Repatha vs Zetia (or generic)

[Z3Dreamer]

DW and many in her family have high cholesterol. No heart issues. Does not have high blood pressure. PCP wants to put her on some med. He has given her the choice of Repatha or Zetia. Previously, DW tried statins but could not tolerate them. The two drugs in the title are not statins. Both are Medicare part D prescriptions.

Repatha is a twice a month self-administered shot. Cost is around $300 per month. Zetia is $260 per month. Once a day pill. Generic is maybe $0. Repatha is significantly more effective than Zetia. DW was thinking of trying Zetia first to see if it does the trick.

Anybody have experience with these two drugs that could assist her in her decision making? Yes, we will look at various methods of lowering cost. I am more interested in your experience with the drugs. Thanks.

 

[Irishgirlyc58]

I don’t have any personal experience but my pharmacist told me that she started taking after several statins made her sick. She said that she feels great and her ldl dropped significantly. I can’t remember now what she said that it dropped to but it was crazy low.
We were talking about statins because I’m on my third brand. They give me GI issues- even though the Dr will say that they shouldn’t.
This pharmacist said that they absolutely can!
If my current statin starts making me sick I plan to ask for Repatha. I made sure that my plan D covers it just in case.
Let me know what your wife decides. I’d be interested in hearing her experiences.

 

[Z3Dreamer]

I don’t have any personal experience but my pharmacist told me that she started taking after several statins made her sick. She said that she feels great and her ldl dropped significantly. I can’t remember now what she said that it dropped to but it was crazy low.
We were talking about statins because I’m on my third brand. They give me GI issues- even though the Dr will say that they shouldn’t.
This pharmacist said that they absolutely can!
If my current statin starts making me sick I plan to ask for Repatha. I made sure that my plan D covers it just in case.
Let me know what your wife decides. I’d be interested in hearing her experiences.

Just to be clear, your pharmacist started taking Repatha?
Thanks.

 

[RetiredHappy]

My PCP recommended Leqvio. He said that many people get runny nose for a couple of weeks when they start on Repatha. My cardiologist does not think I need because my CAC is 0, and to simply drop my low dose statin intake to 3 times a week will reduce the side effects. In the meantime he has scheduled me for an echo cardiogram just to be sure that my heart is good health because I have lose ligaments (known cause of heart arterial problems).

 

[JBTX]

One option would be to take a very low dose of rosuvastatin, maybe 5mg, and stack zetia on top of it. There were little or no documented side effects in trials of 5mg.

 

[Irishgirlyc58]

Just to be clear, your pharmacist started taking Repatha?
Thanks.

Correct. We had the conversation regarding statins when I picked up my prescription.

 

[MdaPetralia]

My cardiologist does not think I need because my CAC is 0, and to simply drop my low dose statin intake to 3 times a week will reduce the side effects.

If you don't mind me asking, why are you on a statin if your CAC score is 0?

 

[MdaPetralia]

Anybody have experience with these two drugs that could assist her in her decision making?

I have taken Zetia and statins in the past. Could not tolerate statins but don't recall any side-effects from Zeita. Have been taking Repatha for about 8 years now and my Cardio is happy with my lipid numbers (LDL between 50 and 60). No notable side-effects from being on Repatha.

I use a manufacture's co-pay card to cap the cost at $75 for a 90-day supply.

Repatha® (evolocumab) Cost and Co-Pay Card Information

See what Repatha® may cost depending on your insurance coverage and if, as a commercial patient, you may be eligible for the Repatha® Co-Pay Card. See Full Prescribing & Safety Info.

www.repatha.com

 

[MarieIG]

https://www.drugs.com/compare/repatha-vs-zetia

I found this online comparison which includes a review of mechanism of action and side effects. One thing that I noted was that Repatha reportedly reduced adverse cardiac events and this was not noted for Zetia. Please note that there may be additional information than what is available in this chart.

I would actually look into what each of these drugs achieve for the patient's health, i.e. what is your wife looking to accomplish by taking the medication.

