Table of ContentsView AllTable of ContentsWhat Is Praluent?What Is Repatha?Dosing GuidelinesSide Effects and PrecautionsReview of EfficacyDiet and Exercise for High CholesterolFrequently Asked Questions
Table of ContentsView All
View All
Table of Contents
What Is Praluent?
What Is Repatha?
Dosing Guidelines
Side Effects and Precautions
Review of Efficacy
Diet and Exercise for High Cholesterol
Frequently Asked Questions
Praluent (alirocumab) and Repatha (evolocumab) are in the proprotein convertase subtilisin kexin type 9 (PCSK9) inhibitor drug class. The active ingredient in Praluent is alirocumab, and the active ingredient in Repatha is evolocumab.
Both medications are typically given as a subcutaneous (under the skin) injection every two or four weeks. The frequency of injections may vary depending on factors, such as the specific U.S. Food and Drug Administration (FDA)-approved use.
In general, the Food and Drug Administration (FDA) approved these PCSK9 inhibitors to reducelow-density lipoprotein cholesterol (LDL-C)in certain people.In the United States, roughly 86 million adults 20 years or older havetotal cholesterol (TC)levels higher than 200 milligrams per deciliter (mg/dL). Approximately 7% of children between the ages of 6 and 19 years old also have high TC.
Though these PCSK9 inhibitors sound very similar, each PCSK9 inhibitor has some important differences, such as other FDA-approved uses, age limitations, and dosage forms. Moreover, some side effects are different.
This article will take a deep dive into the differences between Praluent andRepatha.
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Praluent is a monoclonal antibody called alirocumab, which is also considered the active ingredient.Amonoclonal antibodyis a human-madeimmune (defense) systemprotein.
In the case of Praluent, this monoclonal antibody is made to bind to proprotein convertase subtilisin kexin type 9 (PCSK9).PCSK9 is also another type of protein—but it’s naturally occurring in the body.
The FDA approved Praluent in adults with heart disease to lower the risk ofheart attack,stroke, andunstable angina(chest pain) that requires hospitalization. The FDA also approved Praluent to lower LDL “bad” cholesterol in adults who have primary hyperlipidemia (highcholesterol conditions that run in families)—like heterozygous familial hypercholesterolemia (HeFH) and homozygous familial hypercholesterolemia (HoFH).
In HeFH, Praluent is taken along with a healthy diet alone or in combination with other LDL-lowering medications. In HoFH, the FDA only approved Praluent for use in combination with other LDL-lowering medications.
Some examples of otherLDL-lowering medicationsmay includestatinsand Zetia (ezetimibe). So, PCSK9 inhibitors (like Praluent) are not the initial go-to options for most people. Experts typically recommend a statin first. Afterward, if necessary, ezetimibe is the next add-on choice. Finally, if LDL is still high, then experts may consider a PCSK9 inhibitor in people with familial hypercholesterolemia or a very high risk of heart disease.
Praluent is available as a single-use prefilled pen in two different doses: 75 milligrams (mg) and 150 mg. A prefilled pen is a device that is already “prefilled” or filled ahead of time with a specific dose of Praluent. To inject the medicine under your skin, you push a button on the device.
As of early 2024, no other medications contain alirocumab.There are also no interchangeablebiosimilars(“generic versions”) available for alirocumab.
How It Works
The FDA approved Repatha in adults with heart disease to decrease the risk of heart attack, stroke, and coronary revascularization.Coronary revascularizationis a procedure to restore blood flow in a blocked heart artery.
In general, the FDA also approved Repatha to lower LDL “bad” cholesterol in people 10 and older who have high cholesterol conditions that run in families—like heterozygous familial hypercholesterolemia (HeFH) and homozygous familial hypercholesterolemia (HoFH).
In adults with familial hypercholesterolemia, Repatha is taken along with a healthy diet alone or in combination with other LDL-lowering medications. In children with HeFH, Repatha is taken with a healthy diet and other LDL-lowering medications. As for children with HoFH, the FDA only approved Repatha for use in combination with other LDL-lowering medications.
Some examples of other LDL-lowering therapies may include statins and ezetimibe. So, PCSK9 inhibitors (like Repatha) are not first-line for most people. Experts typically choose a statin first and ezetimibe as the next add-on choice. Then, experts may consider adding a PCSK9 inhibitor to further reduce high LDL levels in people with familial hypercholesterolemia or a very high risk of heart disease.
Repatha is available in three different dosage forms, including a prefilled syringe, a prefilled SureClick® autoinjector, and a Pushtronex® system.
