Praluent (Alirocumab): Dosing, Cost, Safety

What is Praluent (alirocumab)?

Praluent (alirocumab) is a PCSK9 inhibitor: an injectable antibody that lowered LDL cholesterol by 46 to 58% more than placebo in its trials and reduces the risk of heart attack and stroke. You give it yourself with a pre-filled pen, every 2 weeks or every 4 weeks.

Its FDA label covers reducing the risk of major cardiovascular events in adults at increased risk, and lowering LDL in adults with high cholesterol, in children 8 and older with heterozygous familial hypercholesterolemia, and in adults with the homozygous form (Praluent prescribing information, DailyMed).

Praluent belongs to a different class from statins. It joins several PCSK9 options now, alongside Repatha, the once-monthly Lerochol, and the daily pill Lipfendra, and our PCSK9 inhibitors explained guide covers the whole class.

How does Praluent work?

Praluent binds to a protein called PCSK9, which normally destroys the LDL receptors liver cells use to pull LDL out of the blood. With PCSK9 blocked, more receptors stay active and more LDL gets cleared.

Statins work at a different step, by slowing the liver's own cholesterol production, which is why Praluent can be added on top of a statin, as it was in ODYSSEY OUTCOMES.

What is the Praluent dose, and how is it given?

Most adults start with 75 mg every 2 weeks or 300 mg every 4 weeks, injected under the skin. If LDL doesn't fall enough, the dose can be raised to 150 mg every 2 weeks.

Other details from the label (DailyMed):

• Homozygous FH, or heterozygous FH on LDL apheresis: 150 mg every 2 weeks.
• Children 8 and older with heterozygous FH: the dose is based on weight, 150 mg every 4 weeks under 50 kg and 300 mg every 4 weeks at 50 kg or more.
• If you're on the every-4-weeks dose: LDL-C is best measured just before the next dose, because it can drift between doses.
• Latex: the pen's needle shield is not made with natural rubber latex.

How is Praluent administered? (how to use the pen)

You inject Praluent under the skin of your thigh, stomach, or upper arm with a single-use pre-filled pen, and a pen takes up to 20 seconds to finish. The steps below summarize Regeneron's official Instructions for Use for the 150 mg pen (Praluent Instructions for Use, March 2024). Follow the leaflet in your own box and the training your pharmacist or clinician gives you, because pens and versions differ.

1. Warm the pen. Take it out of the refrigerator and let it reach room temperature for 30 to 40 minutes. Skip heating it, and do not put it back in the refrigerator.
2. Check it. Confirm the label and expiration date. The liquid should look clear, colorless to pale yellow, and free of particles. Air bubbles are normal.
3. Prepare the site. Wash your hands and clean the skin with an alcohol wipe. Avoid a 2-inch area around the belly button, and skin that is tender, bruised, hard, or red. Rotate sites each time.
4. Uncap and press. Pull off the blue cap only when ready to inject. Press the yellow safety cover against your skin at roughly 90 degrees until it is fully pushed in.
5. Push the button once and hold. Press and release the button, listen for the click, and keep the pen on your skin until the whole window turns yellow. Skip rubbing the spot afterward.
6. Dispose. Put the used pen and cap in a sharps container right away. Each pen works once.

The leaflet says to call 1-844-772-5836 if the window does not turn fully yellow, and to avoid a second dose before you talk with your healthcare provider. Pens stay good for 30 days at room temperature up to 77°F once out of the refrigerator. Children aged 8 to 11 need a caregiver to give the injection.

How much does Praluent lower LDL?

In its label trials, Praluent lowered LDL by 46 to 58% more than placebo, depending on the dose. The full-strength 150 mg dose every 2 weeks produced the biggest drop.

The numbers (DailyMed):

• 150 mg every 2 weeks (ODYSSEY LONG TERM, people on maximally tolerated statins): 58% more LDL lowering than placebo at 24 weeks.
• 75 mg every 2 weeks (ODYSSEY COMBO I): 46% more than placebo at 12 weeks.
• 300 mg every 4 weeks (ODYSSEY CHOICE I, people on a statin): 54% more than placebo at 12 weeks.

