Category: pharmacological
Aliases: Nexletol
Prodrug activated by very-long-chain-acyl-CoA synthetase (ACSVL1) — present only in liver, not skeletal muscle. Active form inhibits ATP-citrate lyase (upstream of HMG-CoA reductase in cholesterol synthesis). Liver-selective activation means no skeletal muscle exposure → no myalgia. CLEAR Outcomes trial 2023 showed MACE reduction as alternative for statin-intolerant patients.
PO: 21h