Can a patient take a 420 mg dose of Repatha (evolocumab) orally?

Can a Patient Take 420 mg of Repatha?

Yes, 420 mg is a standard FDA-approved dose of Repatha (evolocumab), but it must be administered subcutaneously—never orally—either once monthly or every 2 weeks depending on the indication. 1

Route of Administration: Critical Safety Point

• Repatha cannot be taken by mouth. It is a monoclonal antibody that would be destroyed by digestive enzymes if swallowed and must be given as a subcutaneous injection. 1
• The 420 mg dose is administered subcutaneously using either three consecutive 140 mg injections within 30 minutes at different sites, or via a prefilled single-dose on-body infusor. 2
• Approved injection sites include the thigh, abdomen, or upper arm, with rotation of sites recommended. 2

Standard 420 mg Dosing Regimens

For adults with ASCVD, primary hyperlipidemia, or heterozygous familial hypercholesterolemia (HeFH):

• 420 mg subcutaneously once monthly is equivalent in efficacy to 140 mg every 2 weeks. 2, 1
• The once-monthly 420 mg regimen reduces LDL-C by approximately 58%, while the every-2-week 140 mg regimen reduces it by 64%—both are clinically comparable. 2
• Choice between regimens can be based on patient preference without compromising efficacy. 3

For pediatric patients ≥10 years with HeFH:

• The same dosing applies: either 140 mg every 2 weeks or 420 mg once monthly. 2, 1

Higher-Intensity 420 mg Dosing

For homozygous familial hypercholesterolemia (HoFH):

• Initial dose is 420 mg once monthly. 2, 1
• If inadequate LDL-C reduction after 12 weeks, the dose can be escalated to 420 mg every 2 weeks (effectively doubling the monthly dose). 2, 1
• Patients on lipid apheresis may start directly with 420 mg every 2 weeks to align with their apheresis schedule, administered after each session. 1

Administration Preparation

• Allow refrigerated Repatha to warm to room temperature for at least 30 minutes (autoinjector or syringe) or 45 minutes (on-body infusor) before injection. 1
• Visually inspect the solution—it should be clear to opalescent, colorless to pale yellow; do not use if cloudy, discolored, or contains particles. 1
• Some presentations contain dry natural rubber (latex derivative) in the needle cover; prescribe latex-free presentations for latex-sensitive patients. 2, 1

Efficacy of the 420 mg Dose

• When added to maximally tolerated statin therapy, the 420 mg monthly dose achieves a median LDL-C of 30 mg/dL (59% reduction from baseline median of 92 mg/dL). 3, 4
• In the FOURIER trial, 86% of participants used the every-2-week regimen, but both schedules demonstrated cardiovascular benefit with a 15% reduction in major adverse cardiovascular events. 3, 4
• The 420 mg dose also reduces non-HDL-C by 51%, lipoprotein(a) by 27%, and triglycerides by 16%. 3

Common Pitfall to Avoid

• Never attempt oral administration. Patients or caregivers unfamiliar with biologic therapies may mistakenly believe any medication can be swallowed. Emphasize that Repatha is a subcutaneous injection only and provide hands-on training per the Instructions for Use. 1
• When monitoring LDL-C in patients on the 420 mg monthly regimen, measure just prior to the next scheduled dose, as LDL-C can vary during the dosing interval. 1