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
Repatha
Pravachol vs. Repatha Dosage
Pravachol
Repatha
| 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 |
| 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
| 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
| 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
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