Repatha vs. zetia and statin

I’m taking a combination of Zetia and Nexletol. My LDL-C is 70, HDL 85 and triglycerides 65.

My husband is using Repatha now over a year, instead of statins plus Aspirin 81mg.
No side effects and his cholesterol results are good now.
Yes it is expensive but for us worth it.
Did you get a high dosed statin?

@rainerhans I have been on different statins for years. They all eventually give me mild muscle aches and my PCP immediately switches me to a different one. The current one I am on is pravachol which seems to be doing nothing. My numbers keep going up.

Hi @pjc810, and welcome to Mayo Clinic Connect! You have found a good place to discuss all things cholesterol and related therapies, full of learning and encouragement. Your experience treating cholesterol is unique and you ask a great question.

As you read comments from others I can tell you what I have learned from my own experience. I struggled 30+ years with LDL levels, and treatment after treatment that either didn’t work or made me feel horrible. My numbers finally got to a good level when the approach to my treatment changed. A more personalized approach is what works instead of trial-and-error. I say this to encourage you to work with your doctor to learn all you can about why your particular numbers are where they are at. This way you know exactly what you are treating.

According to Mayo Clinic, one of the most significant predictors of statin intolerance is the dose -the higher the dose, the more likely to develop intolerance. Here is an excellent podcast expanding on this topic you may find valuable, about 11 minutes and well worth the listen:
- Mayo Clinic Cardiovascular Continuing Medical Education (CME): Statin Myopathy (Sept, 2025)
https://cardiovascularcmemayoclinic.podbean.com/e/statin-myopathy/
I love your thoughts of trying rosuvastatin and ezetimibe. Ezetimibe (zetia) and Rosuvastatin worked well for me. My current cardiologist recommended 5 mg twice a week, enough to always have some in my body all the time. I take 1/2 zetia daily. I have a horrible history with it and said, ‘never again’. I guess never say never. My doc had me slowly reintroduce it, gradually working up to this schedule.

I would love to know your thoughts after listening to the above podcast. Please come back and comment.

In the meantime, how much rosuvastatin were you taking, and how often when you noticed side effects? Have you had blood work to learn more about your LDL, like Apolipoprotein B (ApoB) and Apolipoprotein A1 (ApoA1)?

Thank you for posting the podcast. I will have to listen to it several more times to absorb everything.

I was on 20 mg of rosuvastatin. I mentioned to my PCP in May of 2024 that my thigh muscles hurt. He automatically said is was the rosuvastatin. I also mentioned to him it could have been that I started walking further and more often which he dismissed. He immediately switched me to pravachol.

While on the rosuvastatin I had my Apoliprotein B taken twice and it was in normal range both times. Since switching me to pravachol I have only had it tested once and it was high. I have never had my Apoliprotein A1 tested.

I really want to try rosuvastatin again because my cholesterol test results were normal while on it and the muscles aches were minimal and could have been caused by other factors.

I'm thinking he is going to push the repatha which I don't want to do yet.

I was put on Repatha in 2021 and for 3 years had virtually no side effects. It put my cholesterol numbers into an almost ideal range. It also gradually raised my blood pressure from around 117/70 to being over 140/85 most of the time. So replaced one risk factor with another. My plaque score also surged during this time ..almost doubling. High blood pressure is known to drive increased coronary plaque. However that is not all.
One of the common listed side effects is a greater tendency to get upper respiratory tract infections. In April of 2024 I got diagnosed with pneumonia that was successfully treated with antibiotics, steroids etc. 3 months later I had a recurrence and over the next year had 2 more until it dawned on me that Repatha could be part of the problem. I stopped the drug and the recurrences stopped with it but not right away. It takes 3 months + for the drug to completely exit your system so I had one more event since then. I am now at six months without any infection.
Injectables with long half lives may be more convenient, but if you have some problem the downside is that it takes way longer to rid the drug from your body. There is a new one called Inclirisan (i think)..also a PCSK9 inhibitor that you only have to inject once a year. Sounds great..unless you develop a serious problem after a few months!

Some medications require a 'weaning' period where you take up to six months to get off the current dose by cutting the dose a fraction at a time, going for two/three weeks and then cutting once again. Why should that not be the approach to newly prescribed drugs that are known to cause some intolerance, but that otherwise achieve the desired outcome for the patient? Start with a low dose, and increase it by fractions over a three/four month period until the therapeutic effect is achieved. It's not likely to be so urgent that you need a clot-busting or a plaque-busting drug at high dose yesterday. As a heart patient, I think of drugs like Multaq, Tikosyn, and Flecainide, all of which sometimes cause patient's bodies to balk, and with that a good drug is thrown into the garbage.