Evolocumab

Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 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.

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In short

What the research says.

A quick, data-only summary. The full evidence, dosing, and sources are below.

Evolocumab is a fully human monoclonal antibody that lowers low-density lipoprotein cholesterol (LDL-C) by inhibiting proprotein convertase subtilisin/kexin type 9 (PCSK9). NutriStack rates the supporting evidence as strong. Common adult dosing is 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)., though a prescriber sets the actual dose. This profile indexes 2 sources.

What it's good for

Lowering LDL cholesterol in primary hyperlipidemia including heterozygous familial hypercholesterolemia²
Adjunct treatment of homozygous familial hypercholesterolemia²
Reducing risk of myocardial infarction, stroke, and coronary revascularization in adults with established cardiovascular disease¹

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 0 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

Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Randomized controlled trials

1Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease (FOURIER)PMIDSabatine 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

2Repatha (evolocumab) US Prescribing InformationAmgen 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.

FAQ

Common questions.

Quick answers about Evolocumab, drawn from the data on this page.

What is Evolocumab?

What is Evolocumab used for?

Commonly cited benefits of Evolocumab include: 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. NutriStack rates the overall evidence as strong.

What is a typical dose of Evolocumab?

A typical adult dose of Evolocumab is 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).. The commonly recommended form is Subcutaneous injection (prefilled syringe or autoinjector/on-body infusor); inject into abdomen, thigh, or upper arm. These are general ranges, not personalized advice; confirm the right dose with a clinician.

What are the side effects of Evolocumab?

Reported side effects include 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). This is educational information; check with a healthcare professional before use.

How strong is the evidence for Evolocumab?

NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.

Use this with your stack

Evolocumab in NutriStack.

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