Zocor vs. Repatha

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

Key Takeaways

  • Zocor is a low-cost oral statin taken once a day, while Repatha is an injectable antibody given every two weeks or once a month.

  • Repatha produces larger LDL reductions than statins and has no boxed warning, but its list price is far higher than generic Zocor.

  • Both drugs are approved to lower cardiovascular risk, and doctors often add Repatha when a statin alone does not lower LDL enough.

Zocor vs. Repatha Drug Summary

Zocor

Zocor (simvastatin) is a statin that lowers LDL cholesterol by blocking an enzyme the liver uses to make cholesterol. It is taken as a once-daily oral tablet and has been used since 1991 to treat high cholesterol and reduce cardiovascular risk.

Repatha

Repatha (evolocumab) is a PCSK9 inhibitor, a lab-made antibody that helps the liver clear more LDL cholesterol from the blood. It is given as a subcutaneous injection every two weeks or once a month, usually alongside a statin or when statins are not enough.

Zocor vs. Repatha Side Effects

Zocor

Most common
Upper respiratory infection (9%)
Headache (7%)
Abdominal pain (7%)
Constipation (7%)

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%)

Zocor vs. Repatha Dosage

Zocor

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

Zocor vs. Repatha Indications

Zocor

Zocor is FDA-approved to lower LDL cholesterol in adults with high cholesterol, including inherited forms like familial hypercholesterolemia. It is also approved to reduce the risk of heart attack, stroke, and death in people with existing heart disease or diabetes at high cardiovascular risk.

  • Lowers LDL cholesterol in primary hyperlipidemia

  • Treats heterozygous familial hypercholesterolemia (ages 10+)

  • Adjunct therapy for homozygous familial hypercholesterolemia

  • Reduces heart attack, stroke, and death risk in high-risk adults

Repatha

Repatha is FDA-approved to lower LDL cholesterol in adults and children 10 and older with familial hypercholesterolemia, usually alongside a statin or other LDL-lowering therapy. It is also approved to reduce the risk of heart attack, stroke, and certain heart surgeries in adults with established cardiovascular disease.

  • Lowers LDL cholesterol in heterozygous familial hypercholesterolemia (ages 10+)

  • Lowers LDL cholesterol in homozygous familial hypercholesterolemia (ages 10+)

  • Reduces heart attack and stroke risk in established cardiovascular disease

  • Used as add-on to statins or other LDL-lowering therapy

Zocor vs. Repatha Pros and Cons

Zocor

Zocor has decades of real-world safety data and is available as an inexpensive generic that most insurance plans cover easily. Its main risks are muscle-related side effects and interactions with certain other medications, which require some caution with dosing.

Pros

  • Low-cost generic, roughly $75 to $100 per month

  • Once-daily oral tablet, no injections needed

  • Decades of clinical experience since 1991

  • Widely covered by insurance with low copays

Cons

  • Risk of myopathy and rhabdomyolysis, especially at 80 mg

  • Contraindicated with strong CYP3A4 inhibitors

  • Contraindicated in pregnancy

  • Generally smaller LDL reductions than PCSK9 inhibitors

Repatha

Repatha offers larger LDL reductions than statins alone and carries no boxed warning, but it must be injected rather than taken as a pill. Its high list price and lack of a biosimilar competitor make cost a bigger barrier for many patients.

Pros

  • No boxed warning on the label

  • Larger LDL reductions than statins alone

  • Dosing as infrequent as once monthly

  • Fully human antibody with low drug-interaction risk

Cons

  • Roughly $580 to $730 per month without insurance

  • Requires injection every 2 weeks or monthly

  • No biosimilar competition to lower price as of 2026

  • Needle cover contains latex, a risk for allergic patients

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