Nexletol is a brand-name oral tablet prescribed for lowering high cholesterol to help treat certain conditions. Nexletol contains the active ingredient bempedoic acid.

The Food and Drug Administration (FDA) has approved Nexletol to:

  • Decrease low-density lipoprotein (LDL) when used along with a low cholesterol diet, in certain adults. (LDL cholesterol is commonly known as “bad” cholesterol.) For this purpose, Nexletol may be taken with another cholesterol-lowering drug or alone.
  • Reduce the risk of heart attack or need for certain medical procedures in some adults who can’t take or aren’t taking a statin.

For more information about these conditions, see the “Nexletol uses” section.

Drug details

You’ll find key information about Nexletol here:

  • Drug class: adenosine triphosphate-citrate lyase (ACL) inhibitor
  • Drug form: oral tablet
  • Generic available? no
  • Prescription required? yes
  • Controlled substance? no

Nexletol is available only as a brand-name medication. It’s not currently available in generic form.

A generic drug contains the same active ingredient as in the brand-name version. Generics usually cost less than brand-name drugs.

Nexletol can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Nexletol. These lists do not include all possible side effects.

For more information about the possible side effects of Nexletol, talk with your doctor or pharmacist. They can give you tips on how to deal with any side effects that may be bothersome.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medications safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while taking Nexletol and want to tell the FDA about it, visit MedWatch.

Mild side effects

Mild side effects of Nexletol can include:

This is a partial list of mild side effects from Nexletol. To learn about other mild side effects, talk with your doctor or pharmacist, or view Nexletol’s prescribing information.

For more information about respiratory infections, see the “Side effect details” section.

If these side effects become bothersome or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Nexletol aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects can include:

For more information on allergic reaction and ruptured tendon, see the next section.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause.

Allergic reaction

As with most drugs, some people can have an allergic reaction after taking Nexletol. However, it isn’t known how often this side effect may have occurred with Nexletol in clinical trials.

Symptoms of a mild allergic reaction can include:

A more severe allergic reaction is rare but possible. Symptoms of a severe allergic reaction can include:

  • swelling under your skin, typically in your eyelids, lips, hands, or feet
  • swelling of your tongue, mouth, or throat
  • difficulty breathing

Call your doctor right away if you have an allergic reaction to Nexletol, as the reaction could become severe. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Ruptured tendon

A ruptured (torn) tendon can occur while taking Nexletol. Tendons are thick bands of tissue that connect muscles to bones.

In clinical trials, the bicep tendon, rotator cuff (shoulder), and Achilles tendon were most commonly affected. However, a rupture could occur in any tendon.

A ruptured tendon is more likely to happen within the first few weeks or months after starting Nexletol treatment. Your risk of a ruptured tendon while taking Nexletol may be higher if you:

Symptoms of a ruptured tendon can include pain, swelling, or bruising of the affected joint. You may also feel or hear your tendon pop.

If you have any of these symptoms while taking Nexletol, tell your doctor right away. They’ll likely have you stop taking the drug until they can determine whether you have a ruptured tendon. If you do have a ruptured tendon, they’ll probably change your treatment to a drug other than Nexletol.

Respiratory infections

Nexletol may cause upper respiratory infections, such as the common cold, and bronchitis (a chest cold). There were reports of these types of respiratory infections in clinical trials of the drug.

Some symptoms of an upper respiratory infection and bronchitis are similar. These can include:

Bronchitis can also cause wheezing, difficulty breathing, and a buildup of mucus in your airways.

If you experience any of these symptoms while taking Nexletol, talk with your doctor. They can suggest ways to treat respiratory infections.

As with all medications, the cost of Nexletol can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Nexletol, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide whether the drug will be covered.

If you’re not sure whether you’ll need to get prior authorization for Nexletol, contact your insurance company.

