Repatha (Evolocumab) - Subcutaneous

What Is Repatha?

Repatha (evolocumab) is an injectable prescription medication used to lower LDL cholesterol (sometimes called "bad cholesterol")—including high LDL levels caused by heterozygous familial hypercholesterolemia —in adults and children 10 years and older. Repatha belongs to a group of drugs called PCSK9 inhibitors. It works by increasing the amount of LDL cholesterol (LDL-C) your liver removes from your body. Repatha is available as a subcutaneous injection that you administer once or twice per month.

Drug Facts

Generic Name: Evolocumab

Brand Name(s): Repatha

Drug Availability: Prescription

Therapeutic Classification: PCSK9 inhibitor; monoclonal antibody

Available Generically: No

Controlled Substance: No

Administration Route: Subcutaneous

Active Ingredient: Evolocumab

Dosage Form(s): Prefilled syringe; auto-injector; prefilled cartridge for use with on-body infusor

What Is Repatha Used For?

Repatha is used to lower LDL cholesterol (LDL-C), sometimes called "bad cholesterol." The Food and Drug Administration (FDA) has approved Repatha to treat:

High cholesterol affects approximately 12% of adults over age 20 in the United States. High cholesterol doesn't cause any symptoms but can lead to serious long-term problems. Over time, having too much cholesterol in your blood puts you at an increased risk of heart attack and stroke.

In a systematic review (a study that combines data) of 19 studies that included 2,458,456 people with data from 28 countries across four continents (Europe (n=9), North America (n=4), Australia (n=3), Asia (n=2), and Africa (n=1)), it was estimated that heterozygous familial hypercholesterolemia (HeFH) has affected 1 in 250 individuals worldwide (prevalence). This is a higher prevalence that what has been previously noted (1 in 500). Small subpopulations may have a higher incidence of heterozygous familial hypercholesterolemia. For example, Afrikaners from South Africa (1 in 72 to 1 in 100), Ashkenazi Jews from Lithuania (1 in 67), people of French descent in Canada (1 in 270), and Christians from Lebanon (1 in 85) tend to have a higher incidence of HeFH.

Homozygous familial hypercholesterolemia (HoFH) is rarer than HeFH, generally affecting around 1 in 300,000 individuals. That said, like HeFH, the prevalence of HoFH may be higher or lower in different populations.

Medications like Repatha, along with diet and exercise, can help keep your cholesterol levels healthy.

How to Take Repatha

Repatha is a subcutaneous injection that you inject using a needle under your skin. Your healthcare provider may prescribe Repatha to be taken once or twice monthly.

Repatha is available as a prefilled syringe, an auto-injector, and a prefilled cartridge with an infusor attached to your body. Your healthcare provider will teach you how to use your prescribed product.

Follow these tips to ensure you administer your dose safely:

  • Allow Repatha to sit a room temperature for 30–45 minutes before injecting.
  • Repatha should be clear and colorless or slightly yellow. Do not use Repatha if the solution is cloudy, discolored, or contains particles.
  • You may inject Repatha into your thigh, upper arm, or stomach (not within 2 inches of the belly button). Be sure to choose a spot that's not tender, bruised, red, or hardened. Avoid skin with scars or stretch marks.
  • Rotate your injection site each time you administer Repatha.

Storage

Store your Repatha prescription in its original carton in the refrigerator. Do not freeze or shake.

Keep Repatha and all your medicines in a safe location, out of the reach of children and pets.

If you plan to travel with Repatha, get familiar with your final destination's regulations. Note that if you have an infusor attached to your body and are traveling through airports, the U.S. Transportation Security Administration (TSA) may have additional questions and procedures for you. In general, be sure to make a copy of your Repatha prescription. And be prepared to take a bit longer for your travel process through security.

If possible, keep your medication in its original container from your pharmacy with your name on the label. If you have any questions about traveling with your medicine, ask your pharmacist or healthcare provider.

How Long Does Repatha Take to Work?

Repatha lowers cholesterol over time. Your healthcare provider may check your LDL cholesterol levels as early as four weeks after starting Repatha to see how well it is working.

What Are the Side Effects of Repatha?

This is not a complete list of side effects and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

You may experience side effects from Repatha. Be sure to let your healthcare provider know if you develop any side effects that bother you or don't go away.

Common side effects include:

  • Runny nose
  • Sore throat
  • Symptoms of the common cold or flu
  • Back pain
  • High blood sugar levels (diabetes)
  • Injection site reactions, including redness, pain, or bruising

Severe Side Effects

Rarely, Repatha may cause serious side effects. Contact your healthcare provider immediately if you develop any signs of a severe reaction. Call 911 if your symptoms feel life-threatening.

Serious side effects and their symptoms include:

  • Allergic reactions, including a severe form called anaphylaxis. Signs of an allergic reaction include:
  • Trouble breathing or swallowing
  • Hives, rash, or itching
  • Swelling of the face, lips, tongue, or throat

Report Side Effects

Repatha may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much Repatha Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form:
    • For primary hyperlipidemia:
      • Adults and children 10 years of age and older—140 milligrams (mg) injected under your skin every 2 weeks, or 420 mg injected under your skin once a month.
      • Children younger than 10 years of age—Use and dose must be determined by your doctor.
    • For homozygous familial hypercholesterolemia:
      • Adults and children 10 years of age and older—420 milligrams (mg) injected under your skin once a month. Your doctor may adjust your dose as needed.
      • Children younger than 10 years of age—Use and dose must be determined by your doctor.
    • To reduce the risk of heart attack, stroke, and heart surgery:
      • Adults—140 milligrams (mg) injected under your skin every 2 weeks, or 420 mg injected under your skin once a month.
      • Children—Use and dose must be determined by your doctor.

