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Key takeaways
Repatha is an injectable PCSK9 inhibitor used to lower LDL cholesterol in people with heart disease or genetic conditions.
Oral alternatives, such as statins and cholesterol absorption inhibitors, may be easier to take and significantly more affordable for some people.
Injectable options, such as other PCSK9 inhibitors, have similar mechanisms for lowering LDL cholesterol but may have different dosing schedules and pricing.
Repatha (evolocumab) is an injectable medication prescribed to lower LDL (“bad”) cholesterol, especially in people with familial hypercholesterolemia or established heart disease. It works by blocking a protein called PCSK9, allowing the liver to remove more LDL from the bloodstream. While it can be effective when other medications and lifestyle changes aren’t enough, it may not be right for everyone due to costs, side effects, or a preference to avoid injections. Fortunately, several alternatives may also help manage high cholesterol levels and reduce cardiovascular risk.
What can I take instead of Repatha?
If Repatha isn’t the right fit, other medications are available to help lower LDL cholesterol (LDL-C) and reduce heart disease risk. These include oral options like statins, bile acid sequestrants, fibrates, and omega-3 fatty acids. Injectable options include Evkeeza (evinacumab-dgnb) and other PCSK9 inhibitors like Praluent (alirocumab) and Levqio (inclisiran). A newer drug like Nexletol (bempedoic acid) is also a potential alternative. Each option differs in how it works, how it’s taken, and its potential side effects, so it’s important to seek medical advice from your healthcare provider for the best option.
Compare Repatha alternatives |
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|---|---|---|---|
| Drug name | Price without insurance | SingleCare price | Savings options |
| Repatha (evolocumab) | $739 for 2, 1 mL of 140 mg/mL syringes | $493 for 2, 1 mL of 140 mg/mL syringes of brand-name Repatha | See latest prices |
| Praluent (alirocumab) | $700 for 2, 1 mL of 75 mg/mL pens | $512 for 2, 1 mL of 75 mg/mL pens of brand-name Praluent | See latest prices |
| Leqvio (inclisiran) | $4,005 for 1, 1.5 mL of 284 mg/1.5 mL pen | $3,376 for 1, 1.5 mL of 284 mg/1.5 mL pen of brand-name Leqvio | See latest prices |
| Lipitor (atorvastatin) | $679 for 30, 40 mg tablets | $8 for 30, 40 mg tablets of generic Lipitor | See latest prices |
| Crestor (rosuvastatin) | $360 for 30, 10 mg tablets | $8 for 30, 10 mg tablets of generic Crestor | See latest prices |
| Zocor (simvastatin) | $339 for 30, 20 mg tablets | $7 for 90, 20 mg tablets of generic Zocor | See latest prices |
| Colestid (colestipol) | $180 for 60, 1 gm tablets | $35 for 60, 1 gm tablets of generic Colestid | See latest prices |
| Welchol (colesevelam) | $1,047 for 180, 625 mg tablets | $43 for 180, 625 mg tablets of generic Welchol | See latest prices |
| Niaspan (niacin) | $8 for 90, 500 mg tablets | $4 for 90, 500 mg tablets of generic Niaspan | See latest prices |
| Lovaza (omega-3-acid ethyl esters) | $1,233 per 120, 1 gm capsules | $35 per 120, 1 gm capsules of generic Lovaza | See latest prices |
| Nexletol (bempedoic acid) | $589 for 30, 180 mg tablets | $378 for 30, 180 mg tablets of brand-name Nexletol | See latest prices |
| Zetia (ezetimibe) | $812 for 90, 10 mg tablets | $14 for 90, 10 mg tablets of generic Zetia | See latest prices |
| Tricor (fenofibrate) | $267 for 90, 160 mg tablets | $19 for 90, 160 mg tablets of generic Tricor | See latest prices |
| Evkeeza (evinacumab-dgnb) | $13,474 for 2.3 mL of 345 mg/2.3 mL single-dose vial | N/A | *Only available from your prescriber’s office |
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Other alternatives to Repatha
- Questran (cholestyramine)
- Lopid (gemfibrozil)
- Trilipix (fenofibric acid)
- Fenoglide (fenofibrate)
- Vascepa (icosapent ethyl)
- Vytorin (ezetimibe/ simvastatin)
- Mevacor (lovastatin)
- Livalo (pitavastatin)
- Lescol (fluvastatin)
RELATED: What’s the safest cholesterol medication?
Top 5 Repatha alternatives
The following are some of the most common alternatives to Repatha. Remember, all cholesterol-lowering therapies should be used in combination with lifestyle changes and an appropriate diet.
1. Statin medications
Statins are oral cholesterol-lowering medications often used as a first-line treatment for high LDL cholesterol levels. Unlike Repatha, an injectable monoclonal antibody, statins are taken once daily by mouth and are available in many generic forms. They work by blocking an enzyme in the liver (HMG-CoA reductase) to reduce cholesterol production.
Statins are generally effective and affordable, but may cause muscle pain, which can limit their use in some people. They can be used alone or in combination with other treatments, such as Repatha, when stronger cholesterol control is required. Examples include Lipitor (atorvastatin), Crestor (rosuvastatin), and Zocor (simvastatin).
2. Zetia (ezetimibe)
Zetia contains ezetimibe, a cholesterol absorption inhibitor that can be combined with statins to lower LDL-C levels. Zetia is an oral, once-daily drug that works by blocking the absorption of cholesterol in the small intestine. Zetia can be effective in lowering LDL-C levels, with one study showing that Zetia lowered LDL cholesterol by about 17% to 19% more than placebo.
