• Keep this leaflet. You may need to read it again.
• If you have any further questions, ask your doctor or pharmacist.
• This medicine has been prescribed for you only. Do not pass it on to others. It may harm them, even if their signs of illness are the same as yours.
• If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. See section 4.

1. What Nustendi is and what it is used for
2. What you need to know before you take Nustendi
3. How to take Nustendi
4. Possible side effects
5. How to store Nustendi
6. Contents of the pack and other information

Nustendi is a medicine that lowers levels of ‘bad’ cholesterol (also called “LDL-cholesterol”), a type of fat, in the blood. Nustendi also can help reduce cardiovascular risk through lowering the levels of bad cholesterol.

Nustendi contains two active substances, which reduce your cholesterol in two ways:

• bempedoic acid decreases the production of cholesterol in the liver and increases the removal of LDL-cholesterol from the blood;
• ezetimibe works in your bowel by reducing the amount of cholesterol absorbed from food.

• Adults with primary hypercholesterolaemia or mixed dyslipidaemia, which are conditions that cause a high cholesterol level in the blood. It is given in addition to a cholesterol-lowering diet.
• Adults with high cholesterol levels in their blood who already have cardiovascular disease or have other conditions that put them at a higher risk of cardiovascular events.

Nustendi is given:

• if you have been using a statin (such as simvastatin, a commonly used medicine that treats high cholesterol) together with ezetimibe and this does not lower your LDL-cholesterol sufficiently;
• if you have been using ezetimibe and this does not lower your LDL-cholesterol sufficiently;
• to replace bempedoic acid and ezetimibe if you have been using these medicines as separate tablets.

• if you are allergic to bempedoic acid, ezetimibe or any of the other ingredients of this medicine (listed in section 6);
• if you are pregnant;
• if you are breast-feeding;
• if you take more than 40 mg of simvastatin daily (another medicine used to lower cholesterol);
• with a statin if you currently have liver problems.
• Nustendi contains ezetimibe. When Nustendi is given together with a statin, you should also read the information relating to ezetimibe in the Package leaflet of that specific statin.

Talk to your doctor or pharmacist before taking Nustendi:

• if you ever had gout;
• if you have severe kidney problems;
• if you have moderate or severe liver problems. Nustendi is not recommended in this case.

Your doctor should do a blood test before you start taking Nustendi with a statin. This is to check how well your liver is working.

Do not give Nustendi to children and adolescents under 18 years of age. The use of Nustendi has not been studied in this age group.

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. In particular, tell your doctor if you are taking medicine(s) with any of the following active substances:

• atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin (used to lower cholesterol and known as statins).
  The risk of muscle disease may increase when taking both a statin and Nustendi. Tell your doctor immediately about any unexplained muscle pain, tenderness or weakness.
• bosentan (used to manage a condition called pulmonary artery hypertension).
• fimasartan (used to treat high blood pressure and heart failure).
• asunaprevir, glecaprevir, grazoprevir, voxilaprevir (used to treat hepatitis C).
• fenofibrate (also used to lower cholesterol).
  No information is available on the effects of using Nustendi with cholesterol-lowering medicines called fibrates.
• ciclosporin (often used in organ transplant patients).
• colestyramine (also used to lower cholesterol), because it affects the way ezetimibe works.
• medicines to prevent blood clots, such as warfarin as well as acenocoumarol, fluindione, and phenprocoumon.

Do not take this medicine if you are pregnant, trying to get pregnant, or think you may be pregnant, as there is a possibility that it could harm an unborn baby. If you get pregnant while taking this medicine, call your doctor immediately and stop taking Nustendi.

• Pregnancy
  Before starting treatment, you should confirm you are not pregnant and are using effective contraception, as advised by your doctor. If you use contraceptive pills and suffer from an episode of diarrhoea or vomiting that lasts more than 2 days, you must use an alternative method of contraception (e.g. condoms, diaphragm) for 7 days following resolution of symptoms.
  If, after you have started treatment with Nustendi, you decide that you would like to become pregnant, tell your doctor, as your treatment will need to be changed.
• Breast-feeding
  Do not take Nustendi if you are breast-feeding because it is not known if Nustendi passes into milk.

Nustendi has minor influence on the ability to drive and use machines.

However, some people may get dizzy after taking Nustendi. Avoid driving or using machines if you think your ability to react is reduced.

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicine.

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

Contact your doctor or pharmacist immediately.

If you notice that you forgot:

• a dose late in a day, take the missed dose and take the next dose at your regular time the next day.
• the previous day’s dose, take your tablet at the regular time and do not make up for the forgotten dose.

Do not stop taking Nustendi without your doctor’s permission as your cholesterol may rise again.

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via

United Kingdom (Great Britain and Northern Ireland)

or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects, you can help provide more information on the safety of this medicine.

• The active substances are bempedoic acid and ezetimibe. Each film-coated tablet contains 180 mg of bempedoic acid and 10 mg of ezetimibe.
• The other ingredients are:
  • lactose monohydrate (see end of section 2 under ‘Nustendi contains lactose and sodium’)
  • microcrystalline cellulose (E460)
  • sodium starch glycolate (Type A grade) (see end of section 2 under ‘Nustendi contains lactose and sodium’)
  • hydroxypropyl cellulose (E463)
  • magnesium stearate (E470b)
  • silica, colloidal anhydrous (E551)
  • sodium laurilsulfate (E487) (see end of section 2 under ‘Nustendi contains lactose and sodium’)
  • povidone (K30) (E1201)
  • partially hydrolysed poly(vinyl alcohol) (E1203), talc (E553b), titanium dioxide (E171), Indigo Carmine Aluminium Lake (E132), glycerol monocaprylocaprate, Brilliant Blue FCF Aluminium Lake (E133)

Film-coated tablets are blue, oval, debossed with “818” on one side and “ESP” on the other side. Tablet dimensions: 15 mm × 7 mm × 5 mm.

The following pack sizes are registered: 10, 14, 28, 30, 84, 90, 98, or 100 film-coated tablets or unit dose blisters in cartons of 10 x 1, 50 x 1, or 100 x 1 film-coated tablets.

Not all pack sizes may be marketed.

United Kingdom (Great Britain)