A prefilled syringe is a single-use syringe that’s already filled with a specific Repatha dose of 140 mg. The prefilled SureClick® autoinjector is a single-use device that’s also already filled with 140 mg of Repatha. Instead of using a plunger like from a prefilled syringe, however, you will push a button for the device to inject the medication under your skin.
The Pushtronex® system is also a device with an injection button, but it requires you to load a cartridge into it. The cartridge has a prefilled Repatha dose of 420 mg, which is three times higher than the other dosage forms.
As of early 2024, Repatha is the only therapy to contain evolocumab.There are no interchangeable biosimilars (“generic versions”) available for evolocumab either.
Because specific dosages may vary per person, use PCSK9 inhibitors according to the healthcare provider’s recommendations. The following, however, are some general dosing guidelines.
Praluent:
Praluent comes in a 75 mg or 150 mg prefilled pen. So, for 300 mg doses, you will need to use two 150 mg prefilled pens.
Repatha:
Repatha is available as a 140 mg prefilled syringe, 140 mg prefilled autoinjector, and a 420 mg Pushtronex® system. So, for 420 mg doses, you will have the option of using three 140 mg prefilled syringes, three 140 mg prefilled autoinjectors, or one 420 mg Pushtronex® system.
Onset to Action
Refer to the following table for information on how quickly Praluent and Repatha work and how long their effects last.
The following table lists some common side effects of Praluent vs Repatha.
A severe side effect of both PCSK9 inhibitors includes the potential for aserious allergic reaction.Symptoms may include breathing problems, itchiness, and rash. Note that the needle cover of the Repatha prefilled syringe and autoinjector also contain latex.
Get medical help immediately if you develop a severe allergic reaction or serious side effects. Call 911 if your symptoms feel life-threatening.
The long-term safety of both PCSK9 inhibitors is currently unknown.
Safely Taking Praluent vs. Repatha
In general, keep the following in mind about PCSK9 inhibitors:
Praluent is available as a single-use prefilled pen in two different doses: 75 mg and 150 mg. A prefilled pen is a device that is filled ahead of time with a specific dose of Praluent. To inject the medicine under your skin, you push a button on the device.
A prefilled syringe is a single-use syringe that’s already “prefilled” with a specific Repatha dose of 140 mg. The prefilled SureClick® autoinjector is a single-use device that’s also already filled with 140 mg of Repatha. Instead of using a plunger like from a prefilled syringe, however, you will push a button on the autoinjector device to inject the medication under your skin.
The Pushtronex® system is also a device with an injection button but looks different. Instead of being shaped like a pen, it looks like a cube with a door or lid at the top that swings to the side so you can load a cartridge into the cube. The cartridge has a prefilled Repatha dose of 420 mg, which is three times higher than the other Repatha dosage forms.
The Pushtronex® system also has other bells and whistles—like different-colored lights, flashing or solid lights, and beeping noises—that will let you know when the device is ready, when the injection is starting, when the injection is done, and when you’ve removed the device from your body.
Because specific directions might vary per person and the different dosage forms, use the PCSK9 inhibitor according to the healthcare provider’s recommendations. For more detailed instructions, reach out to a healthcare provider.
Potential for Interaction
There is limited information about drug interactions for PCSK9 inhibitors. Though there are drug interaction studies between each PCSK9 inhibitor and statin, the results concluded that the interaction isn’t meaningful.
Past studies showed that PCSK9 inhibitors like Praluent and Repatha are effective at significantly lowering LDL (“bad” cholesterol) levels when added to a statin medication.Prior clinical trials also suggested that these PCSK9 inhibitors may lower the risk of heart disease, such as heart attack and stroke.
Which Is Better?
A meta-analysis (a methodical analysis of a collection of studies) reported that PCSK9 inhibitors may decrease the risk of major heart disease-related events, stroke, and a procedure to restore blood flow in a blocked heart artery. Though Repatha had a positive impact on heart attacks, there were no noted effects for Praluent. So, the meta-analysis suggested that Praluent might be less effective than Repatha.
On the other hand, expert guidelines do not favor one PCSK9 inhibitor over the other. These guidelines also didn’t mention using both PCSK9 inhibitors together.
When it comes to using PCSK9 inhibitors, experts typically choose either PCSK9 inhibitor as a third-line option on top of a statin and ezetimibe when additional LDL-lowering is necessary for people with familial hypercholesterolemia or a very high risk of heart disease.
As for the better PCSK9 inhibitor to choose, this decision will likely depend on factors, such as cost, insurance coverage, and your preferences.
