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

Most common
Headache (up to 6.2%)
Nausea (up to 3.4%)
Myalgia (up to 3.0%)
Asthenia (up to 2.7%)

Repatha

Most common
Nasopharyngitis (up to 10.5%)
Upper respiratory tract infection (up to 9.3%)
Influenza (up to 7.5%)
Back pain (up to 6.2%)

Crestor vs. Repatha Dosage

Crestor

Dosage
Dosage Table
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

Dosage
Dosage Table
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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