Vytorin vs. Repatha

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

Key Takeaways

  • Vytorin is a once-daily pill combining a statin and cholesterol absorption inhibitor, while Repatha is an injectable monoclonal antibody given every two weeks or monthly.

  • Both drugs lower LDL cholesterol, but only Repatha is specifically approved to reduce heart attack and stroke risk in people with existing cardiovascular disease.

  • Vytorin carries a risk of muscle and liver side effects tied to its statin component, while Repatha's main tradeoff is the need for regular injections.

Vytorin vs. Repatha Drug Summary

Vytorin

Vytorin combines ezetimibe and simvastatin in one tablet, blocking cholesterol absorption in the gut while reducing cholesterol production in the liver. It is FDA-approved for lowering LDL cholesterol, total cholesterol, and triglycerides in primary hyperlipidemia, as well as for homozygous familial hypercholesterolemia and homozygous sitosterolemia. It is taken as a single tablet by mouth once a day.

Repatha

Repatha is a PCSK9 inhibitor, a lab-made antibody that helps the liver clear more LDL cholesterol from the blood. It is FDA-approved to lower LDL cholesterol in adults and children 10 and older with familial hypercholesterolemia, and to reduce the risk of heart attack, stroke, and certain heart procedures in adults with existing cardiovascular disease. It is given as a subcutaneous injection every two weeks or once a month.

Vytorin vs. Repatha Side Effects

Vytorin

Most common
headache (up to 5.8%)
increased ALT (up to 3.7%)
upper respiratory tract infection (up to 3.6%)
myalgia (up to 3.6%)

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%)

Vytorin vs. Repatha Dosage

Vytorin

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 10 mg/10 mg once daily At the start
Maximum dose 10 mg/80 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

Vytorin vs. Repatha Indications

Vytorin

Vytorin is approved to lower LDL cholesterol, total cholesterol, triglycerides, and Apo B, and to raise HDL cholesterol in adults with primary hyperlipidemia. It is also approved for homozygous familial hypercholesterolemia and homozygous sitosterolemia, two rare inherited cholesterol disorders. It is not approved for use in patients with active liver disease.

  • Lowers LDL, total cholesterol, and triglycerides

  • Raises HDL cholesterol

  • Treats homozygous familial hypercholesterolemia

  • Treats homozygous sitosterolemia

Repatha

Repatha is approved to lower LDL cholesterol in adults and children 10 and older with heterozygous or homozygous familial hypercholesterolemia, used alongside diet and other cholesterol medications. It is also approved to reduce the risk of heart attack, stroke, and certain heart procedures in adults with established cardiovascular disease. It is not approved for isolated high triglycerides or for children under 10.

  • Lowers LDL in familial hypercholesterolemia

  • Reduces heart attack and stroke risk

  • Reduces need for certain heart procedures

  • Approved for children 10 and older with FH

Vytorin vs. Repatha Pros and Cons

Vytorin

Vytorin is an oral combination pill with decades of clinical use and outcomes data from the IMPROVE-IT trial in people who have had a heart attack. Its statin component carries a known risk of muscle and liver side effects that requires periodic monitoring.

Pros

  • Convenient once-daily oral tablet, no injections

  • Long track record with IMPROVE-IT outcomes data

  • Only cholesterol drug also approved for sitosterolemia

  • Generic-based combination, widely stocked in pharmacies

Cons

  • Interacts with many common drugs via CYP3A4 pathway

  • Not safe for people with active liver disease

  • Carries muscle and rhabdomyolysis risk, especially at 80 mg

  • Requires periodic liver enzyme monitoring

Repatha

Repatha is a monoclonal antibody with strong cardiovascular outcomes evidence from the FOURIER trial and no boxed warning for muscle or liver toxicity. It requires an injection every two weeks or once a month rather than a daily pill, and its needle cover contains latex.

Pros

  • No boxed warning for muscle or liver toxicity

  • FOURIER trial shows reduced cardiovascular events

  • Approved for pediatric FH starting at age 10

  • Fewer drug interactions than statin-based options

Cons

  • Requires injection instead of a pill

  • Needle cover contains latex, a concern for some patients

  • No FDA-approved biosimilar competition to lower cost

  • Injection site reactions can occur

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