Alirocumab: Uses, Dosage, Side Effects, and Injection Guide

Summary of Key Points

Alirocumab is a prescription medication used to lower cholesterol in adults with certain heart conditions or genetic disorders. It works by helping the body remove harmful cholesterol from the bloodstream. Alirocumab is often prescribed for individuals with high cholesterol who have not responded well to other treatments. Always consult your healthcare provider before starting or adjusting your medication. Our telemedicine providers are available to assist you in managing your treatment.

Names of Medication

US Brand Name: Praluent (Alirocumab)

The generic name, which is the active ingredient, is listed in parentheses after the brand name.

Pharmacologic Category

PCSK9 Inhibitors

Alirocumab Dosage

Alirocumab is used to treat various conditions related to high cholesterol and cardiovascular disease. The dosage may vary depending on the specific condition being treated. Always follow your healthcare provider’s instructions and consult them before making any changes to your dose. You can also schedule a telemedicine appointment with one of our providers to discuss your treatment plan.

1. Hyperlipidemia: The usual starting dose is 75 mg injected under the skin every two weeks. Your doctor may increase it to 150 mg every two weeks if necessary.
2. Familial Hypercholesterolemia (HeFH): The typical dose is 75 mg injected every two weeks. Some patients may require 150 mg every two weeks.
3. Atherosclerotic Cardiovascular Disease (ASCVD): The starting dose is 75 mg every two weeks, which may be increased to 150 mg if needed.
4. Coronary Artery Disease (CAD): The dose is usually 75 mg injected every two weeks, with the possibility of increasing to 150 mg every two weeks.
5. Peripheral Artery Disease (PAD): The typical dose is 75 mg every two weeks, which may be increased to 150 mg if necessary.
6. Ischemic Stroke: The starting dose is 75 mg every two weeks, with adjustments to 150 mg if required.
7. Myocardial Infarction (Heart Attack): The dose is usually 75 mg every two weeks, with the possibility of increasing to 150 mg.
8. Diabetes Mellitus: The typical dose is 75 mg every two weeks, which may be increased to 150 mg if needed.
9. Metabolic Syndrome: The starting dose is 75 mg every two weeks, with adjustments to 150 mg if required.
10. Cardiovascular Disease (CVD): The dose is usually 75 mg every two weeks, with the possibility of increasing to 150 mg.

Dosage Forms and Strengths

Alirocumab is available in the following forms:

1. Pre-filled syringe: 75 mg/mL, 150 mg/mL
2. Pre-filled pen: 75 mg/mL, 150 mg/mL

Administration Instructions for Alirocumab Injection

Alirocumab is administered as a subcutaneous injection, typically into the thigh, abdomen, or upper arm. You or a caregiver can be trained to administer the injection at home. Be sure to rotate the injection site with each dose to avoid irritation. If you miss a dose, take it as soon as you remember, but do not take two doses at once. Always follow your healthcare provider’s instructions carefully.

Alirocumab Side Effects and Adverse Reactions

Like all medications, Alirocumab may cause side effects. Not everyone will experience them, but it’s important to be aware of potential reactions. If you experience severe or concerning symptoms, contact your healthcare provider immediately. You can also schedule a telemedicine appointment with one of our providers for further guidance.

Common Side Effects (1-10%)

1. Injection site reactions (redness, swelling, or pain)
2. Cold or flu-like symptoms (runny nose, sore throat)
3. Muscle pain

Less Common Side Effects (<1%)

1. Allergic reactions (rash, itching, swelling)
2. Severe muscle pain or weakness
3. Difficulty breathing

Contraindications for Alirocumab

A contraindication is a specific situation where a medication should not be used because it could cause harm. If you have any of the following conditions, avoid taking Alirocumab. Always consult your healthcare provider before starting or stopping any medication. If you are unsure, one of our telemedicine providers can guide you.

1. Allergy to Alirocumab or its ingredients: If you have had an allergic reaction to Alirocumab or any of its components, you should not take this medication. Allergic reactions can range from mild (such as a rash) to severe (such as difficulty breathing or anaphylaxis).
2. Severe liver disease: Alirocumab is not recommended for patients with severe liver disease, as the liver plays a key role in processing cholesterol and medications. Impaired liver function could lead to unpredictable effects or complications.
3. Pregnancy and breastfeeding: Limited data is available on the safety of Alirocumab during pregnancy and breastfeeding. It is generally advised to avoid the medication unless the potential benefits outweigh the risks. More details are provided in the sections below.

Drug to Drug Interactions

Alirocumab may interact with other medications, potentially increasing the risk of side effects or reducing the treatment’s effectiveness. Inform your healthcare provider about all medications you are currently taking, including over-the-counter drugs, supplements, and herbal products. Here are some known drug interactions:

1. Statins: Alirocumab is often used alongside statins (such as Atorvastatin [Lipitor] or Rosuvastatin [Crestor]). However, since both medications lower cholesterol, monitoring for muscle-related side effects is important.
2. Fibrates: Medications like Fenofibrate (Tricor) or Gemfibrozil (Lopid) may interact with Alirocumab, increasing the risk of liver or muscle issues. Your healthcare provider will monitor your liver enzymes and muscle health if you are taking both medications.
3. Immunosuppressants: Drugs such as Cyclosporine (Neoral) or Tacrolimus (Prograf) may affect how your body processes Alirocumab. These medications can alter your immune system, so combining them with Alirocumab may require careful monitoring.