Drug coupons

You can visit Optum Perks for price estimates of Nexletol. These estimates are based on the use of Optum Perks coupons. Note: Optum Perks coupons cannot be used with insurance copays or benefits.

Financial and insurance assistance

If you need financial support to pay for Nexletol, or if you need help understanding your insurance coverage, help is available.

Esperion Therapeutics Inc., the manufacturer of Nexletol, offers a co-pay card that may help lower the cost of the drug for you. For more information and to find out if you’re eligible for support, call 855-699-8814 or visit the Nexletol website.

Mail-order pharmacies

Nexletol may be available through a mail-order pharmacy. Using this service may help lower the drug’s cost and allow you to get your medication without leaving home.

If recommended by your doctor, you may be able to receive a 90-day supply of Nexletol, so there’s less concern about running out of the medication. If you’re interested in this option, check with your doctor and your insurance company. Some Medicare plans may help cover the cost of mail-order medications.

If you don’t have insurance, you can ask your doctor or pharmacist about online pharmacy options.

Generic version

Nexletol isn’t available in a generic form. A generic drug contains the same active ingredient as in the brand-name version. Generics tend to cost less than brand-name drugs.

Optum Perks is owned by RVO Health. By clicking on this link, we may receive a commission. Learn more.

The Food and Drug Administration (FDA) approves prescription drugs such as Nexletol to treat certain conditions.

Nexletol for lowering LDL cholesterol

Nexletol is FDA approved to help decrease low-density lipoprotein (LDL). (LDL cholesterol is commonly known as “bad” cholesterol.)

Specifically, Nexletol is approved for this use in adults with primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH). Primary hyperlipidemia refers to high cholesterol that results from certain genetic (inherited) conditions.

Nexletol is meant to be used along with a low cholesterol diet. Your doctor may also recommend taking Nexletol with another cholesterol-lowering medication, such as a statin. If your body does not tolerate such medications, they may have you take Nexletol on its own.

About cholesterol

Cholesterol is a fatty substance that occurs naturally in your body. It’s made in your liver but can also be found in foods such as meat, cheese, and eggs. Cholesterol helps your body perform important functions, such as making hormones and vitamins.

However, having more cholesterol than your body needs can lead to serious problems, such as heart disease. High cholesterol can be caused by a lack of exercise and eating too many high-cholesterol foods. It can also be caused by your genes. HeFH is an example of a genetic condition that causes high cholesterol.

To determine whether you have high cholesterol, your doctor will give you a blood test called a lipid panel. High cholesterol doesn’t usually cause any symptoms unless you’ve developed atherosclerosis, a type of heart disease. Atherosclerosis is a narrowing of the arteries. Its symptoms may include fatigue, difficulty breathing, and pain in your chest, arms, or legs.

Nexletol is specifically approved to help decrease a type of cholesterol called LDL. This kind of cholesterol can build up in the arteries and cause them to narrow and harden. When this happens, it can lead to angina (chest pain), decreased blood flow to the heart, or a heart attack or stroke.

Effectiveness for lowering LDL cholesterol

In clinical trials, Nexletol has been found effective in helping lower LDL cholesterol in adults. For more information about these trials, refer to the Nexletol prescribing information.

Nexletol for lowering the risk of heart attack or need for certain medical procedures

Nexletol is FDA approved to help reduce the risk of heart attack or need for medical procedures that restore blood flow to the heart. Examples of such procedures include coronary artery bypass surgery and stent placement.

For this use, Nexletol is approved for adults who can’t take or haven’t taken a statin (a type of cholesterol-lowering drug) and either:

  • have cardiovascular disease or
  • have a high risk of a cardiovascular event, such as a heart attack or stroke, but don’t have cardiovascular disease

Nexletol works by lowering LDL cholesterol, which can build up in the arteries. This buildup can lead to a heart attack or stroke, or decrease blood flow to the heart. By lowering LDL levels, Nexletol helps to prevent such events from occurring. (For more information about cholesterol, see the “About cholesterol” section.)