The following are some tips on healthy lifestyle changes, like diet and exercise, for people with high cholesterol.
Summary
The PCSK9 inhibitor drug class includes Praluent and Repatha. The active ingredient in Praluent is alirocumab, and the active ingredient in Repatha is evolocumab.
In general, the FDA approved these PCSK9 inhibitors to reduce LDL in certain people. In people with heart disease, both PCSK9 inhibitors lower the risk of heart attack and stroke. However, Praluent also decreases the risk of unstable angina that requires hospitalization. Repatha, on the other hand, reduces the risk of coronary revascularization.
For these primary hyperlipidemia conditions, each PCSK9 inhibitor may also slightly differ in its requirements or options for use—like use alone with dietary changes or in combination with other LDL-lowering medications.
Initially, these PCSK9 inhibitors seem very similar, but each PCSK9 inhibitor has some important differences, such as FDA-approved uses, age limitations, and side effects. Additionally, Repatha has more dosage form options than Praluent (which comes only as a prefilled pen), but the needle covers on two of the Repatha dosage forms contain latex. Reach out to a healthcare provider to know more about the differences between Praluent and Repatha.
Store both PCSK9 inhibitors in the fridge between 36 and 46 degrees in the original container to protect the products from light.If necessary, you can store either PCSK9 inhibitor at room temperature (between 68 and 77 degrees) for 30 days. If the product isn’t used within 30 days at room temperature, however, you will need to throw it away.
Store both PCSK9 inhibitors in the fridge between 36 and 46 degrees in the original container to protect the products from light.
If necessary, you can store either PCSK9 inhibitor at room temperature (between 68 and 77 degrees) for 30 days. If the product isn’t used within 30 days at room temperature, however, you will need to throw it away.
Though injection site reactions like redness and itchiness are common, few people have had to stop either PCSK9 inhibitor because of them.
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17 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.U.S. Food and Drug Administration.Praluent label.U.S. Food and Drug Administration.Repatha label.Centers for Disease Control and Prevention.High cholesterol facts.MedlinePlus.PCSK9 gene.Grundy SM, Stone NJ, Bailey AL, et al.2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.Circ. 2019;139(25):e1082–e1143. doi:10.1161/CIR.0000000000000625U.S. Food and Drug Administration.Purple Book: Praluent.U.S. Food and Drug Administration.Biosimlar and interchangeable biologics: more treatment choices.U.S. Food and Drug Administration.Purple Book: Repatha.Toth PP, Worthy G, Gandra SR, et al.Systematic review and network meta-analysis on the efficacy of evolocumab and other therapies for the management of lipid levels in hyperlipidemia.JAHA. 2017;6(10):e005367. doi:10.1161/JAHA.116.005367Toth PP, Bray S, Villa G, et al.Network meta-analysis of randomized trials evaluating the comparative efficacy of lipid-lowering therapies added to maximally tolerated statins for the reduction of low-density lipoprotein cholesterol.JAHA. 2022;11(18):e025551. doi:10.1161/JAHA.122.025551Grover J, Yao WX, Amarasekera AT, et al.Longer-term impact of PCSK9 inhibitors on major adverse cardiovascular events and all-cause mortality: a systematic review and meta-analysis of randomised controlled trials.Eur. Heart J. 2023;44(Suppl 2):ehad655.2808. doi:10.1093/eurheartj/ehad655.2808Guedeney P, Giustino G, Sorrentino S, et al.Efficacy and safety of alirocumab and evolocumab: a systematic review and meta-analysis of randomized control trials.Eur. Heart J. 2022;43(7):e17-e25. doi:10.1093/eurheartj/ehz430Wang HF, Mao YC, Xu XY, et al.Effect of alirocumab and evolocumab on all-cause mortality and major cardiovascular events: a meta-analysis focusing on the number needed to treat.Front. Cardiovasc. Med. 2022;9. doi:10.3389/fcvm.2022.1016802Centers for Disease Control and Prevention.Prevent high cholesterol.MedlinePlus.Alirocumab injection.MedlinePlus.Evolocumab injection.Bär S, Räber I, Koskinas KC, et al.Transient injection site reaction to alirocumab during immune system activation: a case series.Eur Heart J Case Rep. 2022;6(5):ytac187. doi:10.1093/ehjcr/ytac187.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
