Cholesterol Shots: 4 Options, Every 2 Weeks to Twice a Year

A cholesterol shot is an injection that lowers LDL cholesterol by about 50 to 60%, given anywhere from every two weeks to twice a year. The US has four: Repatha, Praluent, and Lerochol, which you inject at home, and Leqvio, which a healthcare professional gives twice a year after the first two doses.

All four work on PCSK9, a liver protein that destroys LDL receptors. With less PCSK9 around, the liver keeps more receptors and pulls more LDL out of your blood. Day to day, they differ in how often you take them, who gives them, how much evidence backs them, and how you pay.

Which cholesterol shots are available? Repatha vs Praluent vs Leqvio vs Lerochol

Four cholesterol shots are FDA-approved as of October 2026: Repatha (evolocumab), Praluent (alirocumab), Lerochol (lerodalcibep), and Leqvio (inclisiran). Repatha and Praluent have the longest track record and completed outcomes trials. Lerochol and Leqvio are newer, or newer in how doctors can use them.

Sources: Repatha label (DailyMed) and AmgenNow announcement; Praluent label (DailyMed) and GoodRx; Lerochol from TCTMD and LIB Therapeutics; Leqvio label (DailyMed), ORION-10 and ORION-11 (Ray, NEJM 2020), and Leqvio.com. LDL-C figures come from different trials with different patients, so use them as ballpark numbers and avoid ranking the drugs strictly by them.

This timeline shows how often each option is taken over a year.

Is there a once-a-month cholesterol injection?

Yes, three of them. Lerochol is a once-a-month shot by design, and Repatha and Praluent each have a monthly dose option, all injected at home under the skin. Repatha and Praluent also come as an every-2-weeks schedule.

• Lerochol is one injection a month from a prefilled syringe that can stay at room temperature for up to three months. An autoinjector pen was FDA-approved on August 17, 2026, and LIB Therapeutics expects it to be available by January 2027 (LIB Therapeutics).
• Repatha can be taken as 140 mg every 2 weeks or 420 mg once a month (DailyMed).
• Praluent starts at 75 mg every 2 weeks or 300 mg every 4 weeks. On the 4-week dose, LDL is best checked just before the next shot, because it can drift between doses (DailyMed).

Our Lerochol guide and Praluent guide go deeper on each.

Is there a twice-a-year cholesterol shot, and how does it compare to a monthly one?

Yes. Leqvio (inclisiran) is given as a first dose, a second dose three months later, and then once every six months, so after the first year it's two shots a year. A healthcare professional gives it, so you go to a clinic or infusion center instead of injecting yourself.

Leqvio works one step earlier than the others. Repatha and Praluent are antibodies that grab PCSK9 after the liver makes it; Leqvio is a small interfering RNA (siRNA) that tells the liver to make less PCSK9 in the first place, which is why one dose lasts months. Its label now covers adults with high cholesterol alongside diet and exercise, with no requirement to be on a statin (DailyMed).

Compared with a monthly home injection, the twice-a-year shot trades a little LDL lowering (about 50% for Leqvio versus 56 to 59% for the others) for two clinic visits a year and no self-injecting. It also has no outcomes results yet, and Leqvio billed in a clinic usually goes through Medicare Part B instead of Part D. If outcomes evidence matters most to you, Repatha and Praluent have it.

We're working with infusion centers to offer Leqvio. Setup is still under way, so if the twice-a-year schedule appeals to you, ask us about availability in your area. Our Leqvio guide covers how it's given and paid for.

How much do cholesterol shots lower LDL cholesterol?

All four lower LDL by roughly half or more compared with placebo: about 50% for Leqvio and 56 to 59% for the others at their full doses. For someone starting at an LDL-C of 140 mg/dL, LDL-C would fall to somewhere around 60 to 70.

In FOURIER, people already on a statin saw their LDL-C fall 59% on Repatha, from a median of 92 mg/dL to 30.

The 2026 ACC/AHA cholesterol guideline notes that PCSK9 inhibitors lower LDL by about 60%, compared with 15 to 20% for ezetimibe. When LDL stays above goal on a statin, it says adding ezetimibe and/or a PCSK9 inhibitor "should be implemented without delay" (ACC). If you're only a little above goal, a pill like ezetimibe may be enough.

Do cholesterol shots prevent heart attacks?

Repatha and Praluent have proven it in large outcomes trials, each cutting major cardiovascular events by about 15%. Lerochol and Leqvio are approved on the strength of LDL lowering, and their own outcomes results haven't come in yet.

• Repatha: in FOURIER, 27,564 people with cardiovascular disease had 15% fewer major events over a median of 2.2 years. In VESALIUS-CV, in 12,257 people with atherosclerosis or diabetes but no prior heart attack or stroke, Repatha lowered the risk of a first heart attack, stroke, or coronary death by 25%.
• Praluent: in ODYSSEY OUTCOMES, 18,924 people who'd recently had a heart attack or unstable angina had 15% fewer major events (9.5% vs 11.1%) over a median of 2.8 years.
• Leqvio: its outcomes trials, ORION-4 and VICTORION-2 PREVENT, haven't published results (ClinicalTrials.gov NCT03705234).
• Lerochol: no Lerochol-specific outcomes trial has reported. Its August 2026 label update notes that outcomes trials of statins and antibody PCSK9 inhibitors have shown lower LDL reduces cardiovascular events, a statement about LDL lowering in general.

What are the side effects of cholesterol shots?

The most common side effect of every cholesterol shot is a mild reaction where the needle goes in: redness, itching, swelling, or tenderness. Most other side effects showed up only slightly more often than with placebo injections.