Effectiveness for lowering the risk of heart attack or need for certain medical procedures

In clinical trials, Nexletol was found to be effective in lowering the risk of heart attack or the need for medical procedures that improve blood flow to the heart. For details about these trials, see the Nexletol prescribing information.

Nexletol and children

Nexletol isn’t approved for use in children. It’s not known whether the drug is safe or effective for children.

Here are answers to some frequently asked questions about Nexletol.

What is the mechanism of action of Nexletol?

A mechanism of action is how a drug acts to cause an effect in the body. Nexletol works by lowering the amount of cholesterol that your body makes. To be specific, Nexletol blocks the action of an enzyme called adenosine triphosphate-citrate lyase (ACL). An enzyme is a protein that helps speed up chemical processes in your body.

For more information, see the “How Nexletol works” section.

Will Nexletol cure my high cholesterol?

No, Nexletol won’t cure high levels of low density lipoprotein (LDL). LDL cholesterol is commonly known as “bad” cholesterol. There isn’t a known cure for a high level of LDL cholesterol.

But Nexletol has been found effective in decreasing LDL cholesterol. For this purpose, the medication is taken along with a low cholesterol diet and possibly another cholesterol-lowering drug. Nexletol works by decreasing the amount of cholesterol your liver makes.

Nexletol should keep working to help decrease your LDL cholesterol as long as you take it. However, once you stop taking the drug, your liver may increase the amount of cholesterol that it makes. This can cause your levels of LDL cholesterol to increase again.

If you have questions about how Nexletol works to lower your LDL cholesterol, see the “How Nexletol works” section. You can also talk with your doctor.

Note that Nexletol is also approved to lower the risk of heart attack or need for certain medical procedures in some adults. For more information, see the “Nexletol uses” section.

Is Nexletol a statin?

No, Nexletol isn’t a statin drug. Nexletol belongs to a class of drugs called adenosine triphosphate-citrate lyase (ACL) inhibitors. A class of drugs is a group of medications that work in a similar way.

Both statins and ACL inhibitors work to prevent your liver from making new cholesterol. Statins do this by blocking the action of an enzyme called HMG-CoA reductase. (An enzyme is a protein that helps speed up chemical processes in your body.) ACL inhibitors work to block the action of the ACL enzyme.

Your doctor may prescribe Nexletol along with a statin drug, depending on the condition you’re taking Nexletol for. To learn more, see “Does Nexletol have to be used with a statin?” next. You can also talk with your doctor if you have questions about the differences between Nexletol and statin drugs.

Does Nexletol have to be used with a statin?

It depends on the condition you’re taking Nexletol for. It’s possible that you’ll use Nexletol with a statin drug.

Nexletol is approved to help decrease low-density lipoprotein (LDL). LDL cholesterol is commonly known as “bad” cholesterol. The drug is used along with a low cholesterol diet and may be taken with a cholesterol-lowering drug, such as a statin. Examples of statins include atorvastatin (Lipitor) and simvastatin (Zocor).

However, some people may have bothersome side effects from statins that keep them from being able to take these drugs. People who have these side effects may use Nexletol with other drugs that lower LDL cholesterol, such as ezetimibe (Zetia). Or they may take Nexletol on its own. For more information, see the “Alternatives to Nexletol” and “Nexletol use with other treatments” sections.

Nexletol is also approved to lower the risk of heart attack or need for certain medical procedures in some adults who can’t take or haven’t taken a statin. In this case, you may take Nexletol on its own or with another drug such as atorvastatin (Lipitor) or rosuvastatin (Crestor).

If you have other questions about taking Nexletol with statin drugs, talk with your doctor.

Could Nexletol affect my kidneys or liver?

Nexletol can affect your liver, but it isn’t known to affect your kidneys.