U.S. Food and Drug Administration.Praluent label.U.S. Food and Drug Administration.Repatha label.Centers for Disease Control and Prevention.High cholesterol facts.MedlinePlus.PCSK9 gene.Grundy SM, Stone NJ, Bailey AL, et al.2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.Circ. 2019;139(25):e1082–e1143. doi:10.1161/CIR.0000000000000625U.S. Food and Drug Administration.Purple Book: Praluent.U.S. Food and Drug Administration.Biosimlar and interchangeable biologics: more treatment choices.U.S. Food and Drug Administration.Purple Book: Repatha.Toth PP, Worthy G, Gandra SR, et al.Systematic review and network meta-analysis on the efficacy of evolocumab and other therapies for the management of lipid levels in hyperlipidemia.JAHA. 2017;6(10):e005367. doi:10.1161/JAHA.116.005367Toth PP, Bray S, Villa G, et al.Network meta-analysis of randomized trials evaluating the comparative efficacy of lipid-lowering therapies added to maximally tolerated statins for the reduction of low-density lipoprotein cholesterol.JAHA. 2022;11(18):e025551. doi:10.1161/JAHA.122.025551Grover J, Yao WX, Amarasekera AT, et al.Longer-term impact of PCSK9 inhibitors on major adverse cardiovascular events and all-cause mortality: a systematic review and meta-analysis of randomised controlled trials.Eur. Heart J. 2023;44(Suppl 2):ehad655.2808. doi:10.1093/eurheartj/ehad655.2808Guedeney P, Giustino G, Sorrentino S, et al.Efficacy and safety of alirocumab and evolocumab: a systematic review and meta-analysis of randomized control trials.Eur. Heart J. 2022;43(7):e17-e25. doi:10.1093/eurheartj/ehz430Wang HF, Mao YC, Xu XY, et al.Effect of alirocumab and evolocumab on all-cause mortality and major cardiovascular events: a meta-analysis focusing on the number needed to treat.Front. Cardiovasc. Med. 2022;9. doi:10.3389/fcvm.2022.1016802Centers for Disease Control and Prevention.Prevent high cholesterol.MedlinePlus.Alirocumab injection.MedlinePlus.Evolocumab injection.Bär S, Räber I, Koskinas KC, et al.Transient injection site reaction to alirocumab during immune system activation: a case series.Eur Heart J Case Rep. 2022;6(5):ytac187. doi:10.1093/ehjcr/ytac187.
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U.S. Food and Drug Administration.Repatha label.
Centers for Disease Control and Prevention.High cholesterol facts.
MedlinePlus.PCSK9 gene.
Grundy SM, Stone NJ, Bailey AL, et al.2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines.Circ. 2019;139(25):e1082–e1143. doi:10.1161/CIR.0000000000000625
U.S. Food and Drug Administration.Purple Book: Praluent.
U.S. Food and Drug Administration.Biosimlar and interchangeable biologics: more treatment choices.
U.S. Food and Drug Administration.Purple Book: Repatha.
Toth PP, Worthy G, Gandra SR, et al.Systematic review and network meta-analysis on the efficacy of evolocumab and other therapies for the management of lipid levels in hyperlipidemia.JAHA. 2017;6(10):e005367. doi:10.1161/JAHA.116.005367
Toth PP, Bray S, Villa G, et al.Network meta-analysis of randomized trials evaluating the comparative efficacy of lipid-lowering therapies added to maximally tolerated statins for the reduction of low-density lipoprotein cholesterol.JAHA. 2022;11(18):e025551. doi:10.1161/JAHA.122.025551
Grover J, Yao WX, Amarasekera AT, et al.Longer-term impact of PCSK9 inhibitors on major adverse cardiovascular events and all-cause mortality: a systematic review and meta-analysis of randomised controlled trials.Eur. Heart J. 2023;44(Suppl 2):ehad655.2808. doi:10.1093/eurheartj/ehad655.2808
Guedeney P, Giustino G, Sorrentino S, et al.Efficacy and safety of alirocumab and evolocumab: a systematic review and meta-analysis of randomized control trials.Eur. Heart J. 2022;43(7):e17-e25. doi:10.1093/eurheartj/ehz430
Wang HF, Mao YC, Xu XY, et al.Effect of alirocumab and evolocumab on all-cause mortality and major cardiovascular events: a meta-analysis focusing on the number needed to treat.Front. Cardiovasc. Med. 2022;9. doi:10.3389/fcvm.2022.1016802
Centers for Disease Control and Prevention.Prevent high cholesterol.
MedlinePlus.Alirocumab injection.
MedlinePlus.Evolocumab injection.
Bär S, Räber I, Koskinas KC, et al.Transient injection site reaction to alirocumab during immune system activation: a case series.Eur Heart J Case Rep. 2022;6(5):ytac187. doi:10.1093/ehjcr/ytac187.
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