Crestor vs. Repatha
See how Crestor and Repatha compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Crestor is a daily statin pill that blocks cholesterol production in the liver, while Repatha is an injectable antibody that helps the liver clear more LDL cholesterol from the blood.
Both drugs are approved to lower LDL cholesterol and reduce cardiovascular risk, but Repatha is typically added on top of a statin like Crestor rather than used in place of it.
Generic Crestor is one of the least expensive cholesterol medications available, while Repatha has no generic competitor and carries a much higher monthly price.
Crestor vs. Repatha Drug Summary
Crestor
Crestor (rosuvastatin) is a statin that blocks an enzyme in the liver to lower LDL cholesterol, total cholesterol, and triglycerides. It comes as an oral tablet taken once daily, with doses ranging from 5 mg to 40 mg. It is also approved to reduce the risk of heart attack, stroke, and artery procedures in adults with cardiovascular risk factors.
Repatha
Repatha (evolocumab) is a PCSK9 inhibitor, a lab-made antibody that helps the liver clear more LDL cholesterol from the blood. It is given as a subcutaneous injection every two weeks or once monthly, using a prefilled syringe, autoinjector, or on-body infusor. It is approved for adults with established heart disease or familial hypercholesterolemia, and for children 10 and older with the inherited forms.
Crestor vs. Repatha Side Effects
Crestor
Repatha
Crestor vs. Repatha Dosage
Crestor
Repatha
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 5-40 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
| STAGE | DOSE | WHEN |
| Starting dose | 140 mg every 2 weeks | At the start |
| Maximum dose | 420 mg every 2 weeks | If needed |
| Dose changes | 2 increases | As tolerated |
Crestor
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg once daily | At the start |
| Maximum dose | 5-40 mg once daily | If needed |
| Dose changes | 3 increases | As tolerated |
Repatha
| STAGE | DOSE | WHEN |
| Starting dose | 140 mg every 2 weeks | At the start |
| Maximum dose | 420 mg every 2 weeks | If needed |
| Dose changes | 2 increases | As tolerated |
Crestor vs. Repatha Indications
Crestor
Crestor is FDA-approved to lower LDL cholesterol, total cholesterol, and triglycerides in adults and children with high cholesterol or mixed dyslipidemia. It also reduces the risk of heart attack, stroke, and artery procedures in adults with cardiovascular risk factors but no diagnosed heart disease. It treats inherited high cholesterol conditions in children as young as 7.
Lowers LDL cholesterol, total cholesterol, and triglycerides
Reduces heart attack, stroke, and revascularization risk in at-risk adults
Treats heterozygous and homozygous familial hypercholesterolemia
Slows progression of atherosclerosis
Approved for children as young as 7 with inherited high cholesterol
Repatha
Repatha is FDA-approved to lower LDL cholesterol in adults with established cardiovascular disease, and to reduce the risk of heart attack, stroke, and certain heart procedures in that group. It is also used, as an add-on to diet and other LDL-lowering drugs, for adults and children 10 and older with heterozygous or homozygous familial hypercholesterolemia. It is not approved for isolated high triglycerides or children under 10.
Reduces heart attack, stroke, and heart procedure risk in adults with CVD
Lowers LDL cholesterol as an add-on to statins and other therapies
Treats heterozygous familial hypercholesterolemia
Treats homozygous familial hypercholesterolemia
Approved for children 10 and older with familial hypercholesterolemia
Crestor vs. Repatha Pros and Cons
Crestor
Crestor has decades of safety data as an oral statin and is widely covered by insurance, with a generic version that is inexpensive at most pharmacies. Its main trade-offs are the need for a daily pill, muscle-related side effects, and periodic liver monitoring.
Pros
Oral tablet, no injections needed
Generic version costs as little as $4 to $20 a month without insurance
Decades of real-world safety data across millions of patients
Flexible dosing from 5 mg to 40 mg to fit different LDL goals
Cons
Must be taken every day to stay effective
Can cause muscle pain, weakness, or rarely rhabdomyolysis
Requires occasional liver enzyme monitoring
Interacts with antacids, warfarin, and certain HIV and hepatitis drugs
Repatha
Repatha offers a needle-based option for patients who cannot tolerate statins or need extra LDL lowering beyond what a statin provides, backed by a large cardiovascular outcomes trial. Its main trade-off is a much higher price with no generic alternative on the market.
Pros
Only needs to be injected every 2 weeks or once a month
FOURIER trial showed a significant drop in major cardiovascular events
No boxed warning and few drug interactions
Fully human antibody rather than a small-molecule drug
Cons
Costs $580 to $730 a month with no generic competition available
Requires self-injection rather than a pill
Needle cover contains latex, a risk for latex-sensitive patients
No oral option for patients who prefer pills
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