In clinical trials, Nexletol was shown to increase levels of liver enzymes. High levels of liver enzymes can be a sign that your liver isn’t working correctly. However, the results of these studies didn’t show any negative effects of Nexletol on the kidneys.

If you have questions about how Nexletol may affect your kidneys or liver, talk with your doctor.

The Food and Drug Administration (FDA) has approved Nexletol to:

LDL cholesterol is commonly known as “bad” cholesterol. This kind of cholesterol can build up in the arteries and cause them to narrow and harden. When this happens, it can lead to angina (chest pain), decreased blood flow to the heart, or a heart attack or stroke.

For more information, see the “Nexletol uses” section.

What Nexletol does

Nexletol works by lowering the amount of cholesterol that your body makes. To be specific, Nexletol blocks the action of an enzyme called adenosine triphosphate-citrate lyase (ACL). An enzyme is a protein that helps speed up chemical processes in your body.

The ACL enzyme helps your liver make LDL cholesterol. By blocking the action of this enzyme, Nexletol decreases your levels of LDL cholesterol. This in turn can help reduce the risk of heart attack or need for medical procedures that restore blood flow to the heart.

How long does it take to work?

Nexletol starts working right away to lower your LDL cholesterol. You won’t be able to feel Nexletol decreasing your cholesterol. However, your doctor will check your cholesterol levels about 8 weeks after you start treatment. If your cholesterol levels haven’t started to improve, they may recommend a different treatment for you.

The following information describes the dosage that is commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Nexletol comes as an oral tablet. It’s available in a strength of 180 milligrams (mg).

Typical dosage

Nexletol is approved to help decrease LDL cholesterol in certain adults. It’s also approved to reduce the risk of heart attack or need for certain medical procedures in some adults.

The recommended dosage for these uses is 180 mg once per day. The drug can be taken with or without food.

Dosage questions

Here are answers to some questions you may have about taking Nexletol.

What if I miss a dose?

If you miss a dose of Nexletol, take your missed dose as soon as you remember. However, if it’s almost time for your next dose, just skip your missed dose. You can start taking your next dose on your regular schedule.

Do not take extra doses to make up for your missed dose. Doing that can increase your risk of side effects from Nexletol. (For more information, see the “Nexletol side effects” section.)

If you’re not sure whether to take or skip a missed dose, ask your doctor or pharmacist.

To help make sure you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app.

Will I need to use this drug long term?

Nexletol is meant to be used as a long-term treatment. If you and your doctor determine that Nexletol is safe and effective for you, you’ll likely take it long term.

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Nexletol, talk with your doctor. They can tell you about other medications that may work well for you.

Note: Some of the drugs listed here are used off-label to treat these specific conditions. Off-label drug use is when a drug is used for a purpose other than what the Food and Drug Administration (FDA) has approved it for.

Alternatives for lowering LDL cholesterol

The FDA has approved the use of Nexletol to help decrease low-density lipoprotein (LDL) in certain adults. (For more about this use of Nexletol, see the “Nexletol uses” section.)

Examples of other drugs that may be used to help decrease LDL cholesterol include:

Alternatives for reducing the risk of heart attack or need for certain medical procedures

The FDA has approved Nexletol to reduce the risk of heart attack or need for medical procedures that restore blood flow to the heart in certain adults. (For more about this use of Nexletol, see the “Nexletol uses” section.)

Examples of other drugs that may be used for this purpose include:

  • statin drugs, such as:
    • atorvastatin (Lipitor)
    • rosuvastatin (Crestor)
    • simvastatin (Zocor)
  • PCSK9 inhibitors, such as:
    • alirocumab (Praluent)
    • evolocumab (Repatha)
  • bempedoic acid/ezetimibe (Nexlizet)

You may wonder whether Nexletol and Repatha are similar.

While their uses vary, both medications are approved to help decrease low-density lipoprotein (LDL) and treat high cholesterol in certain people. However, they belong to different drug classes.