The most common side effects of Zetia are upper respiratory infection, diarrhea, and joint pain. People with severe liver disease should avoid using Zetia because their bodies may not process the drug properly, leading to higher levels and an increased risk of side effects.
3. Nexletol (bempedoic acid)
Nexletol contains bempedoic acid, an ACL inhibitor that lowers LDL cholesterol by blocking cholesterol synthesis in the liver. Nexletol is an oral tablet taken once daily and is only approved for use in adults. Nexletol is intended to be used alongside statin therapy.
Clinical trials have shown that bempedoic acid can lower LDL cholesterol by about 18% when taken with a statin, 21% in people who are unable to take statins, and up to 38% when combined with ezetimibe. Side effects may include increased uric acid levels, elevated liver enzymes, muscle spasms, and back pain. There is no generic for Nexletol, and the average retail price is over $500 per month without insurance.
4. Evkeeza (evinacumab-dgnb)
Evkeeza (evinacumab-dgnb) is a monthly injection used alongside other treatments to lower LDL cholesterol in people with familial hypercholesterolemia, including adults and children 5 and older. Like Repatha, it’s a monoclonal antibody, but it works by blocking enzymes involved in lipid metabolism. Evkeeza can also lower triglyceride levels, offering broader lipid control.
This product is an injection that is only given once per month. The most common side effects are flu-like symptoms, dizziness, and runny nose. Evkeeza does not currently have a generic on the market. Evkeeza can only be administered in a provider’s office and be billed by them. This can not be purchased directly at the pharmacy for self-administration.
5. Other PCSK9 inhibitors
Other injectable PCSK9 inhibitors include Praluent (alirocumab) and Leqvio (inclisiran), both used to help lower LDL cholesterol in people with cardiovascular disease or genetic high cholesterol. Like Repatha, Praluent is a monoclonal antibody administered every two to four weeks, whereas Leqvio is only administered twice a year, following the initial two doses.
Common side effects include injection site reactions, flu-like symptoms, and muscle pain. Like Repatha, these drugs may also raise blood sugar levels. Both options require a prescription and are typically used alongside diet and other cholesterol-lowering therapies.
Natural alternatives to Repatha
A heart-healthy, low-cholesterol diet is an important part of any cholesterol-lowering plan, whether or not you use medication. Focus on lean proteins, such as chicken, turkey, and fish, instead of processed meats like bologna or sausage. Choose fresh vegetables and season them with herbs and spices rather than heavy, oily sauces. You can also opt for low-fat or non-fat dairy products, and make sure to include plenty of fiber-rich foods like whole grains, fruits, beans, and vegetables.
Several natural products and supplements may help lower cholesterol, although they should not be used without medical advice.
- Red yeast rice contains monacolin K, a compound that’s chemically identical to the prescription drug lovastatin. However, in the U.S., the FDA prohibits the sale of red yeast rice products with more than trace amounts of monacolin K, so their effectiveness may vary. Products with higher monacolin K levels have shown cholesterol-lowering benefits, but can also cause statin-like side effects such as muscle pain.
- Psyllium, a soluble fiber, has been shown to lower LDL cholesterol and may help slow the development of atherosclerosis. It forms a gel in the gut that traps bile acids, which are then excreted in waste. To avoid constipation or blockage, it’s important to take psyllium with plenty of fluids.
- Other supplements that may offer modest cholesterol-lowering effects include soy, green tea, berberine, guggul, and garlic.
Always consult a healthcare provider before starting a natural product or supplement to lower cholesterol. They can help determine whether it’s safe and effective for your condition.
RELATED: 10 natural remedies for high cholesterol
How to switch to a Repatha alternative
There may be various reasons you are considering a change from Repatha. Whether it is due to cost, side effects, method of administration, or allergic sensitivities, there are other cholesterol-lowering medications besides Repatha. The first step is to speak to your healthcare provider.
It is important to have your cholesterol checked regularly with blood draws and lab work. The results of those tests can help you and your doctor make an appropriate choice. Other comorbidities, such as diabetes or high blood pressure, may also affect which medication to take.
Your pharmacist or insurance plan can provide more information on your formulary coverage and what options would be most cost-effective with your plan. If you don’t have insurance coverage or want to ensure you are paying the best price, check SingleCare to find the best prices at pharmacies near you.
Choosing the right path for high cholesterol treatment
There are many alternatives to Repatha, including statins, other oral drugs, injectable medications, and even natural supplements. Each option works differently and has its own pros and cons. The best option will depend on your reason for switching from Repatha. Talk to your healthcare provider to find the right treatment plan based on your cholesterol levels, health history, and budget.
- Statin medications, StatPearls (2024)
- Anti-PCSK9 monotherapy for hypercholesterolemia: The MENDEL-2 randomized, controlled phase III clinical trial of evolocumab, Journal of the American College of Cardiology (2014)
- Bempedoic acid: Lipid lowering for cardiovascular disease prevention, Heart International (2023)
- Evkeeza highlights of prescribing information, U.S. Food and Drug Administration (2023)
- Leqvio highlights of prescribing information, U.S. Food and Drug Administration (2024)
- Red yeast rice: What you need to know, National Center for Complementary and Integrative Health (2022)
- Soluble fiber supplementation and serum lipid profile: A systematic review and dose-response meta-analysis of randomized controlled trials, Advances in Nutrition (2023)
- Supplements for lipid lowering: What does the evidence show?, Current Cardiology Reports (2023)