 

[Rapidzap]

I have taken Zetia and statins in the past. Could not tolerate statins but don't recall any side-effects from Zeita. Have been taking Repatha for about 8 years now and my Cardio is happy with my lipid numbers (LDL between 50 and 60). No notable side-effects from being on Repatha.

I use a manufacture's co-pay card to cap the cost at $75 for a 90-day supply.

Repatha® (evolocumab) Cost and Co-Pay Card Information

See what Repatha® may cost depending on your insurance coverage and if, as a commercial patient, you may be eligible for the Repatha® Co-Pay Card. See Full Prescribing & Safety Info.

www.repatha.com

Are you on a medicare part D plan. Because I thought the Co-pay card, which I use right now on regular insurance not medicare yet, could not be used with medicare plan

 

[RetiredHappy]

If you don't mind me asking, why are you on a statin if your CAC score is 0?

My LDL was about 150 9 years ago and my PCP put me on 10mg Atorvastatin. My LDL dropped to 50 to 60 for my 6 monthly lab tests since then. My CAC was done in 2023 or 2024 and was 0. Recently I complained of body aches and my PCP asked me to stop my statin and get on Leqvio. But he wanted a cardiologist to see me. Cardiologist asked me to drop the statin to 3 times a week and he ordered an echo cardiogram for me at end of this month, and as he says, and go from there.

 

[euro]

If you don't mind me asking, why are you on a statin if your CAC score is 0?

Extremely good question! I'm not against statins (or any other lipid lowering drugs) where justified, but with a CAC score of 0, I would NEVER take any lipid drugs unless clearly, specifically and definitively justified by clinical data.

 

[MdaPetralia]

Are you on a medicare part D plan.

No, not yet, still on my old employer's retirement medical plan.

 

[MdaPetralia]

I'm not against statins (or any other lipid lowering drugs) where justified, but with a CAC score of 0, I would NEVER take any lipid drugs unless clearly, specifically and definitively justified by clinical data.

You can have a CAC score of 0, which shows calcified plaque, but still have soft plaque which increases cardiovascular risk.

 

[L-5Player]

I wasted almost four years on different statins and a very brief attempt at Zetia. All of them gave me chronic neck and shoulder pain. LDL was typically in the 90s, lowest measured was 70 something.

Finally got approved for Repatha and my LDL is in the 50s with no side effects. Well worth the price to me.

 

[cmc333]

Amazon Pharmacy has generic Zetia for around $15.00 for 3 month supply. Also check out Mark Cuban Cost +. My Entresto is $47.50 90 days versus $167 thru my Part D insurance.

 

[Z3Dreamer]

Amazon Pharmacy has generic Zetia for around $15.00 for 3 month supply. Also check out Mark Cuban Cost +. My Entresto is $47.50 90 days versus $167 thru my Part D insurance.

Looking forward to playing the game - NOT.

 

[Stormy Kromer]

I was just going to post this question.

Starting out. My cholesterol is about 270. A lot if that is the bad one.

I took the test where they check out your blood. My CAC was zero.

I have taken 3 different statins, they make me sick as can be. I got approved for the self induced shot, Repatha. The first two shots were OK. The third made me feel like I got bit by a rattle snake. I feel like I am going to die and don't even care. but, my cholesterol might be getting better......

 

[joesxm3]

Ezetimibe (Zetia) blocks absorption of cholesterol in the intestines. Most people assume that this means from foods you eat like eggs. But actually the liver dumps cholesterol into the intestine to be excreted and most of what is blocked is reabsorption rather than dietary cholesterol.

The people that benefit from Zetia are those who have a defect in the pathway that prevents the reabsorption. This can be measured by a test from Boston Heart Diagnostics called the Cholesterol Balance Test. I took this test and it suggested I would benefit from Ezetimibe.