Does Praluent prevent heart attacks and strokes?

Yes. In ODYSSEY OUTCOMES, Praluent lowered the risk of coronary death, heart attack, ischemic stroke, or hospitalization for unstable angina by 15% in people who'd recently had an acute coronary syndrome.

The trial enrolled 18,924 people who'd had a heart attack or unstable angina 1 to 12 months earlier and were on high-intensity or maximum-tolerated statins. Over a median of 2.8 years, the main outcome occurred in 9.5% on Praluent and 11.1% on placebo. Deaths from any cause were 3.5% compared with 4.1%. The absolute benefit was larger in people who started with an LDL-C of 100 mg/dL or more.

Is Praluent suitable for long-term use?

Praluent has been studied for years, and the data so far point to steady LDL lowering without new safety signals. ODYSSEY OUTCOMES followed people for a median of 2.8 years, and the label reports that 9,451 people took Praluent for a median of 31 months (DailyMed).

An open-label extension of the program followed 985 adults with heterozygous familial hypercholesterolemia on alirocumab for a median of 2.5 years. LDL-C dropped 44.2% at week 8 and stayed lower through week 96, and the authors found no unexpected long-term safety concerns. 3.4% stopped because of side effects (Farnier et al., Atherosclerosis 2018, DOI 10.1016/j.atherosclerosis.2018.08.036).

The label also notes that some people develop anti-drug antibodies, with up to 5 years of treatment tracked in that analysis. Long-term use also means regular LDL checks, which your clinician uses to adjust the dose (DailyMed).

What are the side effects of Praluent?

The most common side effects are reactions where the shot goes in, flu, diarrhea, and muscle aches, each only slightly more frequent than with placebo. In ODYSSEY OUTCOMES, side effects were similar between groups except injection-site reactions (3.8% vs 2.1%).

From the label's pooled placebo-controlled trials (2,476 people on Praluent):

• Injection-site reactions: redness, itching, swelling, or tenderness in 7.2%, compared with 5.1% on placebo. Few people stopped because of them (0.2% vs 0.4%).
• Flu: 6% vs 5%. Diarrhea: 5% vs 4%. Muscle aches: 4% vs 3%. Muscle spasms: 3% vs 2%. Bruising: 2% vs 1%.
• Allergic reactions: the most common side effect leading people to stop (0.6% vs 0.2%). The label warns that hypersensitivity reactions, including angioedema and hypersensitivity vasculitis, can be serious enough to need hospital care.
• Liver enzymes: liver-related findings, mostly enzyme changes, in 2.5% vs 1.8%.

Stop Praluent and get emergency care for swelling of the face, lips, throat, or tongue, or trouble breathing. For rash, hives, or any side effect that doesn't go away, call your prescriber. Our Repatha side effects guide covers the memory and diabetes questions that come up with this drug class.

Does Praluent cause hair loss?

The Praluent label does not list hair loss among its adverse reactions. Its trial and postmarketing sections name injection-site reactions, flu, diarrhea, muscle aches, allergic reactions, and liver enzyme changes, and angioedema and flu-like illness after approval (Praluent prescribing information, DailyMed). I checked the label only, so I can't speak for every report in the world. If you notice hair thinning after you start, tell your prescriber, who can look at other causes such as thyroid problems, iron levels, and other medicines.

How much does Praluent cost, and is there a copay card?

As of October 2026, GoodRx lists Praluent at $225 for a carton of 2 pens, a month's supply at the every-2-weeks dose, for self-pay patients. GoodRx says it partnered with Inside Rx and Regeneron to set that price, against a listed retail price of $635.99 (GoodRx).

That price lines up with an April 2026 White House announcement that Regeneron would cut Praluent's price from $537 to $225 for patients buying through TrumpRx.gov (White House fact sheet). When we checked TrumpRx on October 2, 2026, Praluent wasn't listed there yet, so the GoodRx coupon is the route we could confirm.

