Repatha Side Effects: Common Ones Run Close to Placebo Rates

What are the side effects of Repatha?

The most common Repatha side effects are cold symptoms, upper respiratory infections, flu, back pain, and mild reactions where the shot goes in. In the trials of Repatha (evolocumab), each of these happened only slightly more often than on placebo injections.

Repatha is a PCSK9 inhibitor, an antibody you inject under the skin every 2 weeks or once a month to lower LDL cholesterol (LDL-C). Because it's an antibody given by injection, its side effects look different from a pill's, and its FDA label has no drug interaction section at all (Repatha prescribing information, DailyMed).

People ask most whether it affects memory and whether it raises diabetes risk. Both were tested directly, and we cover them below.

How common are Repatha side effects?

In Repatha's 52-week placebo-controlled trial, no single side effect occurred in more than about 1 in 10 people, and each one also showed up on placebo at a similar rate. Side effects led 2.2% of people on Repatha to stop treatment, compared with 1% on placebo.

Here's the label's table for that trial, which included 599 people on Repatha 420 mg monthly and 302 on placebo:

Source: Table 1, Repatha prescribing information, revised July 2026 (DailyMed). The table lists side effects seen in at least 3% of people on Repatha and more often than on placebo, so a few smaller ones (musculoskeletal pain, diarrhea, stomach bugs) are left off here.

The big outcomes trial, FOURIER, shows similar results in far more people. Among 27,525 people treated for a median of about two years, the side effects seen in more than 5% of people on Repatha 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%). Apart from injection-site reactions, FOURIER found no significant difference in side effects between Repatha and placebo.

What do Repatha injection-site reactions look like, and how do I reduce them?

Injection-site reactions are redness, pain, or bruising where you gave the shot, and they're usually mild. Across eight pooled trials they happened in 3.2% of people on Repatha and 3.0% on placebo, and only 0.1% stopped Repatha because of them.

In FOURIER they were the one side effect that was clearly more common on Repatha, at 2.1% compared with 1.6%. That's roughly 1 extra person in 200.

The label's instructions help reduce them (DailyMed).

Does Repatha cause muscle pain?

Muscle aches (myalgia) were reported in 4.0% of people on Repatha and 3.0% on placebo in the 52-week trial, so the rates ran close. That gap works out to about 1 extra person in 100.

Does Repatha raise blood pressure?

High blood pressure was reported in 3.2% of people on Repatha and 2.3% on placebo in the same 52-week trial, so it showed up slightly more often on Repatha. The label table above lists it among the side effects seen in at least 3% of people.

Does Repatha affect your memory?

The trial designed to test memory and thinking found no difference. EBBINGHAUS followed 1,204 people on Repatha or placebo (on top of a statin) for a median of 19 months with formal cognitive testing and found no significant differences in executive function, working memory, episodic memory, or psychomotor speed.

The question came from early PCSK9 trials, which raised concern that the drugs, or the very low LDL levels they produce, might affect cognition. EBBINGHAUS tested that with objective memory and thinking tests in place of self-reports. The scores barely moved in either group, and in an exploratory analysis, how low someone's LDL went had no link to cognitive change.

FOURIER, with more than 27,000 people, also found no significant difference in neurocognitive events. Long-term follow-up (below) found the same.

Does Repatha cause diabetes?

FOURIER found no significant increase in new diabetes with Repatha. Among 16,676 people without diabetes at the start, new-onset diabetes occurred in 8.1% on Repatha and 7.7% on placebo, a gap small enough to be chance (hazard ratio 1.05; 95% CI 0.94 to 1.17).

A prespecified analysis looked harder at this, including the 10,344 people who had prediabetes at the start. Their risk of progressing to diabetes was the same on Repatha and placebo (hazard ratio 1.00), and HbA1c and fasting glucose stayed similar between the groups over time. Repatha also lowered cardiovascular events in people with and without diabetes.

Can I use Repatha if I have a latex allergy?

Tell your prescriber first. Some Repatha autoinjectors and syringes have dry natural rubber, a latex derivative, in the needle cover. If you're sensitive to latex, the label recommends a presentation made without it (DailyMed).

Can you be allergic to Repatha?

Yes, though serious reactions are uncommon. In pooled trials, allergic-type reactions occurred in 5.1% of people on Repatha and 4.7% on placebo, most often rash (1.0% vs 0.5%), eczema, redness, or hives.

The label also notes that angioedema (swelling of the face, lips, tongue, or throat) has been reported, and that anyone with a past serious allergic reaction to evolocumab shouldn't take it. Flu-like illness has also been reported after approval.

Is Repatha safe long term?

The longest follow-up, more than 8 years, found no new safety problems. In FOURIER-OLE, 6,635 people continued on Repatha for a median of 5 more years, and rates of serious side effects, muscle problems, new diabetes, hemorrhagic stroke, and neurocognitive events stayed at or below the original placebo group's rates and did not climb over time.

People who started Repatha in the original trial also had a 15% lower risk of major cardiovascular events during the extension than people who started it later. Starting earlier was linked with more benefit.

How do Repatha side effects compare with statin side effects?

Repatha mainly causes a mild reaction at the injection site, while statins are best known for muscle aches. Muscle aches were reported on Repatha too (4.0% vs 3.0% on placebo in the 52-week trial), but at rates close to placebo.

Statins do cause some muscle symptoms, though far fewer than people report. A 2022 meta-analysis of 19 placebo-controlled statin trials (123,940 people) found statins caused a small excess of mostly mild muscle pain, concentrated in the first year, and that more than 90% of muscle symptoms reported by people on statins were not due to the statin.

Many people taking Repatha are also on a statin, and FOURIER tested it on top of one. If you stopped a statin because of aches, our statin side effects guide and statin intolerance program explain how to find out whether a lower dose or a different statin could work. If it truly can't, a PCSK9 inhibitor on its own is one option among several in alternatives to statins.

When should you call your clinician?

Get emergency care for signs of a serious allergic reaction, such as swelling of the face, lips, tongue, or throat, or trouble breathing. Call your prescriber for a rash or hives, an injection-site reaction that spreads or doesn't fade, or any side effect that bothers you or doesn't go away.

Also check in if:

• You have a latex allergy and aren't sure which device you were given.
• You miss a dose. The label says to take it within 7 days and keep your schedule; after 7 days, the right move depends on whether you're on the every-2-weeks or monthly dose.
• You're pregnant or planning to be, so you and your clinician can weigh the options.

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.

If you start Repatha with us, we check in on side effects and recheck your labs every quarter, so the plan follows your actual numbers. If Repatha doesn't suit you, other PCSK9 options include Praluent, the once-monthly Lerochol, and the daily pill Lipfendra. Our Repatha alternatives guide compares them, and Repatha cost covers insurance and cash-pay prices. To get started, see how to get a PCSK9 inhibitor prescription online. Care costs $99 a month, with medicines at cash prices.