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

Most common
Upper respiratory tract infection (up to 4.3%)
Diarrhea (up to 4.1%)
Arthralgia (up to 3.0%)
Sinusitis (up to 2.8%)

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%)

Zetia vs. Repatha Dosage

Zetia

Dosage
Dosage Table
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

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

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

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