Can Repatha (evolocumab) cause a chronic cough that persists after discontinuation?

Repatha Does Not Cause Chronic Cough

Repatha (evolocumab) is not associated with chronic cough as a side effect, and there is no evidence that it causes persistent cough after discontinuation. The FDA label for Repatha lists cough as occurring in only 4.5% of treated patients versus 3.6% in placebo patients—a minimal difference that does not suggest a causal relationship 1. This slight increase is not clinically significant and does not represent a drug-induced cough syndrome.

Why This Confusion May Arise

Your chronic cough is almost certainly due to another cause that requires systematic evaluation:

Most Common Causes to Investigate First

• Upper airway cough syndrome (postnasal drip), asthma, non-asthmatic eosinophilic bronchitis, and gastroesophageal reflux disease account for the vast majority of chronic cough cases in adults with normal chest X-rays 2, 3

• ACE inhibitors (like ramipril, perindopril, lisinopril) are well-documented causes of chronic dry cough in 5-35% of patients 2, 4. If you are taking any ACE inhibitor alongside Repatha, this is the likely culprit—not the Repatha 2

• ACE inhibitor-induced cough typically resolves within 1-4 weeks after stopping the medication, though in some patients it may persist for up to 3 months 2, 4

Key Distinguishing Features

ACE Inhibitor Cough (If Applicable)

• Dry, nonproductive cough with tickling or scratching throat sensation 2, 4
• Not dose-dependent 4
• More common in women, nonsmokers, and persons of Chinese origin 2, 4
• Can begin within hours or be delayed for weeks to months after starting therapy 2, 4

Repatha's Safety Profile

• The 52-week controlled trial showed cough in 4.5% of Repatha patients versus 3.6% of placebo patients—essentially no difference 1
• The most common adverse reactions leading to discontinuation were myalgia (0.3%), not respiratory symptoms 1
• No mechanism exists by which a PCSK9 inhibitor would cause cough, unlike ACE inhibitors which cause bradykinin accumulation 2, 4

What You Should Do

Stop looking at Repatha as the cause and pursue proper chronic cough evaluation:

1. Review all your medications for ACE inhibitors (drugs ending in "-pril" like lisinopril, enalapril, ramipril, perindopril). If taking one, discontinue it under physician supervision and switch to an angiotensin receptor blocker (ARB) like candesartan, which does not cause cough 5, 4

2. Evaluate for the "big three" causes: upper airway cough syndrome, asthma/eosinophilic bronchitis, and gastroesophageal reflux disease, which together account for the overwhelming majority of chronic cough cases 2, 3

3. Consider laryngopharyngeal reflux if you have risk factors like older age, overweight, or diabetes—this often requires ENT evaluation with laryngoscopy 5

Critical Pitfall to Avoid

Do not discontinue Repatha based on unfounded concerns about cough. Repatha provides significant cardiovascular benefit by lowering LDL cholesterol 6, and stopping it without cause could increase your risk of cardiovascular events. The evidence clearly shows it does not cause chronic cough 1.

If you've already stopped Repatha and the cough persists, this definitively proves Repatha was not the cause—you need to investigate the actual etiologies listed above 2, 3.