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Key takeaways
Praluent (alirocumab) and Repatha (evolocumab) are injectable PCSK9 inhibitors used to treat high cholesterol, particularly in patients with extremely high cholesterol levels or those unresponsive to other cholesterol-lowering medications.
Both medications block the PCSK9 enzyme in the liver, increasing the number of LDL receptors available to remove “bad” cholesterol from the blood. However, they contain different active ingredients and come in various strengths and formulations.
Repatha is FDA approved for use in children aged 10 and older, unlike Praluent, which is only approved for adult use. It is a distinct option for younger patients with high LDL cholesterol levels.
While both drugs are effective in reducing LDL-C levels and potentially increasing HDL (“good” cholesterol) levels, their cost, insurance coverage, and side effects may influence individual treatment choices. No generic versions are available, and specific considerations for use during pregnancy or breastfeeding are still under research.
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Praluent (alirocumab) and Repatha (evolocumab) are injectable prescription drugs used to treat high cholesterol. These medications are classified as PCSK9 inhibitors. They work directly in the liver to block the PCSK9 (proprotein convertase subtilisin kexin type 9) enzyme and stop the breakdown of LDL receptors. By stopping the breakdown of LDL receptors, PCSK9 inhibitors help increase the number of LDL receptors, which play a role in removing LDL cholesterol (LDL-C) from the blood. LDL cholesterol is known as the “bad” cholesterol and is responsible for heart disease. High LDL-C levels and untreated heart disease can increase the risk of a heart attack or stroke.
Praluent and Repatha are generally more expensive than statin medications like Lipitor and Crestor. If prescribed Praluent or Repatha, you’ll be recommended to watch your diet and exercise often. Praluent and Repatha are generally reserved for two types of people: those with extremely high levels of cholesterol or those who have been taking other cholesterol-lowering medications with no improvements in their cholesterol levels.
Continue reading to learn more about the differences between Praluent and Repatha.
What are the main differences between Praluent vs. Repatha
Praluent and Repatha contain different ingredients
Praluent and Repatha work as PCSK9 inhibitors, but they contain different active ingredients. Praluent contains alirocumab while Repatha contains evolocumab.
Praluent and Repatha differ in strength and formulations
Both Praluent and Repatha are given as subcutaneous injections (delivered just under the skin). However, Praluent and Repatha come in different strengths and formulations.
Praluent comes as a 75 mg/mL or 150 mg/mL prefilled pen that delivers a single dose at a time. The usual Praluent dosage is 75 mg once every two weeks or 300 mg every month for people with primary hyperlipidemia.
Repatha comes as a 140 mg/mL prefilled syringe or SureClick autoinjector. It is also available as a 420 mg/3.5 mL on-body infusor with a prefilled cartridge. The Repatha infusor is also known as the Repatha Pushtronex system. The formulation prescribed will depend on personal preferences and doctor recommendations. The recommended dosage of Repatha is 140 mg every two weeks or 420 mg every month for people with primary hyperlipidemia.
Repatha is approved for use in children
Praluent is not FDA approved for use in people under the age of 18 years old. Repatha, however, is FDA approved to treat high LDL-cholesterol levels in children aged 10 years and older. Repatha is only recommended to children in combination with a proper diet and other cholesterol-lowering medications.
| Main differences between Praluent and Repatha | ||
|---|---|---|
| Praluent | Repatha | |
| Drug class | PCSK9 inhibitor | PCSK9 inhibitor |
| Brand/generic status | No generic version available | No generic version available |
| What is the generic name? | Alirocumab | Evolocumab |
| What form(s) does the drug come in? | Prefilled pen | Prefilled syringe Prefilled autoinjector (SureClick) On-body infusor with prefilled cartridge (Pushtronex system) |
| What is the standard dosage? | Adults with heart disease or primary hyperlipidemia: 75 mg every 2 weeks or 300 mg every month Certain adults with heterozygous familial hypercholesterolemia (HeFH) or those with homozygous familial hypercholesterolemia (HoFH): 150 mg every 2 weeks |
Adults with heart disease or primary hyperlipidemia: 140 mg every 2 weeks or 420 mg every month Adults and children with heterozygous familial hypercholesterolemia (HeFH): 140 mg every 2 weeks or 420 mg every month Adults and children with homozygous familial hypercholesterolemia (HoFH): 420 mg every month |
| How long is the typical treatment? | Long-term | Long-term |
| Who typically uses the medication? | Adults | Adults and children aged 10 years and older |
Conditions treated by Praluent and Repatha
Praluent and Repatha are prescription injectable drugs used to treat high LDL-cholesterol levels. These drugs are both approved to treat high LDL-cholesterol levels in people with cardiovascular disease or primary hyperlipidemia. Someone with hyperlipidemia has high levels of lipids (fats), such as cholesterol and triglycerides.
