6 Repatha Side Effects You Should Know About

If you have high cholesterol, there’s a newer medication class your healthcare team may consider — PCSK9 inhibitors. Usually, you take one of these medications after you’ve already tried a statin. You also might take a statin and a PCSK9 inhibitor together.

Repatha (evolocumab) is one of two FDA-approved PCSK9 inhibitors. It’s an injection that works well to lower high cholesterol from different causes. And if you have heart disease, it can help lower your risk of heart attack and stroke.

But like any medication, side effects are possible with Repatha. Cold and flu symptoms, back pain, and injection site reactions are a few examples.

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Repatha side effects at a glance

Common Repatha side effects are often mild and can usually be managed at home. Rare but serious side effects may need medical attention. 

Repatha can be administered as a lower dose that’s injected every 2 weeks with a prefilled syringe or SureClick autoinjector. These forms, along with the Pushtronex system, also allow for a higher, once-monthly dose. However, the likelihood of side effects appears to go up with the once-monthly Repatha dose.

Common Repatha side effects (those that happened to at least 3% of people in clinical trials) include:

• Cold and flu symptoms

• Back pain

• Injection site reactions

• Urinary tract infections

• Muscle pain

• Diarrhea

• High blood pressure

• Dizziness

• Headache

Less common but potentially serious Repatha side effects include:

• Hypersensitivity reactions, including angioedema and anaphylaxis

• Higher blood glucose (sugar) levels

Below, we cover six notable Repatha side effects you may experience during treatment.

1. Cold and flu symptoms

Cold and flu symptoms are a common Repatha side effect. These symptoms can include:

• Cough

• Runny nose

• Sore throat

Sometimes they’re from an upper respiratory tract infection (URTI), which is also reported by people using Repatha. Examples of URTIs include the common cold and sinus infections.

Cold and flu symptoms often resolve on their own. But if they’re bothersome, there are a few things you can do. You can use a saline nasal spray, drink plenty of fluids, and use a humidifier. You can also try over-the-counter (OTC) cold medications if they’re safe for you to take.

If you have a URTI, you should start feeling better within a week if your infection is caused by a virus. While less common, bacteria can also cause URTIs. In this case, you may need antibiotics. Contact your healthcare team if your symptoms aren’t going away or become severe.

2. Back pain

You may experience back pain as a Repatha side effect. Experts don’t know for sure why this happens. But there are a few things that can help if you develop back pain while using it.

Some tips include:

• Exercising regularly in a way that’s safe and appropriate for you

• Performing stretches that support lower back muscles

• Using heat or ice packs

• Adjusting your sleep position

• Taking an OTC pain reliever, if appropriate

Talk to your healthcare team if you have bothersome back pain. Severe back pain that doesn’t go away could mean there’s something else going on. Your healthcare team can help determine the likely cause of your back pain and recommend next steps.

3. Injection site reactions

Like many injectable medications, Repatha (all forms, including Repatha SureClick) can cause reactions where you inject it — called injection site reactions. These may include pain, redness, and swelling of the area after your dose.

Following your healthcare team’s instructions for how to inject Repatha SureClick and the other forms of Repatha can help lower your risk of injection site reactions. That’s because if you don’t inject the medication properly, you may be more likely to have a reaction. Rotating injection sites and allowing Repatha to come to room temperature before injecting can also help lessen reactions.

Most injection site reactions go away on their own after a few hours or a few days. If your symptoms aren’t going away, or if they’re getting worse, talk to your healthcare team. They can recommend how to handle the reaction.

4. Higher blood glucose levels

Higher blood glucose levels is another reported Repatha side effect. During clinical trials, a slightly higher percentage of people taking Repatha for heart attack and stroke reduction developed diabetes than those who didn’t take it. However, other studies haven’t found an increased risk.

If you’re currently living with Type 2 diabetes, Repatha has been shown to provide cholesterol benefits if you’re already taking a statin. But if you find that your blood glucose levels are higher than usual after starting Repatha, let your prescriber know.

5. Urinary tract infection

Repatha may also be associated with a higher risk of urinary tract infections (UTIs). It’s not clear exactly why people taking Repatha might get UTIs. Fortunately, there are effective UTI treatments available.

UTI symptoms can include pain or burning when urinating, cloudy or pink urine, and the need to pee frequently. Let your healthcare team know if you have these symptoms. If it’s a UTI, they’ll typically recommend starting an antibiotic, which takes a few days to work. In the meantime, the OTC product AZO (phenazopyridine) can help ease UTI pain.

6. Hypersensitivity reactions

Hypersensitivity (allergic) reactions are possible with Repatha. These types of reactions can range from mild to severe and cause symptoms such as a rash, eczema, and itching. Swelling under the skin (angioedema) and severe allergic reactions (anaphylaxis) are also possible.

You may not know if you’re allergic to evolocumab, Repatha’s active ingredient, before injecting it. But if you know you’re allergic to one of the inactive ingredients in the injection, it’s best to avoid Repatha. And if you’re allergic to latex, be aware that the medication’s needle cover contains a form of latex that may cause a reaction.

Anaphylaxis can be life-threatening. Symptoms can include widespread skin reactions, throat swelling, and low blood pressure. If you experience any of these symptoms, get medical help right away.

If you have a mild allergic reaction to Repatha after starting treatment, let your healthcare team know. They can recommend an alternative medication. If you experience severe or life-threatening symptoms, call 911 or seek emergency medical care.

Good to know: Even if you’ve experienced an allergic reaction to a different PCSK9 inhibitor, you may still be able to take Repatha.

When should you contact your prescriber about Repatha side effects?

It’s a good idea to clear up any questions you have about Repatha side effects before starting the medication. You can check with your healthcare team about what to expect.

If your side effects are mild and temporary, they can usually be addressed at home. Any side effects that become bothersome or require medical care, such as back pain or a UTI, should be reported to your healthcare team. If you’re having symptoms that seem life-threatening, including allergic reactions, get medical care immediately.

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Written by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

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