Praluent vs Statins
Cholesterol is a type of fat molecule that is necessary for building cell membranes, producing hormones, and aiding in digestion. However, too much cholesterol (LDL-C) in the blood can increase the risk of heart disease and stroke. High cholesterol can lead to the buildup of plaque in the arteries, which can eventually lead to blockages that can cause heart attacks or strokes.
If you have been diagnosed with high cholesterol, it is important to make lifestyle modifications such as healthy diet and regular exercise. If these changes are not enough, your doctor may recommend medication to lower your cholesterol levels.
Statins are the most commonly prescribed medication for high cholesterol. They have been extensively studied and are effective at lowering cholesterol. They are also available as cost-effective generic options.
Praluent is a newer cholesterol-lowering drug that was approved by the FDA (Food and Drug Administration) in July, 2015. With alirocumab as the active ingredient Praluent is given as an injection under the skin. Praluent may be considered as an additional treatment option if statins are not effective in reducing LDL cholesterol levels. Or it may be prescribed by itself for patients with familial hypercholesterolemia (HeFH), a genetic condition that causes high cholesterol. Since Praluent is a relatively new drug, there are no generic options at the time of writing.
Statins and Praluent both are effective at lowering cholesterol. To choose the right medication for you, there are a number of factors to consider: your medical history, side effects, interactions, and cost.
How they work
Statins work by blocking a liver enzyme (HMG-CoA reductase) that's necessary for making cholesterol, leading to decreased cholesterol production. Praluent, on the other hand, works by blocking a protein (PCSK9) that is responsible for destroying LDL receptors. By blocking this protein, Praluent allows more LDL receptors to remove excess cholesterol from the body.
How PCSK9 inhibitors (Praluent) work
PCSK9 inhibitors work by targeting two key factors: LDL receptors (LDL-R) and proprotein convertase subtilisin/kexin type-9 (PCSK9).
LDL is a crucial component responsible for transporting cholesterol in the bloodstream. The LDL receptor's primary role is to clear the excess cholesterol from the body. These receptors are located on the surface of cells and bind to the LDL in the bloodstream, bringing it inside the cell where it's broken down to release cholesterol. The cholesterol can then be used by the cell, stored, or eliminated from the body. After delivering the LDL, these receptors return to the cell surface to pick up more LDLs.
However, PCSK9 is a protein that can attach to LDL receptors and destroy them within the cell. This results in a lower number of LDL receptors available to clear excess cholesterol in the body, which can lead to an increase in cholesterol levels.
How PCSK9 can increase LDL levels
- LDL receptor (LDL-R) carries LDL into the cell
- LDL-R goes back to the cell surface to carry more LDL
- PCSK9 attaches to an LDL-R and destroys them
- With fewer LDL-R, the removal of LDL from the bloodstream is impaired, leading to high levels of LDL
Praluent is a PCSK9 inhibitor, which means that it works by blocking PCSK9 from attaching to LDL receptors. By doing so, it allows LDL receptors to do their job effectively, removing excess cholesterol from the bloodstream. This helps to reduce cholesterol levels in the body and lower the risk of cardiovascular disease.
How Praluent works
- Praluent (PCSK9 inhibitor) blocks PCSK9 from attaching to LDL-R
- By doing so, it allows LDL-R to do their job, removing excess cholesterol from the bloodstream
Praluent vs Statins: Which is better at lowering cholesterol?
Both drugs are effective at lowering LDL-C. However, statins are considered as the first-line treatment option for high cholesterol. Statins lower LDL-C levels by 30% to 50% depending on the strength. Praluent is usually recommended when statins or other cholesterol medication have not been successful at reaching your cholesterol goal. Praluent can be used as an adjunct therapy with a statin or a standalone therapy for people with heterozygous familial hypercholesterolemia (HeFH) which is a generic disorder that causes very high LDL cholesterol.
| Statins | Praluent |
| Typically lowers LDL by 30–50% | Typically lowers LDL by 50–60% |
Doses and administration
Praluent
The widely recommended initial dose for this medication is 75 mg administered subcutaneously (SC—under your skin) in your upper arm, thigh, or stomach once every 2 weeks.
- 75 mg/mL every two weeks or monthly
- 150 mg/mL every two weeks or monthly
Although this medication is available in dosages that range between 75–150 mg subcutaneously administered every 2 weeks, you can administer 300 mg in your stomach, thigh, or upper arm once every 4 weeks (monthly) if you prefer a less frequent dosage. Avoid picking a location where your skin is soft, damaged, red, or firm.
To assess the response and the need for potential further dosage changes, your LDL-C levels should be checked 4 to 8 weeks after starting Praluent therapy.
Keep in mind that you should never shake this medication. Only prepare an injection when you're set to administer it. If the medication has picked up particles or changed colors, do not use it.