Primary hyperlipidemia includes two different types of familial hyperlipidemia. This type of hyperlipidemia is caused by genetic factors and is often passed down from parents or family members. The two types of familial hyperlipidemia are heterozygous familial hypercholesterolemia (HeFH) and homozygous familial hypercholesterolemia (HoFH). These conditions are linked to extremely high levels of LDL cholesterol.
People with high cholesterol levels are at high risk of cardiovascular events, including heart attacks (myocardial infarctions), strokes, and severe chest pain (unstable angina). Praluent or Repatha is used along with a good exercise and diet plan, as well as other medications, to help reduce the risk of these complications.
| Condition | Praluent | Repatha |
| High LDL-cholesterol levels in people with diagnosed cardiovascular disease | Yes | Yes |
| High LDL-cholesterol levels in people with primary hyperlipidemia, such as heterozygous familial hypercholesterolemia (HeFH) or homozygous familial hypercholesterolemia (HoFH) | Yes | Yes |
Is Praluent or Repatha more effective?
Praluent and Repatha are both effective medications that can help lower cholesterol. While there are no head-to-head clinical trials comparing Praluent and Repatha, individual clinical trials have shown that they are both effective compared to placebo.
Indirect comparison studies have shown that Praluent and Repatha can cause reductions in LDL-C levels of 54% to 74% versus placebo and 26% to 46% versus Zetia (ezetimibe). In these studies, Praluent and Repatha were combined with statin therapy plus placebo or Zetia. These studies have also shown that Repatha may be more effective at reducing LDL-C levels than Praluent when given in certain doses. Although more research is needed, the use of Repatha is also linked to increased HDL levels (the “good” cholesterol).
Guidelines from the American Heart Association and the American College of Cardiology recommend the use of a PCSK9 inhibitor for people who are at very high risk of experiencing a cardiovascular event. The use of Praluent or Repatha can be beneficial for someone experiencing high cholesterol levels even if they’re already taking a statin medication or other cholesterol drug.
Before using Praluent or Repatha, it’s important to get medical advice and discuss all treatment options with a healthcare provider.
Coverage and cost comparison of Praluent vs. Repatha
Most Medicare and insurance plans will help cover the cost of Praluent. There is no generic version of Praluent available, and the average retail price is around $565. A SingleCare discount card can help lower the price of Praluent.
Most Medicare and insurance plans will also help cover the cost of Repatha. However, fewer insurance plans cover Repatha versus Praluent. The average price for a single prefilled syringe or autoinjector is $258. Using a SingleCare discount card is a potential savings option for someone without insurance or adequate insurance coverage.
| Praluent | Repatha | |
| Typically covered by insurance? | Yes | Yes |
| Typically covered by Medicare Part D? | Yes | Yes |
| Quantity | 1 supply of 2, 75 mg/mL pens | 1 supply of 2, 140 mg/mL syringes or autoinjectors |
| Typical Medicare copay | $265–$1,227 | $95–$1,201 |
| SingleCare cost | $408+ | – |
Common side effects of Praluent vs. Repatha
Praluent and Repatha cause similar side effects. The most common side effects of Praluent and Repatha are reactions at the injection site. There may be mild redness, burning, or swelling around the area where these drugs are injected.
Both Praluent and Repatha can also cause cold and flu-like symptoms. After using Praluent or Repatha, you may experience side effects like nasal congestion, cough, muscle pain, and diarrhea.
