Evolocumab (Repatha): What You Need to Know

Evolocumab, sold as Repatha, is a PCSK9 inhibitor that can drop LDL cholesterol by roughly half. That makes it a useful option when statins alone don't get your LDL low enough or when you can't tolerate statins. This guide gives plain, practical facts so you know how it works, how to use it, and what to watch for.

How Repatha works and who should take it

Evolocumab blocks a protein called PCSK9. That lets your liver recycle LDL receptors, which pull more LDL cholesterol out of the blood. Doctors prescribe it for people with atherosclerotic cardiovascular disease (like prior heart attack or stroke) or familial hypercholesterolemia, and for some who can’t reach LDL goals on other meds.

It’s not a first-line drug for most people. You’ll usually see it added when statins and lifestyle changes aren’t enough, or if side effects prevent statin use. Your doctor will weigh heart risk, LDL numbers, and other meds before recommending it.

Practical dosing, injections, and monitoring

Repatha comes as a prefilled syringe or auto-injector. Common dosing options: 140 mg every two weeks, or 420 mg once monthly. There’s also an on-body injector option for the 420 mg dose. You inject under the skin (subcutaneous) into the thigh, abdomen, or upper arm.

Before starting, get a baseline lipid panel. Repeat it about 4–8 weeks after beginning treatment or after a dose change to see how much your LDL dropped. Keep an eye on liver enzymes if your doctor suggests it, though routine liver checks aren’t always required with this drug.

Storage tips: keep Repatha refrigerated. Unused pens can usually stay at room temperature for up to 30 days—check the label. Let a refrigerated pen warm at room temperature for 30–40 minutes before injection to reduce discomfort. Don’t freeze it.

Common side effects include injection-site reactions, flu-like symptoms, back pain, and nasopharyngitis. Serious side effects are rare but can happen. If you notice severe allergic reactions or sudden symptoms, get medical help right away.

Cost and access are real issues. Repatha is expensive without insurance. Many patients need prior authorization. Check for manufacturer savings programs and talk to your clinic’s financial team about assistance options.

Tips for injections: pick a comfortable spot, rotate injection sites, and throw used needles into a sharps container. If you’re nervous, practice with a demo pen or have a nurse show you once.

Final practical note: Repatha lowers LDL a lot, but it’s only one part of heart risk reduction. Keep working on diet, exercise, blood pressure, and smoking cessation. Talk with your clinician about whether Repatha fits into your overall plan and how you’ll track progress.