This medication can also be kept at room temperature in its original carton for up to 30 days. Do not subject to intense heat. Use this medication within 30 days of taking it out of the fridge. After 30 days, throw away any unused medication.
Statins
There are 7 statins availble with following doses:
- Atorvastatin (brand: Lipitor): 10-80 mg daily
- Lovastatin (Altoprev): 20-80 mg daily
- Rosuvastatin (Crestor): 5-40 mg daily
- Simvastatin (Zocor): 10-40 mg daily in the evening
- Fluvastatin (Lescol XL (extended-release)): 20-80 mg taken in the evening
- Pitavastatin (Livalo, Zypitamag): 1-4 mg daily
- Pravastatin (Pravachol): 10-80 mg daily
Side effects
Praluent: common side effects
- Headache
- Cold or flu-like symptoms, including sore throat, stuffy nose, and/or sneezing
- Upper respiratory tract infection (URTI), including cold or flu-like symptoms
- Urinary tract infection (UTI)
- Back pain, muscle pain, and/or joint pain
- Injection site reaction that may include a severe rash, redness, or any discoloration, bruising, and/or pain at the site of injection
Numerous medications have side effects that usually subside after a few days or weeks. However, talk to your physician or pharmacist if these adverse effects start to concern you.
Praluent: serious side effects
- Allergic reaction
Signs and symptoms that may indicate an allergic reaction include skin rash or hives (raised bumps), excessive itching, and flushing such as redness, warmth, or deepening of skin color.
Although uncommon, a more serious allergic reaction is may occur. One of the signs of a severe allergic reaction is skin swelling, usually in your hands, feet, lips, eyelids, and/or lips. Additionally, swelling in your throat, mouth, or tongue, can make breathing difficulties may occur.
If you experience an adverse response to Praluent, contact your physician immediately. However, use 911 or your local emergency number if you believe you are experiencing a medical emergency.
If you’re experiencing any of the serious side effects listed above, immediately call your doctor or 911 if it's an emergency, and stop taking this medication.
What happens if I miss a dose of Praluent?
This medication must be administered on a regular schedule. Call your doctor or pharmacist for instructions if you forget to take your medication or miss a dosage.
Every 2 weeks: If you missed a dosage, use this medication within 7 days. Return to your usual date after that. Wait until your next planned dosage to start taking Praluent again if the missing dose is not taken within 7 days.
Every 4 weeks: Use this medication within 7 days of the missed dosage if you forget to take it. Afterward, resume your original schedule. Use this medication as soon as possible and restart Praluent based on this date if the missing dosage is not taken within 7 days.
Statins: common side effects
- Myopathy (muscle weakness, stiffness, spasms)
- Myalgias (muscle pain and/or soreness)
- Arthralgia (joint pain and/or aches)
- Cognitive impairment
- Headache
- Cold-like symptoms, including sore throat, stuffy nose, and/or sneezing
- Insomnia
- Nausea
- Heartburn
- Abdominal pain
- Indigestion
- Constipation
- Weakness
Certain patients find that consuming more vitamin D helps them stop experiencing muscle soreness or pain. For some, it's common to experiment with doses and switch statin medications until you discover the most appropriate statin that works best.
Do not abruptly discontinue taking your statin medication if you believe you are experiencing any negative side effects. Consult your doctor to determine whether a dose adjustment or switching to a different drug could be beneficial in your case.
Statins: serious side effects
- Difficulty raising your arms and/or difficulty rising or standing
- Muscle aches in your hips, shoulders, neck, and back
Taking large doses of statins can lead to the breakdown of your muscle cells and the release of myoglobin into your blood. Kidney damage and excruciating muscle pain or soreness may result from this.
- Hepatic (liver) issues, such as upper abdominal pain, weakness, fatigue, decreased appetite, dark urine, and jaundice (yellowing of the skin or eyes).
- High blood sugar or type 2 diabetes, especially if you already have high blood sugar levels.
- Kidney issues, such as little to no urination, ankle or foot swelling, fatigue, or shortness of breath.
- Confusion and/or memory problems
After taking statins, some patients have experienced memory loss and cognitive issues. However, several studies have not found any indication that statins are directly to blame for these issues. Statins may be able to help avoid these problems, according to other research.
If you’re experiencing any of the serious side effects listed above, immediately call your doctor and stop taking this medication.
Warning
Some individuals taking statins may experience blood in their urine, also called hematuria, or protein in their urine commonly referred to as proteinuria.
Speak With Your Doctor
Both Praluent and statins are considered safe and effective when taken appropriately (as prescribed by your doctor). Talk to your doctor today about using Praluent and statins and send your prescription to Marley Drug. Save up to 95% compared to your local pharmacy by using Marley Drug.
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