Repatha side effects and how to avoid them

In this article:

• Common side effects
• Serious side effects
• How long do Repatha side effects last?
• Long-term side effects
• How to avoid Repatha side effects

In this article

• Common side effects
• Serious side effects
• How long do Repatha side effects last?
• Long-term side effects
• How to avoid Repatha side effects

Repatha is the brand name for evolocumab, an FDA-approved monoclonal antibody used to lower cholesterol. In addition to lowering LDL (low-density lipoprotein) cholesterol levels, Repatha helps restore blood flow to the heart, decreasing the risks of heart attack and strokes in people with heart disease. Repatha is often used when medications like statin drugs don’t lower cholesterol enough and can be combined with statin medications. Repatha is given by injections, either every two weeks or once per month.

Common side effects of Repatha

According to data from the FDA, based on clinical trials, the most common side effect of Repatha is nasopharyngitis, which is inflammation of the nasal passages and throat. In other words, Repatha most commonly causes cold-like symptoms, such as stuffy nose, runny nose, and sneezing.

As per the FDA, other common side effects of Repatha include:

• Upper respiratory tract infections
• Flu-like symptoms
• Back pain
• Pain, bruising, or redness at the injection site
• Coughing
• Urinary tract infections
• Sinusitis (inflammation of the sinuses)
• Headaches
• Muscle soreness
• Dizziness
• Musculoskeletal pain
• Elevated blood pressure
• High blood sugar

Serious side effects of Repatha

Thankfully, there are few serious side effects of Repatha. The most serious side effects are allergic reactions or hypersensitivity to the medication or injection packaging.

As the FDA notes, angioedema, or serious swelling of the skin caused by hypersensitivity, has been reported in people taking Repatha. People who are sensitive to latex should take precautions with Repatha because the needle cover and autoinjector of certain Repatha products contains latex. If you are allergic to latex, you should discuss options with your doctor or pharmacist before taking Repatha.

According to the FDA, the serious allergic reactions people should watch for while taking Repatha include:

• Trouble breathing
• Issues with swallowing
• Hives
• Rashes
• Itching
• Swelling of your face, lips, throat, or tongue
• Swelling on other parts of your body 

How soon do Repatha side effects start?

As Soma Mandal, MD, internist at Summit Health, explains how soon side effects occur vary from one person to another. “Some patients may experience side effects shortly after starting the medication, particularly injection site reactions, which can occur immediately or within a few hours of administration,” she says. But other side effects, like cold-like symptoms or back pain, might develop only after taking several doses of Repatha.

How long do Repatha side effects last?

The good news is that most common side effects from Repatha don’t last long and tend to lessen over time. “Injection site reactions usually go away in a couple of days, while other symptoms, like muscle pain or flu-like feelings, might last a bit longer but are typically manageable,” says Raj Dasgupta, MD, a quadruple board-certified physician specializing in internal medicine, pulmonology, critical care, and sleep medicine and chief medical advisor for Garage Gym. Dr. Dasgupta recommends checking in with your doctor if your symptoms stick around or seem to get worse.

What are the long-term side effects of Repatha?

Long-term side effects from taking Repatha are rare. For example, a 2022 study looked at the long-term effects of Repatha among cardiovascular patients. “There were no long-term side effects that were found to be different than a patient who was not taking the medication,” said Dylan Huber, PharmD, interim director of pharmacy/pharmacy clinical coordinator at the Saint Anthony Hospital Pharmacy (SAH Pharmacy). Still, some long-term effects were reported among study participants.

“I do think it is still important to know about some of the long-term side effects that have been reported,” Huber said, in reference to the 2022 study. These long-term side effects included new-onset diabetes and joint/muscle pain. “The joint/muscle pain would resolve with medication discontinuation,” Dr. Huber says. “New onset diabetes is very uncommon, and the risk is no different than if you were not taking the medication, but it is still important to be aware of.”

Repatha interactions

On a positive note, there aren’t any foods that you can’t consume while taking Repatha. “Repatha does not have any known major food or beverage interactions, including alcohol, coffee, or grapefruit,” says Dr. Mandal.

That said, since people taking Repatha typically have heart conditions, it’s important to stick to a heart-healthy diet while taking Repatha. This includes eating foods low in saturated fat, eating plenty of whole grains, prioritizing foods with omega-3 fatty acids like fatty fish, and limiting salt and alcohol intake.