If you have insurance, the options are different (MyPRALUENT):

• Commercial insurance: the MyPRALUENT Copay Card can lower your cost to as little as $50 a month, with up to $3,500 a year in assistance and no income requirement. It can't be used with Medicare, Medicaid, or other government plans.
• Uninsured: Regeneron's patient assistance program provides Praluent at no cost to people who qualify, but it now only re-enrolls existing members and doesn't accept new enrollees or Medicare Part D patients.
• Medicare with limited income: the government's Extra Help program can lower Part D premiums and copays.

Your health plan may require prior authorization before it covers Praluent, and Regeneron notes that approval can take several days. Our Repatha cost guide explains how prior authorization and appeals work, and the process is similar for Praluent.

Is Praluent better than Repatha?

Praluent and Repatha are close enough that coverage, budget, and dosing schedule usually decide between them. Both are PCSK9-blocking antibodies you inject at home, both lower LDL by roughly half or more, and both cut cardiovascular events by about 15% in their outcomes trials.

The newer options, Lerochol and Lipfendra, dose differently, and neither has outcomes results yet.

Sources: Praluent label (DailyMed) and GoodRx; Repatha dosing from its label (DailyMed), FOURIER (Sabatine, NEJM 2017), and AmgenNow, Amgen's direct-to-patient program, at $239 a month (the TrumpRx Repatha page lists the same price for two 140 mg autoinjectors); Lerochol from LIB Therapeutics' launch announcement (May 11, 2026), with no cardiovascular outcomes trial listed on ClinicalTrials.gov as of October 2026; Lipfendra from Chicago Sun-Times coverage of its July 2026 approval, with its outcomes trial still active (ClinicalTrials.gov NCT06008756). LDL figures come from different trials with different patients, so use them as ballpark numbers for rough comparison.

A few practical differences between Praluent and Repatha:

• Dose flexibility. Praluent comes in 75 mg and 150 mg pens, so it can start lower and step up. Repatha comes as 140 mg every 2 weeks or 420 mg monthly.
• Latex. Praluent's needle shield isn't made with natural rubber latex. Some Repatha presentations contain dry natural rubber in the needle cover, though latex-free ones exist.
• Age. Praluent is approved from age 8 for heterozygous FH; Repatha from age 10.
• Price programs. Each has its own cash route and copay card, and your plan may prefer one over the other.

For every option side by side, see Repatha alternatives.

What is the difference between Praluent and Leqvio? (Praluent vs Leqvio)

Praluent is an antibody you inject yourself every 2 or 4 weeks, while Leqvio (inclisiran) is given by a healthcare professional in a clinic twice a year. Praluent has a completed outcomes trial in ODYSSEY OUTCOMES, and Leqvio's outcomes trials have not reported.

No randomized head-to-head trial compares Praluent with Leqvio on heart attacks or strokes. The closest study found is a Sanofi analysis of real-world records for people who started alirocumab 150 mg or inclisiran, which is observational and not randomized, with no results posted as of October 2026 (ClinicalTrials.gov NCT07615166). Without a direct comparison, the choice often comes down to who does the dosing, how often, and what your plan covers. We're working with infusion centers to offer Leqvio, and our Leqvio guide explains where its outcomes trials stand.

Who is Praluent a good fit for?

Praluent fits people who need a large LDL drop that a statin, with or without ezetimibe, hasn't delivered, especially those with cardiovascular disease or familial hypercholesterolemia. People who can't take statins can use it too.

The 2026 ACC/AHA multisociety cholesterol guideline recommends adding a nonstatin, either ezetimibe or a PCSK9 inhibitor, when LDL stays above goal, notes that PCSK9 inhibitors lower LDL by about 60% compared with 15 to 20% for ezetimibe, and says escalation should happen without delay (ACC). If your gap is small, ezetimibe or bempedoic acid may be enough. If it's large, a PCSK9 inhibitor is the more direct route.

How Preval Health helps

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.

Preval runs as a cash practice. If a PCSK9 inhibitor fits, prescriptions go through manufacturer direct pricing and pharmacy cash prices. If another PCSK9 option suits you better, our partner clinicians can prescribe that too. We recheck labs every quarter and adjust from there. For the step-by-step version, see how to get a PCSK9 inhibitor prescription online, and if statins are the problem, see our statin intolerance program. Care costs $99 a month; medicines cost extra at cash prices.