Evolocumab belongs to the class of medications called PCSK9 inhibitors. It blocks a protein in the liver, which allows the liver to remove more low-density lipoproteins (LDL or "bad" cholesterol) and fatty substances called triglycerides from the blood. It also raises the levels of high-density lipoproteins (HDL or "good" cholesterol).

Evolocumab is used to reduce the risk of heart attack, stroke, and certain heart conditions in adults with cardiovascular disease. This medication is also used in addition to diet and other cholesterol-lowering medications to lower LDL levels for adults who have primary hyperlipidemia, including heterozygous familial hypercholesterolemia (HeFH). 

Evolocumab is also used by adolescents over 12 years old and adults with homozygous familial hypercholesterolemia (HoFH) in addition to diet and other treatments to treat high LDL levels.

Both HeFH and HoFH are genetic conditions (inherited from your parents) in which your liver does not work properly to remove bad cholesterol from the bloodstream.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

The recommended dose of evolocumab for prevention of cardiovascular events and to treat primary hyperlipidemia is 140 mg injected subcutaneously (under the skin) every 2 weeks or 420 mg injected subcutaneously once a month.

To treat homozygous familial hyperlipidemia, the starting dose is 420 mg injected once monthly. After 3 months, your doctor may increase your dose to 420 mg every 2 weeks, depending on your response to this medication.

If your dose is 420 mg, you will use 1 prefilled cartridge of 420 mg or 3 prefilled autoinjectors injected one after the other, within 30 minutes. Before injecting the medication, allow it to sit at room temperature for 45 minutes if using the 420 mg cartridge or 30 minutes if using the 120 mg autoinjector. Do not warm it in any other way. Subcutaneous injections are administered in the abdomen, upper arm, or thigh area. Rotate through the sites you use to inject the medication each time. Do not use the injection if it is discolored, cloudy, or if you can see particles in the solution.

If you are injecting this medication yourself, your doctor will show you how to use this medication properly. If you are not sure how to use it or have questions about how to use it, contact your doctor. Before using this medication, thoroughly read the patient information provided and, if you have any questions, ask your doctor. If a family member or caregiver will be giving you the injections, your doctor should instruct them on how to give the injection.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible, as long as there are more than 7 days until your next scheduled dose. If there are 7 days or less until your next scheduled dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication in the refrigerator, protect it from light and moisture, and keep it out of the reach of children. Do not freeze or shake this medication. Once it is removed from the refrigerator, it may be stored at room temperature for 30 days.

140 mg/mL Prefilled Autoinjector
Each 1 mL prefilled autoinjector contains a clear-to-opalescent, colourless-to-yellowish, sterile, preservative-free solution that contains 140 mg of evolocumab. Nonmedicinal ingredients: proline, glacial acetic acid, Polysorbate 80, water for injection, and sodium hydroxide.

120 mg/mL Prefilled Cartridge
Each 3.5 mL prefilled cartridge contains a clear-to-opalescent, colourless-to-yellowish, sterile, preservative-free solution that contains 420 mg of evolocumab. Nonmedicinal ingredients: proline, glacial acetic acid, Polysorbate 80, water for injection, and sodium hydroxide.

Do not take this medication if you are allergic to evolocumab or any ingredients of the medication.

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• back pain
• joint or muscle pain
• nausea
• pain, bruising, or swelling at the injection site

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

• flu-like illness (fever, sore throat, runny nose, cough, chills)
• hives
• rash
• symptoms of high blood sugar (e.g., frequent urination, increased thirst, excessive eating, unexplained weight loss, poor wound healing, infections, fruity breath odour)

Stop taking the medication and seek immediate medical attention if any of the following occur:

• signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Latex: The needle cover of the prefilled syringe and the auto injector is made from dry natural rubber. This may cause an allergic reaction if you are allergic to latex.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if evolocumab passes into breast milk. If you are breast-feeding and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children with HoFH who are less than 12 years old. It has not been studied for use by children with primary hyperlipidemia who are less than 18 years old.

There may be an interaction between evolocumab and any of the following:

• "statin" cholesterol medications (e.g., atorvastatin, lovastatin, simvastatin)

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.