Mechanism of action Bempedoyl-CoA, the active metabolite. Coenzyme A is shown in blue.<unk>  is a prodrug. It is activated to the thioester with coenzyme A by the enzyme SLC27A2 in the liver. The activated substance inhibits ATP citrate lyase, which is involved in the liver's biosynthesis of cholesterol upstream of HMG-CoA reductase, the enzyme that is blocked by statins. The substance also activates AMP-activated protein kinase, but this effect is likely not relevant in humans. Pharmacokinetics ESP15228, the (also) active metabolite Following oral intake,<unk>  reaches highest blood plasma concentrations after 3.5 hours. Food does not affect its absorption. When in the bloodstream, 99.3% of the substance are bound to plasma proteins. About a fifth of the substance is reversibly converted by an aldo-keto reductase enzyme to a metabolite (called ESP15228) that is also pharmacologically active in form of its coenzyme A–thioester. Of ESP15228, 99.2% are bound to plasma proteins. Both<unk>  and the metabolite are inactivated by glucuronidation of their carboxylic acid groups.<unk>  has a biological half-life of 21±11 hours. Over 95% of the substance are excreted in form of metabolites; about 70% with the urine and 30% with the feces.
Bempedoic acid
Domoic acid
Ricin
Delta-Palutoxin
Ioxaglic acid
Deoxygedunin
Proscillaridin
Ajulemic acid