Zypitamag® vs Nexletol®/Nexlezet®
Struggling to reach your LDL-C goal, or struggling with cost?
Lowering LDL C (“bad cholesterol”) is the single most important thing you can do to lower the risk of heart attack and stroke. 1 in 4 cardiovascular deaths is related to long-term high LDL-C exposure, and for people with very high LDL-C, lowering it becomes even more urgent.
The first-line treatment has always been statins. However, many people seek non-statin options like Nexletol® (bempedoic acid) or Nexlizet® (bempedoic acid + ezetimibe) specifically to avoid muscle-related side effects.
While these are effective tools, they come with two major hurdles:
- Cost Barrier: If you are under-insured or non-insured, they cost from $230-$500+ per month. Even with commercial insurance, prior authorization, step therapy, and high deductibles often block access.
- Efficacy Ceiling: If you have high LDL-C, these options may not be enough. Nexletol lowers LDL-C by about 17–23%, and even the combination Nexlizet caps out at around 38% (close to moderate intensity statins). For many, that still leaves them far from their "safe" target.
And if your LDL C is very high (≥190 mg/dL)…
Even if you can access Nexletol/Nexlizet, they may not be enough alone to get you to goal. Many people still need additional LDL-C lowering.
Nexleto vs Statins: How They Work
Both drugs lower cholesterol production in the liver. The difference is where in the process they work.
- Nexletol (ACL Inhibitor): This works at the very beginning of the process. It blocks the ACL enzyme, which is responsible for creating the "raw material" (acetyl-CoA) needed to start cholesterol synthesis.
- Statins (HMG-CoA Reductase Inhibitors): These work one step further down the line. They target the HMG-CoA Reductase enzyme, which takes that raw material and turns it into the "intermediate" building blocks (mevalonate).
The Muscle Factor (The "Prodrug" Difference)
The biggest practical difference is side effects, especially muscle pain (myalgia):
- Bempedoic Acid (Nexletol): It is a "prodrug." It is inactive when you take it and requires a specific liver enzyme to "turn it on." Because this activating enzyme is not found in muscle cells, fewer people report muscle issues.
- Statins: Most statins are active the moment they enter the bloodstream. They can enter muscle cells and interfere with pathways there (like CoQ10 production), which is why some patients experience muscle pain.
What if there is an affordable option that can lower LDL-C by 45% with high tolerability?
Meet Zypitamag® (pitavastatin)
A newer generation statin that many clinicians recommend for people who have struggled with other statins.
Why Zypitamag Is Different
Zypitamag (pitavastatin) is known for being well tolerated, especially for patients who had muscle symptoms on other statins. Clinicians who prescribe it report high tolerability:
It’s a fundamentally different statin. The majority of statin intolerant patients will tolerate Zypitamag.
— Dr. Nate Lebowitz, Clinical Cardiologist & Lipid Specialist
Key Benefits of Zypitamag
- Lowers LDL-C by up to 45%, more effective than Nexlezet
- Available in low-dose, highly potent in 2 mg or 4 mg tablets (side effects are dose-dependent; most statins range from 5–80 mg)
- Gentler on CoQ10: Preserves muscle-protecting CoQ10 levels better than other statins, potentially cutting muscle pain risk.
- Blood sugar friendly: Minimal impact on glucose, ideal for diabetics or pre-diabetics watching A1C
- Fewer drug interactions: Most drugs (even grapefruit juice and CBD products) are processed by the liver's CYP450 pathway. Zypitamag uses a different pathway, making it safer for people on multiple medications.
Compare Zypitamag vs Nexletol vs Nexlizet
| Zypitamag (2–4 mg) | Nexletol (180 mg) | Nexlizet Combo |
|---|---|---|
| Up to 45% LDL-C ↓ | 17–23% LDL-C ↓ | Up to 38% LDL-C ↓ |
| $39 or less at Marley Drug | ~$230–500 w/ coupons | ~$230–500 w/ coupons |
| Muscle pain: 3.1% | Low muscle pain but gout/joint issues | Similar to Nexletol |
What People Say about Zypitamag
Zypitamag has made a world of difference in my health. I have not had any side effects of muscle pain. Thank you, Marley Drug for making the process of getting this medication so fast and easy. I never have any problems or delays in your service. You guys are great!
Anne H.
I have always had trouble with statins. My doctor recommended Marley Drug’s statin, Zypitamag (pitavastatin), and I have been taking that with no side effects and my bad cholesterol has gone down significantly. It is a relief to find a statin drug that gives me no side effects.
Jacquie N.
Why So Many Patients Never Get to Try Zypitamag
If Zypitamag is so effective, why haven’t you heard of it?
- Guideline inertia: Many guidelines and insurers push atorvastatin as the first statin to try, then a second or third statin before considering Zypitamag (pitavastatin).
- Insurance restrictions: Plans often require you to “fail” other statins before they will cover Zypitamag, so many people give up before they ever reach it.
How to Get Zypitamag through Marley Drug
Through our direct partnership with the manufacturer, anyone can get Zypitamag at a transparent price, with no insurance, no prior authorization, and no step therapy.
Bring this information sheet to your next doctor's appointment.
Your doctor can send the prescription to Marley Drug (phone, fax, or e-script. We’re in every system)
We call you to confirm details, and ship it free, usually arrives in 2 business days
Questions?
Call us at 800-810-7790 or email us info@marleydrug.com.