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How does Repatha work?

Medically reviewed by N. France, BPharm. Last updated on Feb 15, 2021.

Official Answer


Repatha (evolocumab) is a monoclonal antibody that works by inhibiting PCSK9 (proprotein convertase subtilisin kexin type 9). PCSK9 is a protein found in the liver that plays a key role in plasma cholesterol metabolism.

Repatha is used to prevent heart attacks, strokes and the need for coronary revascularization in those with existing cardiovascular disease. It is also used to reduce low-density lipoprotein (LDL) or ‘bad’ cholesterol in certain people with hyperlipidemia or hypercholesterolemia.

Repatha works differently from statins, which are another class of drugs used to treat high cholesterol.

What is Repatha’s mechanism of action?

Repatha is administered via a subcutaneous injection under the skin. Once administered it binds to PCSK9 and prevents the circulating PCSK9 from binding to LDL receptors. This increases the amount of LDL receptors available to clear the ‘bad’ LDL cholesterol from the blood.

Without Repatha’s binding action, PCSK9 would be free to bind to the LDL receptors. This leads to the breakdown of the receptors, after which they are recycled back to the surface of liver cells and are no longer available to clear the LDL cholesterol.


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