Repatha Side Effects You Need To Know, Plus How It Compares to Statins for Lowering Cholesterol
Doctors reveal how to tell which option may be best for you
Key Takeaways
- Repatha lowers LDL cholesterol more than statins, but isn't the best first choice for everyone.
- Repatha is less likely to cause muscle aches, higher blood sugar and elevated liver enzymes.
- Doctors often prescribe Repatha alongside a statin when cholesterol remains too high.
You’ve been managing your cholesterol the best you can, but during your last check-up, you received the same message: Your “bad” LDL cholesterol was still too high. So your doctor recommended Repatha, an injectable medication to help lower your levels. But what exactly is Repatha, and what are the side effects you need to watch for? Plus how does it compare to statins? We asked two top cardiologists.
What is Repatha?
“Repatha is a prescription medicine that lowers LDL cholesterol, the ‘bad’ cholesterol that builds up in your arteries and raises your risk of heart attack and stroke,” explains Kardie Tobb, DO, MS, FASPC, FACC, a board‑certified preventive cardiologist and the medical director for the Cone Health HeartCare Women’s Heart Health and Cardio-Obstetrics Clinic. “Instead of a pill, it’s given as a shot under the skin, usually once every two weeks or once a month. Many people learn to give it to themselves at home, similar to how someone with diabetes might give themselves insulin.”
Dr. Tobb explains that Repatha is a type of drug called a PCSK9 inhibitor. Outside of Repatha (evolocumab), she says the other two main options are Praluent (alirocumab) and Leqvio (inclisiran).
Woman's World Answers
If you’ve only heard of Repatha, you may be wondering why it’s so popular for reducing cholesterol. “It has the longest track record of any of these drugs,” explains Dr. Tobb. “A major study called FOURIER, now with over eight years of follow-up, showed it lowers the risk of heart attack and stroke, and that its safety record has stayed steady over time.”
She adds that although Repatha and Praluent both lower LDL cholesterol by 50 to 65 percent, Repatha was one of the first PCSK9 inhibitors approved in 2015, giving healthcare providers more experience with this treatment option and making it more familiar to insurance companies.
How does Repatha lower cholesterol?
If you’ve been trying several lifestyle changes to lower your LDL cholesterol with no results, you may be wondering how Repatha could help. Dr. Tobb offers a helpful analogy.
“Your liver has ‘receptors,’” explains Dr. Tobb. “Think of them like tiny docking stations that grab LDL cholesterol out of your bloodstream and clear it away. A protein called PCSK9 normally destroys these docking stations, which limits how much cholesterol your liver can remove. Repatha works by attaching to PCSK9 and blocking it. With PCSK9 out of the way, your liver keeps more of these docking stations available, so it can pull more LDL cholesterol out of your blood. That’s why Repatha can lower LDL cholesterol so dramatically.”
Repatha side effects to watch for
Compared to statins, “There are typically fewer side effects, and in particular, we see far less body-wide muscle pain and weakness (though some researchers believe the pain associated with statins may be overreported) [with Repatha],” says Rajesh Banker, MD, a double board-certified cardiologist and cardiac electrophysiologist in practice in southern California since 2010.
However, Repatha is not without side effects. Dr. Banker says the most common Repatha side effects include:
- Injection site reactions such as pain, redness, swelling or bruising
- Back pain
- Mild joint stiffness
- A sore throat
- Nasal congestion or a runny nose
How does that compare to statins? Dr. Tobb explains that statins are more commonly associated with:
- Muscle aches
- Elevated liver enzymes
- Higher blood sugar
Repatha vs. statins: Which better lowers cholesterol?
“Statins are the pills most people think of first for high cholesterol, and how much they lower LDL depends on the dose,” explains Dr. Tobb. “A typical dose lowers LDL by about 30 to 40 percent; the highest doses can lower it by around 45 to 55 percent.”
“Repatha, on its own, typically lowers LDL by 55 to 70 percent,” she adds. “If you add it on top of a statin you’re already taking, it can lower your LDL by another 55 to 65 percent from wherever the statin left it. So, gram for gram, Repatha is the stronger of the two at lowering cholesterol numbers.”
Before you send your doctor a telehealth message asking about Repatha, Dr. Tobb shares that even though Repatha is “stronger,” that doesn’t necessarily make it better than statins for everyone.
“Statins are still recommended first for most people because they’ve been used safely for decades, they come as a pill instead of a shot and they’re far less expensive,” says Dr. Tobb. “Repatha usually comes into the picture when a statin alone, even at the highest dose someone can tolerate, isn’t bringing cholesterol down enough, especially in people who already have heart disease.”
Should you consider Repatha?
Dr. Tobb says Repatha is a good option for those who:
- Have familial hypercholesterolemia (a genetic condition that causes very high cholesterol)
- Have already had a cardiac event such as a stroke, heart attack or stent placement and still have cholesterol that’s too high
- Have tried more than one type of statin and still can’t tolerate them
- Feel comfortable giving themselves an injection or have someone who can help
She adds that Repatha may not be a good fit for those who:
- Have low heart disease risk and mildly high cholesterol that can be managed with lifestyle changes or a statin alone
- Haven’t given statins a fair try yet, such as trying another dose, a different statin or taking one every other day
- Aren’t able to give themselves an injection or don’t have help
Dr. Banker and Dr. Tobb both say that clinicians often prescribe Repatha alongside a statin for the right patients. “I rarely use Repatha in place of a statin. I usually add it on top of one, after a statin at the highest dose someone can handle (sometimes with another pill called ezetimibe) still isn’t getting cholesterol low enough, especially for someone who already has heart disease or is at very high risk,” explains Dr. Tobb.
The bottom line on lowering your cholesterol
Living with high cholesterol can feel overwhelming, especially if you’re already concerned about reducing your risk of heart trouble. But whether you and a healthcare professional decide on statins, Repatha or a combination of both, the good news is you have options to protect your heart.
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