InfoSynergy
Berberine
Berberine may add modest lipid-lowering effects to Evolocumab.
Recommendation: Use as part of the lipid plan, not as a substitute for prescribed therapy; recheck lipids after regimen changes.
Evolocumab
Prescription ·Strong evidence ·Reviewed May 2026
Evolocumab is a fully human monoclonal antibody that lowers low-density lipoprotein cholesterol (LDL-C) by inhibiting proprotein convertase subtilisin/kexin type 9 (PCSK9). It is given by subcutaneous injection as an adjunct to diet and maximally tolerated statin therapy in patients with established atherosclerotic cardiovascular disease, primary hyperlipidemia, or familial hypercholesterolemia. Large outcome data show it reduces major cardiovascular events on top of statins.
What it's good for
What to watch for
- Injection-site reactions (erythema, pain, bruising)
- Nasopharyngitis and upper respiratory tract infection
- Influenza-like symptoms
- History of serious hypersensitivity reaction to evolocumab or any component of the formulation
The bottom line
Evidence rating strong. Most-documented uses: lowering ldl cholesterol in primary hyperlipidemia including heterozygous familial hypercholesterolemia, adjunct treatment of homozygous familial hypercholesterolemia, reducing risk of myocardial infarction, stroke, and coronary revascularization in adults with established cardiovascular disease. 2 sources indexed (2017–2021), with 5 interaction records on file.
The science
How it works, mechanistically.
Core mechanism
PCSK9 binds to hepatic LDL receptors and targets them for lysosomal degradation, reducing the liver's capacity to clear circulating LDL-C. Evolocumab binds free PCSK9 in the plasma and prevents it from interacting with LDL receptors, so more receptors are recycled back to the hepatocyte surface. The resulting increase in LDL receptor density enhances clearance of LDL particles from the blood, lowering LDL-C by roughly 55 to 60 percent. This LDL receptor sparing effect is independent of and additive to the LDL lowering produced by statins.
Class
PCSK9 inhibitor (lipid-lowering monoclonal antibody)
Dosing
Dosing & protocol.
Common range
For primary hyperlipidemia and cardiovascular risk reduction: 140 mg subcutaneously every 2 weeks OR 420 mg subcutaneously once monthly. For homozygous familial hypercholesterolemia: 420 mg subcutaneously once monthly (may be uptitrated to every 2 weeks if needed).
Recommended form
Subcutaneous injection (prefilled syringe or autoinjector/on-body infusor); inject into abdomen, thigh, or upper arm
Administered subcutaneously, not orally, so dietary intake does not affect absorption. Bioavailability is approximately 72 percent after subcutaneous dosing with peak serum concentration in about 3 to 4 days. Allow refrigerated product to reach room temperature for about 30 to 45 minutes before injecting to reduce injection-site discomfort; do not warm by other means.
Safety
Full safety detail.
Side effects
- Injection-site reactions (erythema, pain, bruising)
- Nasopharyngitis and upper respiratory tract infection
- Influenza-like symptoms
- Back pain and arthralgia
- Hypersensitivity reactions including rash and urticaria (rarely angioedema)
Contraindications
- History of serious hypersensitivity reaction to evolocumab or any component of the formulation
Interactions
Interaction records.
InfoSynergy
Psyllium Husk
Psyllium Husk may add modest lipid-lowering effects to Evolocumab.
Recommendation: Use as part of the lipid plan, not as a substitute for prescribed therapy; recheck lipids after regimen changes.
InfoSynergy
Fish Oil
Fish Oil may add modest lipid-lowering effects to Evolocumab for triglyceride management.
Recommendation: Use as part of the lipid plan, not as a substitute for prescribed therapy; recheck lipids after regimen changes.
InfoSynergy
Coenzyme Q10
Coenzyme Q10 (ubiquinone) is sometimes used by patients on lipid-lowering therapy because of concerns about statin-associated muscle symptoms. Evolocumab is a PCSK9 inhibitor monoclonal antibody and, unlike statins, does not deplete the mevalonate pathway and is not associated with myopathy or reductions in endogenous CoQ10. There is no pharmacokinetic interaction between CoQ10 and evolocumab. Co-use is benign, but CoQ10 should not be expected to add meaningful LDL-lowering or to mitigate a side effect that evolocumab does not cause.
Recommendation: No interaction-based restriction. CoQ10 may be continued if a patient takes it, but it is not required with evolocumab and does not address any evolocumab-specific risk. Do not substitute CoQ10 for evidence-based LDL-lowering therapy.
InfoCaution
Berberine
Berberine is taken by some patients to lower LDL cholesterol and improve glycemic measures. Mechanistically it is of interest here because berberine upregulates hepatic LDL-receptor expression in part by reducing PCSK9 expression - the same target evolocumab antagonizes. The two therefore act on overlapping biology and may produce additive LDL reduction. There is no pharmacokinetic interaction, but patients should not rely on berberine as a substitute for proven therapy, and clinicians should be aware berberine may contribute to lipid lowering when interpreting LDL changes.
Recommendation: If a patient takes berberine, continue lipid monitoring as usual; additive LDL lowering is possible but berberine is not a validated replacement for evolocumab. Note that berberine inhibits intestinal and hepatic CYP3A4 and may affect other co-prescribed drugs (not evolocumab itself). Advise patients to disclose berberine use given its broader interaction profile.
Sources
Sources, by evidence tier.
Numbered references. Citations throughout the page link here.
Randomized controlled trials
1- 1Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease (FOURIER)Needs reviewPMIDSabatine MS, Giugliano RP, Keech AC, et al. · New England Journal of Medicine · 2017
In about 27,500 patients on statin therapy, evolocumab lowered LDL-C by roughly 59 percent and reduced the composite of cardiovascular death, MI, stroke, hospitalization for unstable angina, or coronary revascularization (HR 0.85) over a median 2.2 years.
Reference material
1- 2Repatha (evolocumab) US Prescribing InformationNeeds reviewNo linkAmgen Inc. · FDA Prescribing Information · 2021
Approved for primary hyperlipidemia (including heterozygous familial hypercholesterolemia), homozygous familial hypercholesterolemia, and reduction of cardiovascular events; dosing of 140 mg every 2 weeks or 420 mg monthly typically lowers LDL-C by about 55 to 60 percent.
Keep exploring
Deep dives & adjacent profiles.
This page is educational. Do not start, stop, or change a supplement or medication based on it without checking with a qualified healthcare professional.
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