serious side effects

  • A ruptured or torn tendon

    Tendons are strong tissue strands that attach muscles to bones. Your arm, shoulder, and back of the ankle tendons, among others, might experience discomfort, swelling, rupture, and inflammation as a result of tendon complications.

    You are more likely to experience tendon issues while using while taking this medication if:

    • You’re taking antibiotics or steroids, including corticosteroids
    • You’re 60 years or older
    • You have experienced tendon issues in the past
    • You have developed renal failure

  • Increased levels of uric acid in your blood (hyperuricemia). Gout may result from high blood uric acid levels.

    This might occur 4 weeks after you start taking Nexletol and could persist all the way through your therapy. While you're on Nexletol, your doctor may check the levels of uric acid in your blood.

    Signs of high levels of uric acid include includes significant pain, redness, and/or tenderness in your joints

  • Allergic reaction (symptoms may include skin rash, itching, or swelling that may occur under your skin, such as your lips, hands, feet, tongue, mouth, and/or throat, and difficulty breathing).

If you’re experiencing any of the serious side effects listed above, immediately call your doctor or 911 if it's an emergency, and stop taking this medication.

Statins: common side effects

  • Myopathy (muscle weakness, stiffness, spasms)
  • Myalgias (muscle pain and/or soreness)
  • Arthralgia (joint pain and/or aches)
  • Cognitive impairment
  • Headache
  • Cold-like symptoms, including sore throat, stuffy nose, and/or sneezing
  • Insomnia
  • Nausea
  • Heartburn
  • Abdominal pain
  • Indigestion
  • Constipation
  • Weakness

Certain patients find that consuming more vitamin D helps them stop experiencing muscle soreness or pain. For some, it's common to experiment with doses and switch statin medications until you discover the most appropriate statin that works best.

However, do not abruptly discontinue taking your statin medication if you believe you are experiencing any negative side effects. Consult your doctor to determine whether a dose adjustment or switching to a different drug could be beneficial in your case.

Statins: serious side effects

  • Difficulty raising your arms and/or difficulty rising or standing
  • Muscle aches in your hips, shoulders, neck, and back

    Taking large doses of statins can lead to the breakdown of your muscle cells and the release of myoglobin into your blood. Kidney damage and excruciating muscle pain or soreness may result from this.

  • Hepatic (liver) issues, such as upper abdominal pain, weakness, fatigue, decreased appetite, dark urine, and jaundice (yellowing of the skin or eyes).
  • High blood sugar or type 2 diabetes, especially if you already have high blood sugar levels.
  • Kidney issues, such as little to no urination, ankle or foot swelling, fatigue, or shortness of breath.
  • Confusion and/or memory problems

    After taking statins, some patients have experienced memory loss and cognitive issues. However, several studies have not found any indication that statins are directly to blame for these issues. Statins may be able to help avoid these problems, according to other research.

If you’re experiencing any of the serious side effects listed above, immediately call your doctor and stop taking this medication.


Some individuals taking statins may experience blood in their urine, also called hematuria, or protein in their urine commonly referred to as proteinuria.

Speak With Your Doctor

Both Nexletol and statins are considered safe and effective when taken appropriately (as prescribed by your doctor). Talk to your doctor today about using Nexletol and statins and send your prescription to Marley Drug. Save up to 95% compared to your local pharmacy by using Marley Drug.

Marley Drug provides free nationwide shipping, allowing you to receive your medication at no additional cost straight to your door.

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