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Lipid-Lowering Agents

Evolocumab

Brand names: Repatha

Evolocumab is a subcutaneously injected monoclonal antibody (a PCSK9 inhibitor) used to lower LDL-cholesterol in primary hypercholesterolaemia, mixed dyslipidaemia and familial hypercholesterolaemia, and for cardiovascular risk reduction.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It binds and inhibits proprotein convertase subtilisin/kexin type 9 (PCSK9), preventing degradation of hepatic LDL receptors so that more receptors recycle to the cell surface and clear LDL-cholesterol from the blood.

Prescribing in practice

  • It is usually added to a maximally tolerated statin (with or without ezetimibe) rather than used alone, and is prescribed within NICE-defined LDL thresholds and risk categories.
  • Given by self-administered subcutaneous injection that should be rotated between sites; injection-site reactions are the commonest adverse effect.
  • Pre-filled pens require correct cold-chain storage and should be allowed to reach room temperature before injecting.

Monitoring

Check lipid profile to confirm LDL-cholesterol response, with routine review of adherence and injection technique.

Counselling the patient

  • Rotate injection sites and expect occasional redness or soreness where you inject.
  • Keep the pens in the fridge and let one warm to room temperature before use.
  • Continue your statin and other heart medicines unless told otherwise.

Evidence & guidelines

NICE recommends PCSK9 inhibitors such as evolocumab for eligible patients, supported by the FOURIER trial showing reduced cardiovascular events.

Reference: FOURIER trial NEJM 2017; 376(18):1713-1722; NICE TA394; ESC/EAS Lipid Guidelines 2019; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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