Repatha (Evolocumab) Missed-Dose Protocol: What to Do and When
The instructions depend on how late the dose is and whether your prescription is every two weeks or once monthly. Within seven days of the missed dose, take it and return to the original schedule. More than seven days late, an every-two-week dose is skipped until the next scheduled date; a monthly dose is taken and becomes the start of a new monthly schedule. Repatha prescribing information, section 2.2.
Check the pharmacy label before choosing a row below. Count from the date the injection was due, not the date of the previous injection. These instructions concern a known missed dose; an incomplete injection or uncertainty about whether you injected needs advice from the pharmacist or prescriber.
The missed-dose decision table
| Time since the scheduled dose | Every-two-week prescription | Once-monthly prescription |
|---|---|---|
| Within 7 days, including day 7 | Give the missed dose, then keep the original schedule. | Give the missed dose, then keep the original schedule. |
| More than 7 days | Wait for the next dose on the original schedule. | Give the missed dose and set a new monthly schedule from that date. |
The manufacturer's patient instructions and MedlinePlus describe this same distinction. Do not take an extra catch-up dose or combine separate scheduled doses.
Two examples that make the difference clear
- Every two weeks: An injection was due on the 1st, with the next due on the 15th. Remembering on the 5th means taking the missed dose and keeping the 15th. Remembering on the 10th means waiting until the 15th.
- Once monthly: An injection was due on the 1st. Remembering on the 5th means taking it and keeping the original monthly calendar. Remembering on the 10th means taking it and using the 10th as the new monthly scheduling date.
Ask the pharmacy to confirm the next date if the calendar is unclear, particularly around months of different lengths. Update reminders after a monthly schedule changes so an old alert does not prompt an unintended extra dose.
If the injection failed or you are unsure it was completed
A device problem is different from forgetting a scheduled injection. Do not estimate how much medicine entered your body and make up the difference yourself. Record the device used, what happened, the scheduled dose and the time of the attempt. Contact the pharmacist or prescribing team for instructions and keep the packaging information available.
For recurring problems, ask for another demonstration using the instructions for your exact device. Repatha has several presentations, and instructions for one should not be assumed to describe another. The current label includes 140 mg single-dose devices; a prescribed 420 mg dose uses three 140 mg injections within 30 minutes. Those three injections constitute one prescribed dose, not three separate catch-up doses. Prescribing information, sections 2.3 and 16.
Why staying on schedule matters
Use the missed-dose instructions above to return to the prescribed schedule. Evolocumab's cardiovascular benefit was studied with ongoing treatment alongside other cholesterol-lowering care.
In FOURIER, 27,564 people with established atherosclerotic cardiovascular disease received evolocumab or placebo alongside statin treatment. Over a median 2.2 years, the primary composite cardiovascular outcome occurred in 9.8% versus 11.3%, respectively, with a hazard ratio of 0.85. The composite included cardiovascular death, heart attack, stroke, hospitalization for unstable angina or coronary revascularization. For a missed injection, follow the label's schedule-specific instructions rather than using the trial's overall event rate to estimate immediate risk. Sabatine and colleagues, 2017.
The AMUNDSEN design paper describes a separate research setting: starting evolocumab before a coronary intervention during an acute heart attack. Outpatient missed-dose instructions come from the prescribing information. Montalescot and colleagues, 2026.
Repeated missed doses need an access and follow-up plan
Bring the actual injection dates to the prescriber, including partial attempts and missed refills. Explain whether the barrier is cost, insurance authorization, travel, device use or remembering. That information is more useful than simply reporting that treatment was taken "most of the time."
Agree on who will resolve a refill problem, whether the prescribed schedule still fits your routine, and when lipid testing would change management. Do not compensate by changing another cholesterol medicine yourself. People receiving a specialized regimen for homozygous familial hypercholesterolemia or lipid apheresis should coordinate missed treatments with their specialist.
Storage and urgent symptoms
MedlinePlus advises storing evolocumab in its original carton, refrigerated and protected from light, without freezing or shaking. It may be kept at room temperature for up to 30 days. Follow the product's temperature limits and expiration date; returning it to a refrigerator does not create a new 30-day allowance. Ask the pharmacist about uncertain storage conditions rather than assuming the medicine is usable.
Trouble breathing or swallowing, swelling of the face or throat, or a severe allergic reaction requires immediate medical care. Possible heart attack or stroke symptoms also require emergency care. Resolving an injection calendar should never delay that assessment.
Frequently asked questions
Is exactly seven days late the same as more than seven days?
No. The label distinguishes "within 7 days" from "more than 7 days." Use the first row for day seven. If you cannot establish the due date, have the pharmacy help reconstruct it.
Can I change from every two weeks to monthly because I missed a dose?
Discuss a prescribed schedule change with the clinician. For an authorized change between these regimens, the label places the first dose of the new regimen on the next scheduled date of the old one. Missing a dose alone does not change the prescription.
Do I need a cholesterol test immediately?
The missed-dose instructions do not require an automatic test after each lapse. The prescribing team can decide whether testing is useful based on the length of the gap, your risk, recent results and other treatment. Tell them the injection dates so they can interpret the result in context.
References
- DailyMed. Repatha (evolocumab) prescribing information, revised July 2026.
- Amgen. How to take Repatha.
- MedlinePlus. Evolocumab injection.
- Sabatine MS, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. New England Journal of Medicine. 2017;376:1713-1722. doi:10.1056/NEJMoa1615664.
- Montalescot G, et al. Evolocumab before percutaneous coronary intervention for acute myocardial infarction: design of the AMUNDSEN trial. American Heart Journal. 2026;292:107295. doi:10.1016/j.ahj.2025.107295.