Modifications

The following modifications (changes) should be kept in mind when using Repatha:

Pregnancy: We don't know enough about the safety and effectiveness of Repatha in pregnant people and their unborn fetuses. Let your healthcare provider know if you are or plan to become pregnant, and discuss the benefits and risks of taking Repatha during your pregnancy.

Breastfeeding: We don't know enough about the safety of Repatha in human breastmilk and nursing babies. Talk with your healthcare provider if you plan to breastfeed, and discuss the benefits and risks of taking Repatha while nursing and the different ways to feed your baby.

Adults over 65: Results from clinical trials did not show any difference in the safety or effectiveness of Repatha in adults over 65 compared with younger adults.

Children: The safety and effectiveness of using Repatha in children under age 10 have not been established.

Missed Dose

If you forget to take your dose of Repatha and it is within seven days of your missed dose, administer Repatha and resume your regular dosing schedule.

If it's been more than seven days since your missed dose and you take Repatha every two weeks, take your next dose at the normally scheduled time.

If it's been more than seven days since your missed dose and you take Repatha once a month, administer Repatha and start a new monthly schedule from that date.

Try to find ways to help yourself remember to take your medications routinely. If you miss too many doses, Repatha might be less effective at lowering your cholesterol.

Overdose: What Happens If I Take Too Much Repatha?

There is limited information available about a Repatha overdose.

If you think that you're experiencing an overdose or life-threatening symptoms, however, seek immediate medical attention.

What Happens If I Overdose on Repatha?

If you think you or someone else may have overdosed on Repatha, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Repatha, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly to lower your cholesterol level and to decide if you should continue to use it. Blood tests may be needed to check for unwanted effects.

Serious allergic reactions, including angioedema may occur while you are using this medicine. Tell your doctor right away if you have a rash, itching skin, difficulty with breathing or swallowing, hives, large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs, nausea, reddening of the skin, especially around the ears, swelling of the eyes, face, or inside of the nose, or unusual tiredness or weakness.

The needle cover of the prefilled syringe or autoinjector contains dry natural rubber (a derivative of latex), which may cause allergic reactions in people who are sensitive to latex. The single use Pushtronex® system is not made with natural rubber latex. Tell your doctor if you have a latex allergy before you start using this medicine.

What Are Reasons I Shouldn’t Take Repatha?

Do not take Repatha if you are allergic to evolocumab or any other ingredient in Repatha. Ask your pharmacist or healthcare provider for a full list of the ingredients if you're unsure.

What Other Medications Interact With Repatha?

Use caution when taking Repatha with the following medications:

  • Vyvgart (efgartigimod alfa)

Other medications may interact with Repatha. Be sure to inform your healthcare provider and pharmacist about all the medicines you take, including over-the-counter, nonprescription products, vitamins, and herbal medicines.

What Medications Are Similar?

Repatha is a monoclonal PCSK9 inhibitor used to lower cholesterol. Other monoclonal PCSK9 inhibitors include:

  • Praluent (alirocumab)

The effectiveness of Repatha and Praluent are similar; however, Praluent may cause more injection site reactions. Praluent is only approved to treat adults, while Repatha can be used in children 10 years and older. You and your healthcare provider will work together to pick the best product for you.

Frequently Asked Questions

  • What is Repatha used for?

    Repatha is used to lower cholesterol in adults and children over the age of 10 with certain forms of high cholesterol. Repatha also helps decrease the risk of heart attack, stroke, and a heart surgery called coronary revascularization in adults with heart disease.

  • How does Repatha work?

    Repatha belongs to a group of drugs called monoclonal PCSK9 inhibitors. It works by increasing the amount of LDL cholesterol ("bad cholesterol") your liver removes from your body.

  • How long does it take for Repatha to work?

    Your healthcare provider may measure your cholesterol levels with a blood test as early as four weeks after starting Repatha.

  • What are the side effects of Repatha?

    The most common side effects of Repatha include runny nose, sore throat, symptoms of the common cold or flu, back pain, high blood sugar levels (diabetes), and injection site reactions, such as redness, pain, or bruising.

How Can I Stay Healthy While Taking Repatha?

If you're taking Repatha, chances are you've been having trouble controlling your cholesterol levels. You may have tried different approaches or treatments. While living with high cholesterol does have its challenges, there are ways to help improve your quality of life. Refer below for some general tips to support your health, lower your cholesterol, and help prevent heart disease:

  • Take cholesterol-lowering medications as recommended by your healthcare provider.
  • Eat a well-balanced diet, low in saturated and trans fat. Talk with your healthcare provider about following a cholesterol-lowering diet or discuss working with a registered dietitian nutritionist.
  • Maintain a healthy weight.
  • Stay physically active. For most people, the current movement recommendations are 30 minutes of physical activity at least five days per week.
  • If you smoke, talk with your healthcare provider about ways to help you quit.
  • Limit your alcohol intake. Aim for no more than two drinks per day for men and no more than one drink per day for women.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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