Repatha may also cause side effects like high blood sugar levels, back pain, headache, and dizziness.
| Praluent | Repatha | |||
| Side Effect | Applicable? | Frequency | Applicable? | Frequency |
| Injection site reactions | Yes | 7% | Yes | 6% |
| Cold and flu symptoms | Yes | N/A | Yes | N/A |
| Diarrhea | Yes | 5% | Yes | 3% |
| High blood sugar levels | No | – | Yes | 9% |
| Back pain | No | – | Yes | 6% |
| Muscle pain | Yes | 4% | Yes | 4% |
| Headache | No | – | Yes | 4% |
| Dizziness | No | – | Yes | 4% |
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Praluent), DailyMed (Repatha)
Drug interactions of Praluent vs. Repatha
Combining statin medications with Praluent or Repatha may cause reduced blood levels of Praluent or Repatha. However, despite possible reduced levels, clinical trials have not found any evidence that statin therapy has an impact on how Praluent or Repatha works. Praluent or Repatha is often used in combination with a statin medication. There are no known drug interactions between Praluent or Repatha with other drugs.
Warnings of Praluent and Repatha
Both Praluent and Repatha carry warnings for possible allergic reactions after injection. Signs and symptoms of an allergic reaction can include rash, hives, redness, and itching. Contact a healthcare provider if you experience signs or symptoms of an allergic reaction after using Praluent or Repatha.
The Repatha syringes and autoinjectors contain dry natural rubber. People who are allergic to latex or rubber may need to avoid the use of Repatha syringes or autoinjectors.
There is not enough research to determine whether Praluent or Repatha is safe in women who are pregnant or breastfeeding. The use of Praluent or Repatha may harm an unborn baby or breastfeeding infant. Discuss treatment options with a healthcare provider if you are pregnant or breastfeeding.
Frequently asked questions about Praluent vs. Repatha
What is Praluent?
Praluent is a brand-name injectable medication used to treat high cholesterol levels. The generic name of Praluent is alirocumab. Praluent is available as a 75 mg/mL or 150 mg/mL prefilled pen. The usual dosage of Praluent is 75 mg every two weeks or 300 mg every month for someone with heart disease or primary hyperlipidemia. It can also be administered as 150 mg every two weeks in certain people.
What is Repatha?
Repatha is a brand-name injectable drug that, like Praluent, is also used to treat high cholesterol levels. The generic name of Repatha is evolocumab. Repatha comes as a 140 mg/mL prefilled syringe or autoinjector. It is also available as a 420 mg/3.5 mL infusor that is placed on the body. The usual dosage of Repatha is 140 mg every two weeks or 420 mg every month.
Are Praluent and Repatha the same?
Praluent and Repatha are both PCSK9 inhibitors, but they contain different ingredients. Praluent contains alirocumab while Repatha contains evolocumab. They also have different manufacturers: Praluent is manufactured by Regeneron and Repatha is manufactured by Amgen. In addition, Repatha is available in more dosage forms than Praluent. Repatha is also approved for use in children aged 10 years and older while Praluent is only approved for adults.
Is Praluent or Repatha better?
Both Praluent and Repatha are effective medications to help lower LDL cholesterol and decrease the risk of heart attack, stroke, or chest pain. They are similarly effective when used along with statin medications or other cholesterol-lowering drugs. One drug may be preferred over the other depending on different factors, such as price, potential side effects, and allergies.
Can I use Praluent or Repatha while pregnant?
It is not known whether Praluent or Repatha is safe to use while pregnant. Praluent and Repatha were not found to cause significant side effects in animals. However, there is no sufficient data available for humans. Praluent and Repatha are known to be transported across the placenta to the developing fetus. Caution should be taken before using Praluent or Repatha while pregnant. Discuss the potential benefits and risks with a healthcare provider.
Can I use Praluent or Repatha with alcohol?
Alcohol is not known to interact with Praluent or Repatha. It is likely safe to drink alcohol in moderation while using Praluent or Repatha.
Is Praluent effective without a statin?
Praluent is generally used along with a cholesterol–lowering therapy like a statin drug. It can be used with or without a statin or cholesterol-lowering drug in people with familial hypercholesterolemia (HeFH). However, people with homozygous familial hypercholesterolemia (HoFH) should take Praluent with a statin or other cholesterol-lowering drug.
Does Praluent cause weight gain?
Weight gain is not a listed side effect based on data from the Praluent FDA label. You may experience weight gain while taking Praluent due to other factors or medications. Talk to a healthcare provider if you experience weight gain while using Praluent.
How long can you take Praluent?
Praluent is a long-term treatment option for high LDL-cholesterol levels. It is injected under the skin every two or four weeks.