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Cholesterol Shots: 4 Options Compared

Four cholesterol shots are FDA-approved in the US: Repatha, Praluent, Lerochol and Leqvio. Repatha and Praluent are given every 2 weeks or monthly, Lerochol monthly, and Leqvio twice a year. Each lowers LDL cholesterol by roughly 50 to 60%.

One year of doses, side by side
  • Repatha26 doses in year one

    Every 2 weeks, or monthly at the higher dose. Shot you give yourself.

  • Praluent26 doses in year one

    Every 2 weeks, or every 4 weeks at the higher dose. Shot you give yourself.

  • Lerochol12 doses in year one

    Once a month. Monthly shot you give yourself.

  • Leqvio3 doses in year one

    First dose, a second at 3 months, then every 6 months. Shot given at a clinic.

  • Lipfendradaily

    One tablet every morning on an empty stomach. Daily pill.

Each dot marks one dose in the first year. Repatha and Praluent also offer a monthly or every-4-weeks dose. After year one, Leqvio drops to two doses a year. Your clinician sets your schedule from the label.

What a year costs at cash or list price
  • Lerochol$2,388 a year

    $199 a month direct from LIB Therapeutics

  • Praluent$2,700 a year

    $225 a month self-pay through GoodRx

  • Repatha$2,868 a year

    $239 a month cash through AmgenNow

  • Lipfendra$3,780 a year

    About $315 a month list price

  • Leqvioabout $10,760 a year

    $3,587.73 a dose list price for uninsured patients; most people use insurance

As of October 2026. Cash and list prices come from the manufacturers’ programs and announcements linked in each guide. Most insured patients pay less, and Leqvio is usually covered through insurance. Daily generic pills such as ezetimibe cost far less and are left out. Confirm current prices before you fill.

Estimate your LDL on each medicine
LDL goal
  • Repathaabout 52 mg/dL

    Average result would reach under 70.

  • Lipfendraabout 53 to 57 mg/dL

    Average result would reach under 70.

  • Praluentabout 55 to 70 mg/dL

    Average result would reach under 70.

  • Lerocholabout 57 mg/dL

    Average result would reach under 70.

  • Leqvioabout 65 mg/dL

    Average result would reach under 70.

  • Nexlizetabout 81 mg/dL

    Average result stays above 70. A second medicine can close the gap.

  • Ezetimibeabout 98 to 104 mg/dL

    Average result stays above 70. A second medicine can close the gap.

  • Nexletolabout 103 to 108 mg/dL

    Average result stays above 70. A second medicine can close the gap.

The dark line marks your goal. Starting LDL: 130 mg/dL.

Rough estimate. Trials report the average drop for one medicine, usually compared with placebo and often in people already on a statin, and your result can differ. Use the LDL you have now, on your current treatment. Your clinician sets your goal. Figures match the guides on this site; see each medicine’s guide for the sources.

Which cholesterol shots are available?

As of October 2026, the four are Repatha (evolocumab), Praluent (alirocumab), Lerochol (lerodalcibep) and Leqvio (inclisiran). All four act on PCSK9, a liver protein that destroys LDL receptors. With less PCSK9 around, the liver keeps more receptors and pulls more LDL out of your blood.

Repatha, Praluent and Lerochol are home injections. A healthcare professional gives Leqvio in a clinic or infusion center.

  • Repatha: every 2 weeks or monthly, 59% LDL lowering in FOURIER
  • Praluent: every 2 weeks or every 4 weeks, 46 to 58% depending on dose
  • Lerochol: once a month, about 56%
  • Leqvio: day 1, month 3, then every 6 months, about 50%

Is there a once-a-month cholesterol injection?

Yes, three of them. Lerochol is monthly by design. Repatha (420 mg monthly) and Praluent (300 mg every 4 weeks) each have a monthly option. All three go under the skin at home.

Lerochol comes as a prefilled syringe that can stay at room temperature for up to three months. An autoinjector pen was FDA-approved on August 17, 2026, and the maker expects it by January 2027.

Is there a twice-a-year cholesterol shot?

Yes. Leqvio is a first dose, a second dose 3 months later, then once every 6 months. After the first year, that adds up to two shots a year.

Leqvio is an siRNA that tells the liver to make less PCSK9. Compared with monthly home shots, it lowers LDL a little less (about 50% versus 56 to 59%) and has no outcomes results yet. Its label now covers adults with high cholesterol with no requirement to take a statin first.

Do cholesterol shots prevent heart attacks?

Repatha and Praluent have outcomes trials. In FOURIER, 27,564 people with cardiovascular disease had 15% fewer major events over a median of 2.2 years. In ODYSSEY OUTCOMES, 18,924 people with a recent heart attack or unstable angina had 15% fewer major events (9.5% vs 11.1%) over a median of 2.8 years.

In VESALIUS-CV, 12,257 people with atherosclerosis or diabetes and no prior heart attack or stroke had a 25% lower risk of a first heart attack, stroke or coronary death on Repatha.

Lerochol and Leqvio are approved on LDL lowering. Their own outcomes trials have not reported.

What are the side effects of cholesterol shots?

The most common side effect of every shot is a mild reaction where the needle goes in: redness, itching, swelling or tenderness. Praluent showed injection-site reactions in 7.2% versus 5.1% on placebo. Leqvio's label also lists joint pain and bronchitis. Lerochol's trials listed cold-like symptoms and mild ankle or leg swelling.

Any of these medicines can rarely cause an allergic reaction. Get emergency care for swelling of the face, lips or throat, or trouble breathing.

How much does a cholesterol shot cost without insurance?

As of October 2026, cash prices run $199 a month for Lerochol (LIB Therapeutics), $225 a month for Praluent (self-pay through GoodRx) and $239 a month for Repatha (AmgenNow). Leqvio has a list price of $3,587.73 per dose, so most people get it through insurance.

Cash programs usually run outside your insurance, so what you pay may not count toward your deductible. Ask your clinician which route fits you.

Trials in this guide

Each links to a plain summary with a quote from the PubMed abstract.

Common questions

▸Which cholesterol shot is best?

Repatha and Praluent have completed outcomes trials. Lerochol is a monthly home shot with a $199 cash price, and Leqvio is two clinic shots a year. Your clinician can match the choice to your LDL goal, coverage and comfort with injecting at home.

▸Are twice-yearly Leqvio shots safe long term?

In the ORION-8 extension (3,274 people, up to 6.8 years of exposure) the authors reported no new safety signals, with injection-site reactions the main finding. ORION-8 had no placebo group and Novartis funded it. Neither it nor a pooled analysis tests heart attack prevention.

▸Are Repatha and Praluent approved for children?

For some. Repatha's label covers ages 10 and older with familial hypercholesterolemia (heterozygous or homozygous). Praluent's covers ages 8 and older with heterozygous familial hypercholesterolemia. Leqvio's covers ages 12 and older.

▸Is there a pill instead of a shot?

Yes. Lipfendra (enlicitide), approved in July 2026, is a once-daily PCSK9 inhibitor pill that lowered LDL by about 56 to 59% versus placebo. Its list price is about $315 a month and its outcomes trial is still running.

The full guideRead the complete, referenced version on Preval Health More detail, every study, and the date each figure was checked.

Read next

See it on lipid.site

Sources

Not medical advice. General education from published trials and drug labels, last updated October 2026. lipid.site is not a healthcare provider and cannot tell you what to take or change. Talk to your clinician before starting or stopping any treatment. If you have chest pain or other signs of a heart attack or stroke, call 911.