Mt LDL-C dropped from 170 to 107 in response to 10mg Rosuvastatin. Adding 10mg Ezetimibe dropped it to around 30. I backed off to 5mg Rosuvastatin and was 50 last test.

My response to Ezetimibe was much greater than the expected 20 or 30 points, suggesting that I am a "hyper-absorber".

Repatha is what is called a PCSK9 inhibitor. It prevents the PCSK9 protein from suppressing LDL receptors on the liver. This allow the liver to suck in more circulating LDL and excreting it to the intestine.

PCSK9 inhibitors are the newer product and are considered to be as/more effective as statins without the side effects of muscle pain or increasing insulin resistance (diabetes).

Statins work by interfering with the cholesterol synthesis pathway in the liver and many other organs. Note that almost all organs synthesize their own cholesterol. This pathway also produces CoQ10 and vitamin K2 which is why there is the muscle pain side effect caused by affecting this pathway in the muscle tissue.

As mentioned earlier dose like 5mg Rosuvastatin is less likely to cause side effects and has been shown to have an anti-inflammatory effect on the plaque in the artery wall.

Assuming Ezetimibe drops LDL, the main argument for 5mg Rosuvastatin plus 10mg Ezetimibe (generic) is the cost.

Dr. Thomas Dayspring, the famous lipidologist, himself, takes a PCSK9 inhibitor because he said he cannot tolerate statin.

 

[JBTX]

Ezetimibe (Zetia) blocks absorption of cholesterol in the intestines. Most people assume that this means from foods you eat like eggs. But actually the liver dumps cholesterol into the intestine to be excreted and most of what is blocked is reabsorption rather than dietary cholesterol.

The people that benefit from Zetia are those who have a defect in the pathway that prevents the reabsorption. This can be measured by a test from Boston Heart Diagnostics called the Cholesterol Balance Test. I took this test and it suggested I would benefit from Ezetimibe.

Mt LDL-C dropped from 170 to 107 in response to 10mg Rosuvastatin. Adding 10mg Ezetimibe dropped it to around 30. I backed off to 5mg Rosuvastatin and was 50 last test.

My response to Ezetimibe was much greater than the expected 20 or 30 points, suggesting that I am a "hyper-absorber".

Repatha is what is called a PCSK9 inhibitor. It prevents the PCSK9 protein from suppressing LDL receptors on the liver. This allow the liver to suck in more circulating LDL and excreting it to the intestine.

PCSK9 inhibitors are the newer product and are considered to be as/more effective as statins without the side effects of muscle pain or increasing insulin resistance (diabetes).

Statins work by interfering with the cholesterol synthesis pathway in the liver and many other organs. Note that almost all organs synthesize their own cholesterol. This pathway also produces CoQ10 and vitamin K2 which is why there is the muscle pain side effect caused by affecting this pathway in the muscle tissue.

As mentioned earlier dose like 5mg Rosuvastatin is less likely to cause side effects and has been shown to have an anti-inflammatory effect on the plaque in the artery wall.

Assuming Ezetimibe drops LDL, the main argument for 5mg Rosuvastatin plus 10mg Ezetimibe (generic) is the cost.

Dr. Thomas Dayspring, the famous lipidologist, himself, takes a PCSK9 inhibitor because he said he cannot tolerate statin.

Comparison of the Efficacy of Rosuvastatin 5 mg and 10 mg in Patients of Type 2 Diabetes Mellitus With Dyslipidemia - PMC

Objectives We did this study intending to compare the efficacy of rosuvastatin 5 mg and 10 mg in patients of type 2 diabetes mellitus with dyslipidemia by validating their effect on lipid profile and the side effects. Methodology This study was ...

pmc.ncbi.nlm.nih.gov

10mg rosuvastatin decreased ldl about 50%. 5 mg dropped it about 40%.

Out of 150 on 10mg 9 reported myalgia. Out of 150 subjects only 1 reported myalgia at 5mg.

Seems to me for anyone with statin fears 5mg Crestor plus zetia will likely get you over 50% reduction in LDL