Alirocumab in Pregnancy

Is it safe to take Alirocumab when pregnant?

There is limited information regarding the safety of Alirocumab during pregnancy. While animal studies have not shown significant harm to the fetus, there is not enough evidence to confirm its safety in humans. Cholesterol levels naturally increase during pregnancy to support fetal development, which may reduce the need for cholesterol-lowering medications like Alirocumab. If you are pregnant or planning to become pregnant, it’s important to discuss the potential risks and benefits with your healthcare provider. In many cases, alternative treatments or lifestyle adjustments may be recommended during pregnancy.

Alirocumab while Breastfeeding

Is it safe to take Alirocumab while breastfeeding?

It is unclear whether Alirocumab passes into breast milk. Due to the lack of available data, it is generally advised to avoid using Alirocumab while breastfeeding unless the potential benefits clearly outweigh the risks. If you are breastfeeding and need to manage your cholesterol, your healthcare provider may suggest alternative treatments or lifestyle changes. Always consult your healthcare provider before making any decisions about medications while breastfeeding.

Estimated Cost of Alirocumab

The cost of a 30-day supply of Alirocumab can vary depending on the dosage and the pharmacy. Without insurance, the estimated cost using a GoodRX coupon ranges from approximately $500 to $700. Prices may fluctuate, so it’s a good idea to check with your pharmacy or use a discount service like GoodRX to find the best available price.

Possible Alternatives to Alirocumab

If Alirocumab is not suitable for you, or if you are exploring additional ways to manage your condition, there are alternative treatments and lifestyle changes that may help. Always discuss these options with your healthcare provider before making any changes to your treatment plan. You can also schedule a telemedicine appointment with one of our providers to explore these alternatives.

Hyperlipidemia

Other cholesterol-lowering medications, such as statins (Atorvastatin, Simvastatin), ezetimibe (Zetia), or fibrates, may be considered. Lifestyle changes, including adopting a heart-healthy diet, engaging in regular physical activity, and managing your weight, can also help lower cholesterol levels.

Familial Hypercholesterolemia

In addition to Alirocumab, other treatments such as statins, ezetimibe, or LDL apheresis (a procedure to remove LDL cholesterol from the blood) may be used. Genetic counseling and lifestyle modifications are also important components of managing this condition.

Atherosclerotic Cardiovascular Disease

Medications such as statins, aspirin, and blood pressure-lowering drugs may be recommended. Lifestyle changes, including quitting smoking, eating a balanced diet, and exercising regularly, are essential for managing this condition.

Coronary Artery Disease

In addition to cholesterol-lowering medications, treatments may include beta-blockers, ACE inhibitors, or calcium channel blockers. Lifestyle changes, such as improving your diet and increasing physical activity, are also crucial for managing coronary artery disease.

Peripheral Artery Disease

Medications to improve blood flow, such as cilostazol (Pletal), or antiplatelet drugs like aspirin may be prescribed. Exercise therapy and smoking cessation are key lifestyle changes that can help manage this condition.

Ischemic Stroke

Blood thinners like warfarin (Coumadin) or direct oral anticoagulants (DOACs) may be prescribed. Managing blood pressure, cholesterol, and blood sugar levels through medication and lifestyle changes is also critical in reducing the risk of future strokes.

Myocardial Infarction (Heart Attack)

After a heart attack, medications such as beta-blockers, ACE inhibitors, and statins are often prescribed. Lifestyle changes, including following a heart-healthy diet, engaging in regular exercise, and managing stress, are essential for recovery and preventing future heart attacks.

Diabetes Mellitus

Managing blood sugar levels with medications like metformin (Glucophage) or insulin is key. A healthy diet, regular physical activity, and weight management are also important for controlling diabetes and reducing cardiovascular risk.

Metabolic Syndrome

Lifestyle changes such as weight loss, increased physical activity, and a healthy diet are the first-line treatments for metabolic syndrome. Medications to manage high blood pressure, cholesterol, and blood sugar may also be necessary.

Cardiovascular Disease

A combination of medications, including statins, blood pressure medications, and antiplatelet drugs, may be used to manage cardiovascular disease. Lifestyle changes, such as quitting smoking, improving your diet, and increasing physical activity, are essential for long-term management.

Recent Updates on Alirocumab Research

Recent research on Alirocumab continues to explore its benefits beyond cholesterol lowering. Studies suggest that Alirocumab may reduce the risk of major cardiovascular events, such as heart attacks and strokes, in patients with high cholesterol who are already on statin therapy. Ongoing trials are also investigating its potential use in patients with conditions like diabetes and metabolic syndrome, where cholesterol management plays a crucial role.

Researchers are also examining the long-term safety and efficacy of Alirocumab, particularly in patients with familial hypercholesterolemia and those at high risk for cardiovascular events. As more data becomes available, Alirocumab may become an even more valuable tool in managing cardiovascular health.

If you have questions about whether Alirocumab is right for you, or if you want to learn more about the latest research, our telemedicine providers are available to help you make informed decisions about your health.

James Kingsley

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