What is the recommended dose of Praluent (alirocumab)?

Praluent (Alirocumab) Dosing

For adults with ASCVD or primary hyperlipidemia including HeFH, initiate alirocumab at 75 mg subcutaneously every 2 weeks, with dose escalation to 150 mg every 2 weeks if additional LDL-C reduction is needed; alternatively, start with 300 mg every 4 weeks. 1

Adult Dosing by Indication

ASCVD or Primary Hyperlipidemia (Including HeFH)

• Starting dose: 75 mg subcutaneously every 2 weeks 2, 1
• Dose escalation: Increase to 150 mg every 2 weeks if LDL-C response is inadequate 2, 1
• Alternative regimen: 300 mg every 4 weeks as starting dose 2, 1
  • For the 300 mg dose, administer two consecutive 150 mg injections at different injection sites 2, 1
  • Important caveat: For patients on 300 mg every 4 weeks, measure LDL-C just prior to the next scheduled dose, as LDL-C can vary between doses in some patients 1

HeFH Undergoing LDL Apheresis or HoFH

• Fixed dose: 150 mg subcutaneously every 2 weeks 2, 1
• Alirocumab can be administered without regard to timing of LDL apheresis 1

Pediatric Dosing (Age 8 Years and Older with HeFH)

Body Weight <50 kg

• Starting dose: 150 mg every 4 weeks subcutaneously 1
• Dose escalation: 75 mg every 2 weeks if LDL-C response inadequate 1

Body Weight ≥50 kg

• Starting dose: 300 mg every 4 weeks subcutaneously 1
• Dose escalation: 150 mg every 2 weeks if LDL-C response inadequate 1

Administration Details

• Route: Subcutaneous injection in thigh, abdomen, or upper arm 2, 1
• Rotation: Rotate injection sites with each administration; avoid areas that are tender, bruised, red, or indurated 1
• Timing: Can be administered without regard to food 1
• Preparation: Allow to warm to room temperature for 30-40 minutes if refrigerated 1

Efficacy Expectations

• 75 mg every 2 weeks: Reduces LDL-C by additional 45% when added to maximally tolerated statin therapy 2
• 150 mg every 2 weeks: Reduces LDL-C by additional 58% when added to maximally tolerated statin therapy 2
• Monitoring: LDL-lowering effect may be measured as early as 4 weeks after initiation 1

Missed Dose Management

• Within 7 days: Administer immediately and resume original schedule 1
• More than 7 days (every 2-week dosing): Wait until next scheduled dose 1
• More than 7 days (every 4-week dosing): Administer dose and start new schedule based on this date 1

Key Clinical Considerations

Cardiovascular outcomes: The ODYSSEY Outcomes trial in 18,600 post-ACS patients demonstrated that alirocumab reduced the composite endpoint of CHD death, MI, ischemic stroke, or hospitalization for unstable angina 2. This mortality and morbidity benefit supports the use of alirocumab in high-risk populations beyond just LDL-C lowering.

Common pitfall: Failing to measure LDL-C appropriately in patients on the 300 mg every 4-week regimen—always measure just before the next dose to account for potential variability 1.