Repatha (evolocumab) is taken either once every two weeks or once a month, depending on your preference. The every-two-week dose is 140 mg, while the once-monthly dose is 420 mg. Both schedules lower LDL cholesterol by the same amount, so the choice typically comes down to which routine fits your life better.
The Two Standard Dosing Schedules
For adults with high cholesterol or established heart disease, Repatha offers two options: a single 140 mg injection every 14 days, or a larger 420 mg injection once a month. The biweekly option uses a prefilled autoinjector pen, while the monthly option uses either three separate injections from the pen or a wearable on-body device that delivers the full dose over several minutes.
There is one exception. Patients with homozygous familial hypercholesterolemia, a rare inherited condition that causes extremely high cholesterol from birth, are prescribed the 420 mg monthly dose specifically. For everyone else, the schedule is a personal choice made with your prescriber.
Switching Between Schedules
If you start on one schedule and want to switch, the transition is simple. You take your first dose on the new schedule on the date your next dose under the old schedule would have been due. There’s no washout period or dose adjustment needed. Some people start biweekly and later switch to monthly for convenience, or vice versa if they prefer a smaller injection volume more frequently.
What to Do If You Miss a Dose
If you miss your scheduled injection by seven days or fewer, take it as soon as you remember and then resume your regular schedule from that point. If more than seven days have passed since the missed dose, skip it entirely and take your next dose on the originally scheduled date. Don’t double up to make up for a missed injection.
How to Prepare and Give the Injection
Repatha is stored in the refrigerator but needs to warm up before you inject it. Let the autoinjector or prefilled syringe sit at room temperature for at least 30 minutes before use. If you’re using the on-body infusor for the monthly dose, give it at least 45 minutes. Don’t use a microwave, warm water, or any other method to speed this up. Injecting cold medication is more likely to sting.
You can inject into your abdomen, thigh, or upper arm. Avoid areas that are bruised, red, hard, or scarred, and rotate your injection site each time to prevent skin irritation. If someone else is giving you the injection, the upper arm is an option. If you’re doing it yourself, the abdomen and thigh are usually easiest to reach.
Storing Repatha at Home
Keep Repatha in the refrigerator until you’re ready to use it. If needed, you can store it at room temperature for up to 30 days, which is helpful for travel. Write down the date you took it out of the fridge, because any pen or syringe that has been at room temperature for more than 30 days must be thrown away, even if it hasn’t been opened. Never put it back in the refrigerator after it has warmed to room temperature.
How Quickly Repatha Works
Most people see a significant drop in LDL cholesterol within the first few weeks, but the full effect becomes clear at about the three-month mark. Data from the HEYMANS observational study found a median 58% reduction in LDL cholesterol within three months of starting treatment, and that reduction held steady over 30 months of follow-up. Your prescriber will typically order a blood test around 4 to 12 weeks after you start to confirm the medication is working as expected.
Because both dosing schedules produce equivalent cholesterol reductions, your follow-up timeline and target numbers are the same regardless of whether you chose the biweekly or monthly option.