By medicine, from the labels and trials:

• Repatha: in FOURIER, the side effects seen in more than 5% of people were diabetes (8.8% vs 8.2% on placebo), cold symptoms (7.8% vs 7.4%), and upper respiratory infections (5.1% vs 4.8%) (DailyMed). Overall, FOURIER found no significant difference in side effects between Repatha and placebo, including new-onset diabetes and neurocognitive (thinking and memory) events, apart from injection-site reactions (2.1% vs 1.6%). Our Repatha side effects guide has the full numbers.
• Praluent: injection-site reactions in 7.2% vs 5.1% on placebo; allergic reactions were the most common reason people stopped (0.6% vs 0.2%) (DailyMed).
• Lerochol: cold-like symptoms, injection-site reactions, and mild ankle or leg swelling; in its main trial, injection-site reactions were more common than with placebo and mild to moderate. See our Lerochol guide.
• Leqvio: the label lists injection-site reactions, joint pain, and bronchitis as the common ones (3% or more) (DailyMed).

Any of these can rarely cause an allergic reaction. Get emergency care for swelling of the face, lips, or throat, or trouble breathing.

Are twice-yearly Leqvio shots safe to receive long term?

In the longest follow-up available, Leqvio showed no new safety signals for up to about 6 years, though the evidence comes mostly from open-label follow-up. The ORION-8 extension followed 3,274 people from earlier Leqvio trials, with a mean of 3.7 years on treatment including the earlier trials (up to 6.8 years) and 12,109 patient-years in total. LDL lowering held steady, injection-site reactions were the main drug-related finding (5.9%, all mild or moderate), and 2.4% stopped because of side effects. The authors reported no new safety signals (Wright et al., Cardiovascular Research 2024).

ORION-8 had no placebo group. A pooled analysis of seven trials that did include placebo (3,576 people on Leqvio, with follow-up up to 6 years, and 1,968 on placebo for up to 1.5 years) found serious side effects, liver, muscle, and kidney events, and new diabetes at similar rates in both groups, and concluded Leqvio was well tolerated without new safety signals (Wright et al., JACC 2023). The ORION-8 report was funded by Novartis, and neither analysis tests whether Leqvio prevents heart attacks. That answer waits on ORION-4 and VICTORION-2 PREVENT. Ask your clinician how this evidence fits your own health history.

Are Repatha and Praluent approved for children?

Yes, for some children with inherited high cholesterol, and Praluent starts at a younger age. Per the labels, Repatha is approved with diet and other therapy for children aged 10 and older with heterozygous or homozygous familial hypercholesterolemia (Repatha label, DailyMed). Praluent is approved for children aged 8 and older with heterozygous familial hypercholesterolemia, and its label has no pediatric indication for the homozygous form (Praluent label, DailyMed). So Praluent is approved for younger children than Repatha.

Leqvio's label covers patients aged 12 and older with either form (Leqvio label, DailyMed). All three labels state that safety and effectiveness are not established below those ages or for other types of high cholesterol in children. A pediatric lipid specialist makes these decisions, and labels can change, so check the current label with the prescriber.

How much does a cholesterol shot cost? Compare the options by price

Without insurance, as of October 2026, the home shots run from $199 to $239 a month through manufacturer cash programs: Lerochol $199, Praluent $225, and Repatha $239. Leqvio lists at $3,587.73 per dose for uninsured patients, so most people get it through insurance.

With insurance, the shots usually need prior authorization, and plans often ask for proof that you've tried a statin, sometimes ezetimibe too. For commercially insured patients, manufacturer copay cards can bring the cost down a lot. Leqvio, when given in a clinic, is usually billed to Medicare Part B rather than Part D, and Novartis says patients with traditional Medicare plus a supplemental plan may pay as little as $0 (Leqvio.com). Our Repatha cost guide walks through prior authorization and appeals.

Cash programs usually run outside your insurance, so what you pay may not count toward your deductible. Our Repatha cost guide explains the AmgenNow terms. That trade often pays off when insurance blocks access.

This chart compares a year of cash or list prices.

What if you don't want a shot?

The same class now includes a pill. Lipfendra (enlicitide), approved in July 2026, is a once-daily PCSK9 inhibitor that lowered LDL by about 56 to 59% compared with placebo, in the same range as the shots (prescribing information, DailyMed).

You take it every morning on an empty stomach and wait 30 minutes to eat, the list price is about $315 a month (Chicago Sun-Times), and its outcomes trial is still running. Our Lipfendra guide covers it, and new cholesterol drugs in 2026 covers everything else that changed this year.

Enter your LDL and goal to see what each medicine could do on average.

How do you get a cholesterol shot?

You need a prescription from a licensed clinician, and then either insurance approval or a cash program. The home shots (Repatha, Praluent, Lerochol) are filled at a pharmacy or shipped to you; Leqvio needs a clinic or infusion center to give it.

Preval Health focuses only on prescription cholesterol care. A board-certified preventive cardiologist writes our treatment protocols, and licensed clinicians prescribe through our partner telehealth network. Our partner clinicians prescribe Repatha, Praluent, Lerochol, and the Lipfendra pill, and we're working with infusion centers to offer Leqvio.

Preval runs as a cash practice. Prescriptions go through manufacturer direct programs and pharmacy cash prices, so you skip the prior authorization wait. If your insurer denied a PCSK9 inhibitor, you can start here.

If statins are the problem, our statin intolerance program starts there. We recheck your labs every quarter and adjust to reach goal and keep you there. Care costs $99 a month, with medicines at cash prices. For the step-by-step version, see how to get a PCSK9 inhibitor prescription online.