Praluent (Alirocumab): Dose, Cost and Side Effects

Praluent is an injectable antibody that binds PCSK9, a protein that normally destroys the LDL receptors liver cells use to pull LDL out of the blood. With PCSK9 blocked, more receptors stay active and more LDL gets cleared. You give it yourself with a pre-filled pen.

Statins work at a different step, so Praluent can be added on top of a statin, as it was in ODYSSEY OUTCOMES. The FDA label covers reducing the risk of major cardiovascular events in adults at increased risk, and lowering LDL cholesterol (LDL-C) in adults with high cholesterol, in children 8 and older with heterozygous familial hypercholesterolemia, and in adults with the homozygous form.

Most adults start with 75 mg every 2 weeks or 300 mg every 4 weeks, injected under the skin. If LDL doesn't fall enough, the dose can be raised to 150 mg every 2 weeks. On the every-4-weeks dose, LDL-C is best measured just before the next dose. The pen's needle shield isn't made with natural rubber latex.

LDL lowering versus placebo in the label trials:

In ODYSSEY OUTCOMES, Praluent lowered the risk of coronary death, heart attack, ischemic stroke or hospitalization for unstable angina by 15% in people who had recently had an acute coronary syndrome. The trial enrolled 18,924 people on high-intensity or maximum-tolerated statins who had a heart attack or unstable angina 1 to 12 months earlier.

Over a median of 2.8 years, the main outcome occurred in 9.5% on Praluent and 11.1% on placebo. Deaths from any cause were 3.5% compared with 4.1%. The absolute benefit was larger in people who started with an LDL-C of 100 mg/dL or more.

From the label's pooled placebo-controlled trials (2,476 people on Praluent), the most common side effects ran only slightly above placebo. In ODYSSEY OUTCOMES, side effects were similar between groups except injection-site reactions (3.8% vs 2.1%).

As of October 2026, GoodRx lists Praluent at $225 for a carton of 2 pens (a month at the every-2-weeks dose) for self-pay patients, against a listed retail price of $635.99.

With commercial insurance, the MyPRALUENT Copay Card can lower your cost to as little as $50 a month, with up to $3,500 a year in assistance and no income requirement. It can't be used with Medicare, Medicaid or other government plans.

Regeneron's patient assistance program now only re-enrolls existing members. People on Medicare with limited income can look at the government's Extra Help program, which can lower Part D premiums and copays.

Your plan may require prior authorization, and Regeneron notes that approval can take several days.

Praluent and Repatha are close. Both are PCSK9-blocking antibodies you inject at home, both lowered LDL by roughly half or more, and both cut cardiovascular events by about 15% in their outcomes trials. Coverage, budget and dosing schedule usually decide between them.

They differ in a few practical ways. Praluent comes in 75 mg and 150 mg pens, so it can start lower and step up, while Repatha comes as 140 mg every 2 weeks or 420 mg monthly.

Praluent's needle shield isn't made with natural rubber latex, and some Repatha presentations contain dry natural rubber in the needle cover. Praluent is approved from age 8 for heterozygous FH, and Repatha from age 10.