Pravachol vs. Repatha

See how Pravachol and Repatha compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Pravachol is a low-cost daily statin pill, while Repatha is an injectable PCSK9 inhibitor often added when statins alone don't lower LDL enough.

  • Both drugs are approved to cut heart attack and stroke risk, but only Repatha treats homozygous familial hypercholesterolemia, which statins cannot.

  • Repatha costs far more per month than generic pravastatin, so many patients try a statin first unless LDL is very high or a genetic disorder is present.

Pravachol vs. Repatha Drug Summary

Pravachol

Pravachol (pravastatin) is a statin that blocks an enzyme the liver uses to make cholesterol, lowering LDL and reducing cardiovascular risk. It comes as a tablet taken once daily, with or without food. It's approved for adults with high cholesterol or existing heart disease, and for children 8 and older with a genetic cholesterol disorder.

Repatha

Repatha (evolocumab) is a PCSK9 inhibitor, a lab-made antibody that helps the liver clear more LDL cholesterol from the blood. It's given as a subcutaneous injection every 2 weeks or once a month, at home or in a clinic. It's approved for adults with heart disease and for people 10 and older with certain inherited high-cholesterol conditions.

Pravachol vs. Repatha Side Effects

Pravachol

Most common
musculoskeletal pain (up to 24.9%)
upper respiratory infection (up to 21.2%)
nausea/vomiting (up to 10.5%)
diarrhea (up to 6%)

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%)

Pravachol vs. Repatha Dosage

Pravachol

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 40 mg once daily At the start
Maximum dose 80 mg once daily If needed
Dose changes 1 increase 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

Pravachol vs. Repatha Indications

Pravachol

Pravachol is FDA-approved to lower LDL cholesterol in adults with primary hyperlipidemia and to reduce the risk of heart attack, stroke, and related procedures in adults with or without existing coronary heart disease. It's also approved for children 8 and older with heterozygous familial hypercholesterolemia and for certain adults with high triglycerides or a rare lipid disorder.

  • Lowers LDL cholesterol in adults with primary hyperlipidemia

  • Reduces heart attack and stroke risk in adults with existing coronary heart disease

  • Reduces heart attack risk in adults with high LDL but no diagnosed heart disease

  • Treats children 8 and older with heterozygous familial hypercholesterolemia

Repatha

Repatha is FDA-approved to lower the risk of heart attack, stroke, and coronary procedures in adults with established cardiovascular disease. It's also approved to lower LDL cholesterol in adults and children 10 and older with heterozygous or homozygous familial hypercholesterolemia, always used alongside diet and other LDL-lowering treatment.

  • Lowers heart attack, stroke, and cardiac procedure risk in adults with heart disease

  • Lowers LDL cholesterol in adults and children 10+ with heterozygous familial hypercholesterolemia

  • Lowers LDL cholesterol in adults and children 10+ with homozygous familial hypercholesterolemia

  • Used as an add-on to diet and other LDL-lowering therapies

Pravachol vs. Repatha Pros and Cons

Pravachol

Pravachol is an older, well-studied statin with decades of real-world safety data and a low generic price. It's a reasonable first choice for moderate cholesterol elevation, though it's less potent than newer options for patients who need aggressive LDL lowering.

Pros

  • Costs roughly $9 to $30 a month as a generic, versus $580 to $730 for Repatha

  • Oral tablet, no injections or needles required

  • More than 30 years of long-term safety data

  • Approved for children as young as 8, younger than Repatha's cutoff of 10

Cons

  • Less effective at lowering LDL than PCSK9 inhibitors like Repatha

  • Carries a risk of muscle pain and, rarely, muscle breakdown

  • Not approved for homozygous familial hypercholesterolemia

  • Requires daily dosing, so missed doses are more common

Repatha

Repatha works through a different mechanism than statins, so it can lower LDL further in patients who don't reach goal on pills alone. It's a newer therapy with less price competition, and it requires an injection rather than a pill.

Pros

  • Only needs to be injected every 2 weeks or once a month

  • Approved for homozygous familial hypercholesterolemia, which statins cannot treat

  • Large outcomes trial showed fewer heart attacks and strokes when added to a statin

  • Not linked to the muscle pain seen with statins

Cons

  • Costs roughly $580 to $730 a month, far more than generic pravastatin

  • Requires self-injection; needle cover contains latex

  • No biosimilar available yet, so the price isn't likely to drop soon

  • Fewer years of real-world use than decades-old statins like Pravachol

Common Symptoms and Related Diseases You Can Explore

Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.