What are the next steps if I experience burning and tingling in my hands after starting Repatha (evolocumab)?

Management of Burning and Tingling in Hands After Starting Repatha

If you experience burning and tingling in your hands after starting Repatha (evolocumab), you should contact your healthcare provider promptly as this may represent a peripheral neuropathy requiring evaluation and potential medication adjustment.

Assessment of Symptoms

When experiencing burning and tingling in the hands after starting Repatha, your healthcare provider should:

• Assess symptom severity using a simple pain scale (0-10)
• Document onset timing in relation to medication start
• Evaluate distribution pattern (palms only vs. fingers/entire hand)
• Check for associated symptoms (redness, swelling, or skin changes)
• Rule out other potential causes of neuropathy

Potential Causes

The burning and tingling sensation may represent:

1. Medication side effect: Although not specifically listed as a common side effect in the FDA label for Repatha, peripheral neuropathy symptoms can occur with various medications 1

2. Hand-foot skin reaction (HFSR): Characterized by dysesthesia (abnormal sensation), tingling, burning pain, swelling, and erythema in palms 1

3. Carpal tunnel syndrome: Common in the general population (prevalence 2.7-4.9%) and can present with similar symptoms 2

Management Algorithm

Step 1: Initial Management

• Continue Repatha unless symptoms are severe (grade 3) or intolerable
• Apply topical treatments:
  • Topical high-potency steroid twice daily 1
  • Consider lidocaine 5% cream or patches for pain relief 1
• Implement supportive measures:
  • Avoid excessive hand washing with hot water
  • Use alcohol-free moisturizing creams containing urea (5-10%)
  • Avoid skin irritants and chemical exposure

Step 2: If Symptoms Persist or Worsen After 2 Weeks

• Pharmacological options:
  • Consider duloxetine for neuropathic pain symptoms 1
  • Acetaminophen or NSAIDs may help with pain management 1
• Non-pharmacological approaches:
  • Physical therapy with stretching exercises 1
  • Acupuncture (shown effective for treatment-related joint pain) 1
  • Regular physical activity (shown to improve pain in multiple RCTs) 1

Step 3: For Severe or Intolerable Symptoms

• Interrupt Repatha treatment until symptoms improve to grade 0-1 1
• Consider medication alternatives:
  • Discuss with your provider about alternative lipid-lowering therapies
  • Bempedoic acid may be considered as an alternative 1
• Specialist referral:
  • Neurology consultation if symptoms suggest peripheral neuropathy
  • Dermatology consultation if skin manifestations are prominent

Monitoring and Follow-up

• Reassess symptoms after 2 weeks of initial management
• Document any improvement or worsening
• If symptoms improve, continue current management
• If symptoms worsen or do not improve, proceed to next step in algorithm

Important Considerations

• Medication adherence: Poor compliance with lipid-lowering therapy increases cardiovascular risk 1, so finding a tolerable treatment approach is essential
• Hypersensitivity reactions: If symptoms are part of a broader hypersensitivity reaction to Repatha, discontinue therapy and treat according to standard of care 1
• Documentation: Keep a symptom diary to track severity, timing, and response to interventions

When to Seek Immediate Medical Attention

• Symptoms rapidly worsening or spreading
• Development of muscle weakness
• Signs of serious hypersensitivity reaction (rash, difficulty breathing)
• Severe pain unresponsive to initial management

By following this structured approach, most patients experiencing burning and tingling in the hands after starting Repatha can achieve symptom relief while maintaining effective lipid management.