Nexletol belongs to a class of drugs called adenosine triphosphate-citrate lyase inhibitors. It works by preventing your liver from making new cholesterol.

Repatha is a PCSK9 inhibitor. It helps your body remove cholesterol more effectively.

Nexletol comes as oral tablets, while Repatha comes as a solution that’s given by subcutaneous injection.

If you’d like additional information about these two drugs and help determining whether one might be right for you, talk with your doctor.

Like Nexletol, statin drugs can be used to treat high cholesterol and lower the risk of heart problems in certain people.

However, Nexletol isn’t a statin. Instead, it belongs to a class of drugs called adenosine triphosphate-citrate lyase inhibitors.

Both types of drugs work by preventing your liver from making new cholesterol.

Depending on the condition your doctor prescribes Nexletol for, they may have you take Nexletol in combination with a statin drug. To learn more about this, see “Does Nexletol have to be used with a statin?” in the “Common questions about Nexletol” section. Also, see the “Nexletol use with other treatments” section next.

Examples of statins include:

Talk with your doctor if you have questions about how Nexletol compares with statin drugs.

Nexletol is approved to:

For more information, see the “Nexletol uses” section.

Depending on the condition your taking Nexletol for, you may use the drug with other treatments.

Low-cholesterol diet

Cholesterol is made in your liver but can also be found in such foods as meat, cheese, and eggs. Eating too many high-cholesterol foods can cause high cholesterol.

Along with taking Nexletol, your doctor will likely recommend that you eat a diet low in cholesterol. This type of diet may help reduce the levels of cholesterol in your body and lower your risk of heart disease.

For more information on a recommended diet while taking Nexletol, talk with your doctor.

Statins

Nexletol may be used with a statin drug. Statins are another group of drugs used to treat high cholesterol. Examples of statins include atorvastatin (Lipitor) and simvastatin (Zocor).

However, statins may not lower cholesterol enough. Or, a person may have had bothersome side effects from statins that prevent them from using these drugs. If this is your situation, your doctor may prescribe another cholesterol-lowering drug to take with Nexletol. Or they may recommend that you take Nexletol on its own.

Also, Nexletol may interact with some statins. For more information, see the “Nexletol interactions” section.

Other drugs

People who can’t use statins may take Nexletol with other drugs that lower LDL cholesterol, such as ezetimibe (Zetia). Bempedoic acid (the active ingredient in Nexletol) is also available in a combination drug that contains ezetimibe. The brand name for this drug combination is Nexlizet.

The manufacturer of Nexletol does not make a recommendation for other drugs in combination with Nexletol to reduce the risk of heart attack or need for medical procedures that restore blood flow. For this use, your doctor will let you know whether they recommend taking Nexletol alone or with another medication.

If you have questions about taking Nexletol with other drugs, talk with your doctor or pharmacist.

There are no known interactions between Nexletol and alcohol. However, drinking in excess can harm your liver. And Nexletol can increase your levels of liver enzymes, which can be a sign of liver problems. Therefore, if you take Nexletol and have a history of heavy alcohol use, you may have a greater risk of this side effect.

If you drink alcohol, talk with your doctor about the amount that’s safe for you to consume while taking Nexletol. If you have a history of heavy alcohol use or liver problems, be sure to tell your doctor before you start taking Nexletol.

Nexletol can interact with several other medications. It can also interact with certain supplements as well as certain foods.

Different interactions can cause different effects. For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe.

Nexletol and other medications

Here you’ll find examples of medications that can interact with Nexletol. This section doesn’t contain all drugs that may interact with Nexletol.

Before taking Nexletol, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Nexletol and certain statin drugs

Nexletol is sometimes used with statin drugs to help decrease low-density lipoprotein (LDL). (LDL cholesterol is commonly known as “bad” cholesterol.) Statins are another group of drugs used to treat high cholesterol.