Part of the reason Repatha is less likely to interact with foods you eat is because of how the medication is administered. This is also why it’s less likely to interact with medications. “Repatha is given via an injection, which limits the potential for gastrointestinal absorption of food or drug interactions,” shares Claudia Cometa, PharmD, founder and CEO at Peace Advocacy Group.

Although Repatha is unlikely to interact with other medications you are taking, Dr. Dasgupta says that you should stay in touch with your doctor or pharmacist if you are taking both Repatha and a statin. “It’s a good idea to tell your doctor about any other medications you’re taking, especially cholesterol drugs like statins since combining them could make muscle pain more likely,” he advises.

Safety measures while using Repatha

Although Repatha is safe for most individuals, there are certain people who should avoid Repatha, or speak to a healthcare professional before taking it. Here’s what to know, according to DailyMed at the National Institutes of Health:

• Pregnant women: Clinical trials are not available for pregnant people taking Repatha, which means it’s not known whether the drug will harm your baby
• Breastfeeding: At this time, there is no date on whether Repatha gets into breast milk, how it affects breastfed babies, and whether it impacts milk supply
• Children: Repatha is used safely and effectively in children aged 10 and up who have heterozygous familial hypercholesterolemia (HeFH), but safety hasn’t been established in younger children

As of this writing, Repatha has never been recalled by the FDA and there are no black box warnings for Repatha. However, in June of 2024, the manufacturer of Repatha (Amgen) discontinued one Repatha product: the Repatha Pushtronex® System. Other products, like Repatha® SureClick® Autoinjector, are still in use. 

How to avoid Repatha side effects

There are several steps you can take to avoid some common Repatha side effects. Here’s what the experts we spoke to recommended.

Injection site reactions

If you have experienced injection site reactions in the past, Huber recommends taking an antihistamine like Benadryl prior to your injection. “This should only be done if there is a known history of injection reactions and should be discussed with your doctor,” he emphasizes. Benadryl can cause significant drowsiness, so keep this in mind when determining when you will give your dose.

Colds, flu, or other upper respiratory infections

If you are prone to get colds or flu while on Repatha, you can boost your immune system by “maintaining a healthy and immune-supporting lifestyle, through whole foods and treating vitamin deficiencies,” Cometa recommends.

Allergies

If you have allergies to latex, you should avoid any latex-containing syringes or other injection components, Cometa advises. Your doctor can recommend the correct Repatha product for you. If you have a severe allergic reaction to Repatha, your doctor will likely recommend alternative cholesterol-lowering medicines.

How to treat side effects of Repatha

Again, most individuals will not experience side effects while taking Repatha. Or, if they do, the side effects will go away fairly quickly, Huber emphasizes. “However, it is always important to know what to look out for,” he says. “For side effects that are difficult to tolerate or last longer than a few days, I would recommend discussing this with your prescribing doctor.”

Here are some tips for treating any side effects that arise while taking Repatha.

Injection site irritation

Rotating where you give yourself the injection can help you avoid repeated soreness or irritation, Dr. Dasgupta advises. “A cold pack or a mild pain reliever can also ease discomfort,” he recommends.

Muscle pain

Muscle pain, including back pain, can be treated similarly to other types of pain. “Staying well-hydrated, engaging in regular physical activity, and discussing any persistent pain with your provider can help manage these symptoms,” Dr. Mandal offers.

Cold or flu-like symptoms

If you are experiencing any of these symptoms, resting and staying well hydrated will help, says Dr. Dasgupta. However, note that if you are experiencing any symptoms that are difficult to manage or that don’t respond to at-home treatments, you should not hesitate to reach out to your doctor.

Allergic reactions

While rare, if you experience symptoms like rash, itching, or difficulty breathing, you should seek medical attention immediately, Dr. Mandal says. “Your provider may recommend discontinuing the medication and provide appropriate treatment for the reaction, such as antihistamines or corticosteroids,” she says.

Bottom line: Is Repatha safe?

Repatha is generally safe and well tolerated, and the benefits typically outweigh the potential risks. “Overall, I think that Repatha is a safe drug to take,” Huber shares. “It can be a beneficial option to those who have tried other cholesterol-lowering therapies and require additional therapy to lower their cholesterol to goal, or those who are intolerant to other cholesterol-lowering therapies.” Repatha can show significant results 2-3 weeks from starting treatment.

Cometa agrees. “In practice, I find a large majority of patients tolerate Repatha without limiting side effects; however, every individual’s comorbidities must be taken into account when choosing Repatha or any other medication.”

If you have further questions about taking Repatha, and any possible side effects, please reach out to your healthcare provider.