Zetia vs. Repatha
See how Zetia and Repatha compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Zetia is a daily pill that blocks cholesterol absorption in the gut, while Repatha is an injectable antibody that helps the liver clear more LDL cholesterol from the blood.
Repatha has clinical trial evidence showing it lowers the risk of heart attack and stroke in people with existing cardiovascular disease, while Zetia is approved to lower LDL-C but hasn't been shown on its own to reduce those events.
Zetia is available as a low-cost generic tablet, while Repatha remains a pricier injectable with no generic or biosimilar option available yet.
Zetia vs. Repatha Drug Summary
Zetia
Zetia (ezetimibe) is a cholesterol absorption inhibitor that lowers LDL cholesterol by blocking its absorption in the small intestine. It comes as a once-daily oral tablet, taken alone or alongside a statin or fenofibrate.
Repatha
Repatha (evolocumab) is a PCSK9 inhibitor, a lab-made antibody that helps the liver remove more LDL cholesterol from the blood. It's given as a subcutaneous injection every two weeks or once a month, at home or in a clinic.
Zetia vs. Repatha Side Effects
Zetia
Repatha
Zetia vs. Repatha Dosage
Zetia
Repatha
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 10 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
| 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 |
Zetia
| STAGE | DOSE | WHEN |
| Starting dose | 10 mg once daily | At the start |
| Maximum dose | 10 mg once daily | Same as starting |
| Dose changes | None | Fixed dose |
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 |
Zetia vs. Repatha Indications
Zetia
Zetia is FDA-approved to lower LDL cholesterol in adults with primary hyperlipidemia, either on its own or combined with a statin. It's also approved for use with fenofibrate in mixed hyperlipidemia and with a statin for both forms of familial hypercholesterolemia, including in children 10 and older.
Primary hyperlipidemia, alone or with a statin
Mixed hyperlipidemia, with fenofibrate
Heterozygous familial hypercholesterolemia (age 10+), with a statin
Repatha
Repatha is FDA-approved to reduce the risk of heart attack, stroke, and certain heart procedures in adults with established cardiovascular disease. It's also approved to lower LDL cholesterol in people with heterozygous or homozygous familial hypercholesterolemia, including children 10 and older.
Reduce cardiovascular risk in established heart disease
Heterozygous familial hypercholesterolemia (age 10+)
Homozygous familial hypercholesterolemia (age 10+)
Zetia vs. Repatha Pros and Cons
Zetia
Zetia is a low-cost, well-established oral option that's easy to add to a statin for extra LDL lowering. It hasn't been shown on its own to reduce heart attacks or strokes the way some other cholesterol drugs have.
Pros
Simple once-daily pill, no injections needed
Roughly $8 to $50 a month as a generic, far less than Repatha's $580 to $730
Long track record since its 2002 approval
Can be combined with fenofibrate for mixed hyperlipidemia
Cons
Not shown to directly reduce cardiovascular events on its own
Smaller LDL-C reduction than PCSK9 inhibitors
Requires strict daily adherence to stay effective
Repatha
Repatha delivers a larger LDL-C reduction than oral options and has trial evidence linking it to fewer heart attacks and strokes. It requires injections and costs considerably more, which can mean more insurance hurdles for patients.
Pros
Proven to reduce heart attack and stroke risk in trials
Larger LDL-C reduction than oral cholesterol drugs
Dosing as infrequent as once monthly
No boxed warning on the label
Cons
Requires self-injection every 2 to 4 weeks
Roughly $580 to $730 a month before insurance, with no generic yet
Injection site reactions and flu-like symptoms possible
Common Symptoms and Related Diseases You Can Explore
Explore a range of common symptoms the Doctronic Symptom Checker can help you understand.