Taking Nexletol with certain statin drugs can raise your risk of muscle pain or muscle weakness. (These are possible side effects from statin drugs.) This happens because Nexletol can raise the levels of these statins in your blood.

The specific statin drugs that interact with Nexletol are simvastatin (Zocor) and pravastatin. If you take Nexletol with these statins, your doctor will likely limit your doses of these drugs.

Be sure to tell your doctor about any specific statin drugs you use before you start taking Nexletol.

Certain products that should be used with caution while taking Nexletol

Using certain medications with Nexletol may increase your risk of side effects. Some of these drugs are described here. (To learn about possible side effects, see the “Nexletol side effects” section.)

Nexletol and drugs that raise your risk of a ruptured tendon

A ruptured (torn) tendon is a possible side effect of Nexletol. Your risk of a ruptured tendon during Nexletol treatment may be higher if you’re taking corticosteroids or a group of antibiotics called fluoroquinolones.

Prednisone is an example of a corticosteroid. And ciprofloxacin (Cipro) is an example of a fluoroquinolone antibiotic.

Be sure to tell your doctor if you’re taking any of these drugs before you start Nexletol treatment. And if you’re prescribed these drugs after you’ve started taking Nexletol, be sure your doctor knows that as well. They may suggest alternative treatment options for your conditions.

Nexletol and herbs and supplements

There aren’t any herbs or supplements that have been specifically reported to interact with Nexletol. However, you should still check with your doctor or pharmacist before using any of these products while taking Nexletol.

Nexletol and foods

There aren’t any foods that have been specifically reported to interact with Nexletol, including grapefruit or grapefruit juice.

However, if you take Nexletol with a statin drug, you’ll need to avoid eating grapefruit or drinking grapefruit juice. It isn’t safe to consume them while using statins.

If you have any questions about eating certain foods with Nexletol, talk with your doctor.

You should take Nexletol according to your doctor’s or another healthcare professional’s instructions.

Nexletol comes as an oral tablet, which you take by swallowing.

When to take

You’ll likely take Nexletol once per day. You can take the drug any time of day, but try to take your dose around the same time each day.

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app.

Taking Nexletol with food

You can take Nexletol with or without food.

Can Nexletol be crushed, split, or chewed?

The manufacturer of Nexletol hasn’t stated whether the tablets can be crushed, split, or chewed. If you have difficulty swallowing Nexletol tablets, talk with your doctor or pharmacist. They can discuss different ways to take the medication.

It isn’t known whether Nexletol is safe to use during pregnancy. The drug hasn’t been studied during pregnancy. However, based on the way Nexletol works in the body, it may not be safe to take while pregnant.

If you’re pregnant or planning to become pregnant while taking Nexletol, talk with your doctor. They can discuss the risks and benefits of using the drug during pregnancy.

It’s not known whether Nexletol is safe to take during pregnancy. If you’re sexually active and you or your partner can become pregnant, talk with your doctor. They can offer information about your birth control needs while you’re taking Nexletol.

For more information about taking Nexletol during pregnancy, see the “Nexletol and pregnancy” section.

You should not breastfeed while taking Nexletol. It’s not known whether the drug can pass into breast milk while breastfeeding. If Nexletol does pass into breast milk, the drug could cause serious harm to a child who is breastfed.

If you’re breastfeeding or planning to breastfeed, talk with your doctor about treatment options other than Nexletol.

Before taking Nexletol, discuss your health history with your doctor. Nexletol may not be right for you if you have certain medical conditions or other factors affecting your health. Be sure to talk with your doctor if any of the following apply to you:

Note: For more information about the potential negative effects of Nexletol, see the “Nexletol side effects” section.

Do not use more Nexletol than your doctor recommends. For some drugs, doing so may lead to unwanted side effects or overdose.

What to do in case you take too much Nexletol

If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. But if your symptoms are severe, call 911 or your local emergency number, or go to the nearest emergency room right away.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.