Praluent vs. Repatha: Similarities, differences, and which is better for you

In this article:

• Main differences
• Conditions treated
• Is Praluent or Repatha more effective?
• Coverage and cost
• Side effects
• Drug interactions and warnings
• FAQs about Praluent and Repatha

In this article

• Main differences
• Conditions treated
• Is Praluent or Repatha more effective?
• Coverage and cost
• Side effects
• Drug interactions and warnings
• FAQs about Praluent and Repatha

Praluent (alirocumab) and Repatha (evolocumab) are injectable drugs used to treat high cholesterol, typically when statins or other medications haven’t worked well enough. They belong to a drug class called PCSK9 inhibitors, which work in the liver to prevent the breakdown of LDL receptors. As a result, it helps the body remove more LDL cholesterol linked to heart disease, heart attacks, and strokes. While they’re part of the same class of drugs, they have several differences.

What are the main differences between Praluent and Repatha?

Praluent and Repatha differ in their active ingredients, dosage forms, and age restrictions.

Different ingredients

Though they work the same to increase the liver’s ability to remove LDL from the blood, Praluent and Repatha contain different active ingredients: Praluent contains alirocumab, while Repatha contains evolocumab. 

Different strengths 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 forms. 

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 adults with heart disease or primary hyperlipidemia. The dosage can go up to 150 mg every two weeks.

Repatha comes in one strength as a 140 mg/mL prefilled syringe or SureClick autoinjector. The recommended dosage of Repatha is 140 mg every two weeks or 420 mg every month. In some cases, the dosage could go up to 420 mg every two weeks. Repatha was also once available as a Pushtronex system (420 mg/3.5 mL on-body infusor), but this device was discontinued in 2024.

Age limits

Praluent is FDA-approved for use starting at age 8, while Repatha is approved for use starting at age 10. Both are also approved for adults and are used along with a balanced diet and other cholesterol-lowering medications when needed.

Praluent vs. Repatha key differences comparison
	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)
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 The dosage in children depends on weight	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 or once every 2 weeks
How long is the typical treatment?	Long-term	Long-term
Who typically uses the medication?	Adults and children aged 8 years and older	Adults and children aged 10 years and older

 

Conditions treated by Praluent and Repatha

Praluent and Repatha are prescription injectable drugs used to manage high LDL-cholesterol levels. These drugs are both approved to treat high LDL-cholesterol levels in people with cardiovascular disease or primary hyperlipidemia, a genetic condition where cholesterol and other blood fats like triglycerides are too high.

Primary hyperlipidemia includes two different types of familial hyperlipidemia: heterozygous familial hypercholesterolemia (HeFH) and homozygous familial hypercholesterolemia (HoFH). These conditions cause extremely high LDL levels that often need stronger treatment than lifestyle changes or statins alone.

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 and Repatha are used alongside an exercise and diet plan, as well as other medications, to reduce the risk of these complications.  

Compare Praluent vs. Repatha conditions treated
Condition	Praluent	Repatha
High LDL-cholesterol levels in people with heart 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. There aren’t any large studies that directly compare the two drugs side by side, but clinical trials show they’re both effective when compared to a placebo. 

A 2023 meta-analysis of more than 76,000 patients found that both medications lower LDL cholesterol and help prevent heart attacks, strokes, and the need for procedures like stent placement. Both drugs were also safe without any serious side effects. However, Praluent may lower the risk of death slightly more than Repatha.

The most recent American College of Cardiology and American Heart Association guidelines recommend more aggressive cholesterol-lowering for people who’ve had a recent heart attack or other acute coronary event. If LDL goals aren’t met with statins alone, or if someone can’t take statins, adding a PCSK9 inhibitor like Praluent or Repatha is recommended. 

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

Many Medicare and commercial insurance plans may help cover the cost of Praluent. However, there is no generic version of Praluent available, and the average retail price is around $710. A SingleCare discount card may help lower the price of Praluent. 

Medicare and commercial insurance plans also provide coverage for Repatha, although it depends on the plan. Without insurance, the average price for Repatha is around $795. A SingleCare discount card is a potential savings option for Repatha for someone without insurance or adequate insurance coverage. 

Compare cost and coverage of Praluent vs. Repatha
	Praluent	Repatha
Typically covered by insurance?	Varies	Varies
Typically covered by Medicare Part D?	Varies	Varies
Quantity	1 supply of 2, 75 mg/mL pens	1 supply of 2, 140 mg/mL syringes
SingleCare cost*	$512	$498

*Cost at time of publication. Prices fluctuate and vary by pharmacy and location.

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. Reactions might include mild redness, swelling, or soreness around the area where the injection is given. 

Both Praluent and Repatha can also cause cold and flu-like symptoms. After using Praluent or Repatha, a person 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. 

Compare side effects of Praluent vs. Repatha
	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 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 and 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 signs or symptoms of an allergic reaction develop after using Praluent or Repatha. 

The Repatha syringes and autoinjectors may contain dry natural rubber. People who are allergic to latex or rubber may need to use the syringes and autoinjectors that don’t contain natural rubber latex. 

There isn’t enough research to determine whether Praluent or Repatha is safe in women who are pregnant or breastfeeding. Although some case reports suggest PCSK9 inhibitors may be safe, there may still be potential risks to an unborn baby or breastfeeding infant. Discuss treatment options with a healthcare provider while pregnant or breastfeeding. 

Frequently asked questions about Praluent vs. Repatha

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. They also have different dosages and potential side effects. 

Is Praluent or Repatha better?

Both Praluent and Repatha are effective for lowering LDL cholesterol and reducing the risk of heart attack, stroke, or chest pain. They are similarly effective when used along with statin medications or other cholesterol-lowering drugs. 

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 adverse effects in animal studies. However, 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 most often prescribed alongside a statin to help lower cholesterol. However, it can also be effective when used on its own, especially for people who can’t take statins. For people with very high cholesterol levels, Praluent may offer better results when used with a statin. 

Does Praluent cause weight gain?

Weight gain is not a listed side effect based on data from the Praluent FDA label. Some people may see weight gain while taking Praluent due to other medications or health conditions. Talk to a healthcare provider if weight gain becomes a problem 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.