Evolocumab !

A monoclonal antibody against PCSK9, injected under the skin. It keeps LDL receptors working, lowers LDL strongly and reduces heart attacks.

Updated 2026-11-01

Class: PCSK9 inhibitors
Target: PCSK9 (circulating protein)
ATC code: C10AX13

PCSK9 (circulating protein)Evolocumab

The figure shows PCSK9 bound to the EGF-A domain of the LDL receptor. Evolocumab binds PCSK9 on this same surface and blocks that contact; the antibody itself is not in this structure.

Target in 3D: PCSK9 (circulating protein). PDB structure 3BPS (RCSB PDB, public domain). View the structure at RCSB PDB

Mechanism of action

Evolocumab is a human monoclonal antibody that binds free PCSK9 in the blood. PCSK9 can then no longer attach to the LDL receptor and send it for lysosomal destruction, so more receptors recycle to the hepatocyte surface and remove LDL from the blood.

Antibody binds circulating PCSK9
PCSK9 can no longer grab the LDL receptor
LDL receptors recycle to the liver cell surface
Blood LDL falls strongly

Pharmacokinetics

Absorption: Subcutaneous injection every 2 weeks or once a month.
Elimination: Broken down like other antibodies and proteins, not by liver CYP enzymes.

Indications

Established atherosclerotic cardiovascular disease, to lower the risk of heart attack, stroke and revascularization Atherosclerosis and dyslipidaemia →
Heterozygous and homozygous familial hypercholesterolemia, with other LDL-lowering therapy Familial hypercholesterolemia →
After a myocardial infarction when LDL remains high despite a statin Myocardial Infarction (Heart Attack) →

Adverse effects

Common

Injection-site redness, itching, swelling or pain
Flu-like symptoms, runny nose, sore throat (nasopharyngitis)
Back or muscle pain, headache

Contraindications

Serious hypersensitivity to evolocumab or an excipient

Key interactions

Statins and ezetimibe: Used together on purpose: LDL-lowering effects add up. No known pharmacokinetic drug interactions.

What is monitored

Lipid panel some weeks after starting
Injection sites and allergic symptoms

Administration and safety

Subcutaneous injection in the thigh, abdomen (away from the navel) or upper arm; sites rotated.
Kept refrigerated; warmed to room temperature before use, never shaken.
The solution should be clear to pale yellow; it is not used if cloudy or with particles.
Each syringe, pen or on-body device is used once.

Nursing care

Before: lipid panel and allergy history.
Teach injection technique, storage and safe disposal of sharps.
Teach the signs of a serious allergic reaction.
Remind that the statin and diet continue.

Pregnancy and breastfeeding

Human data are limited; use in pregnancy is weighed case by case.

Test yourself

Think of the answer, then tap the question to see it.

Why does evolocumab lower LDL more when there are working LDL receptors?

It acts by preventing receptor destruction; patients with no functional LDL receptors respond much less.

Does evolocumab have CYP-based drug interactions?

No. It is an antibody cleared like other proteins; there are no known drug interactions.

What are the most common adverse effects of evolocumab?

Injection-site reactions, nasopharyngitis and flu-like symptoms, back pain.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: Evolocumab Injection: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2025); PCSK9:EGF-A complex (RCSB Protein Data Bank, 2008); Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed., ch. 37 (McGraw Hill, 2023); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.