<?xml version="1.0" encoding="UTF-8"?><edgarSubmission xmlns="http://www.sec.gov/edgar/ownership" xmlns:ns2="http://www.sec.gov/edgar/common">
    <headerData>
        <submissionType>144</submissionType>
        <filerInfo>
            <filer>
                <filerCredentials>
                    <cik>0001423898</cik>
                    <ccc>XXXXXXXX</ccc>
                </filerCredentials>
            </filer>
            <liveTestFlag>LIVE</liveTestFlag>



        </filerInfo>
    </headerData>
    <formData>
        <issuerInfo>
            <issuerCik>0001157601</issuerCik>
            <issuerName>MADRIGAL PHARMACEUTICALS INC</issuerName>
            <secFileNumber>001-33277</secFileNumber>
            <issuerAddress>
                <ns2:street1>Four Tower Bridge 200 Barr Harbor Drive</ns2:street1>
                <ns2:street2>Suite 200</ns2:street2>
                <ns2:city>West Conshohocken</ns2:city>
                <ns2:stateOrCountry>PA</ns2:stateOrCountry>
                <ns2:zipCode>19428</ns2:zipCode>
            </issuerAddress>
            <issuerContactPhone>267-824-2827</issuerContactPhone>
            <nameOfPersonForWhoseAccountTheSecuritiesAreToBeSold>REBECCA A TAUB</nameOfPersonForWhoseAccountTheSecuritiesAreToBeSold>
            <relationshipsToIssuer>
                <relationshipToIssuer>Officer</relationshipToIssuer>
            </relationshipsToIssuer>
        </issuerInfo>
        <securitiesInformation>
            <securitiesClassTitle>Common</securitiesClassTitle>
            <brokerOrMarketmakerDetails>
                <name>Morgan Stanley Smith Barney LLC Executive Financial Services</name>
                <address>
                    <ns2:street1>1 New York Plaza</ns2:street1>
                    <ns2:street2>8th Floor</ns2:street2>
                    <ns2:city>New York</ns2:city>
                    <ns2:stateOrCountry>NY</ns2:stateOrCountry>
                    <ns2:zipCode>10004</ns2:zipCode>
                </address>
            </brokerOrMarketmakerDetails>
            <noOfUnitsSold>76564</noOfUnitsSold>
            <aggregateMarketValue>18719898.00</aggregateMarketValue>
            <noOfUnitsOutstanding>19897425</noOfUnitsOutstanding>
            <approxSaleDate>04/03/2024</approxSaleDate>
            <securitiesExchangeName>NASDAQ</securitiesExchangeName>
        </securitiesInformation>
        <securitiesToBeSold>
            <securitiesClassTitle>Common</securitiesClassTitle>
            <acquiredDate>04/03/2024</acquiredDate>
            <natureOfAcquisitionTransaction>Exercise of Stock Options</natureOfAcquisitionTransaction>
            <nameOfPersonfromWhomAcquired>Issuer</nameOfPersonfromWhomAcquired>
            <isGiftTransaction>N</isGiftTransaction>
            <amountOfSecuritiesAcquired>76564</amountOfSecuritiesAcquired>
            <paymentDate>04/03/2024</paymentDate>
            <natureOfPayment>Cash</natureOfPayment>
        </securitiesToBeSold>
        <nothingToReportFlagOnSecuritiesSoldInPast3Months>Y</nothingToReportFlagOnSecuritiesSoldInPast3Months>
        <remarks>The reported sales occur automatically pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on 11/17/2023.
</remarks>
        <noticeSignature>
            <noticeDate>04/03/2024</noticeDate>
            <planAdoptionDates>
                <planAdoptionDate>11/17/2023</planAdoptionDate>
            </planAdoptionDates>
            <signature>/s/ Rebecca A Taub</signature>
        </noticeSignature>
    </formData>
</edgarSubmission>
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144
0001423898
XXXXXXXX
LIVE
0001157601
MADRIGAL PHARMACEUTICALS INC
001-33277
Four Tower Bridge 200 Barr Harbor Drive
Suite 200
West Conshohocken
PA
19428
267-824-2827
REBECCA A TAUB
Officer
Common
Morgan Stanley Smith Barney LLC Executive Financial Services
1 New York Plaza
8th Floor
New York
NY
10004
76564
18719898.00
19897425
04/03/2024
NASDAQ
Common
04/03/2024
Exercise of Stock Options
Issuer
N
76564
04/03/2024
Cash
Y
The reported sales occur automatically pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on 11/17/2023.
04/03/2024
11/17/2023
/s/ Rebecca A Taub