Cardiovascular prevention · UK
Inclisiran, twice a year, for LDL that will not come down.
A long-acting PCSK9-silencing injection given every six months, added to your statin. NICE-approved for the right patients — and free on the NHS when you meet the criteria.
Why patients choose us
- 01
Two injections a year, not 365 tablets
Inclisiran is given twice a year after loading. If daily statins have never quite become a habit, that alone changes the maths of long-term LDL control.
- 02
A lipid specialist, not a walk-in
A consultant lipidologist reviews your history, your statin trial, and your cardiovascular risk before anyone prescribes. NICE criteria checked properly.
- 03
Independent, and free
We are paid by no clinic and by no manufacturer. If a statin plus ezetimibe is the right answer, we say so.
Indicative pricing
What inclisiran costs in the UK — NHS and private.
NHS-funded when you meet NICE criteria. Private ranges below for patients paying directly or via insurance.
In short
Annual maintenance privately: £3,800–£4,600. NHS-funded when NICE criteria are met: free at point of care.
| Item | Indicative range | Typical duration | Turnaround |
|---|---|---|---|
| Lipid consultation (consultant lipidologist) | £220–£380 | 30–45 min | Same visit |
| Inclisiran 300mg — single injection (private) | £1,900–£2,400 | 15 min | Same visit |
| Loading course (2 injections, months 0 and 3) | £3,800–£4,600 | 15 min each | Same visit |
| Annual maintenance (2 injections per year) | £3,800–£4,600 | 15 min each | Same visit |
| Repeat lipid panel | £85–£140 | 5 min blood draw | 24–48 hours |
| NHS-funded route (via GP or lipid clinic) | Free at point of care | As above | Referral-dependent |
The NHS list price is £1,968 per dose, but a confidential Novartis–NHS commercial arrangement brings the effective cost down (Novartis has publicly said around £1,900 per patient per year). Private pricing varies by clinic and covers the drug, the injection appointment and the consultation.
The problem
The right patient, the right drug, the right pathway.
Inclisiran is powerful and NHS-funded — but only for patients who meet NICE TA733 or TA810 criteria. The commonest failures are prescribing it too early, prescribing it instead of statin optimisation, and missing that a PCSK9 antibody would suit better.
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Statin dose actually maximum?
Atorvastatin 40–80mg or rosuvastatin 20–40mg, plus ezetimibe, before anyone reaches for a PCSK9 agent. We check this properly.
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NICE criteria met?
Established CVD with LDL above 2.6, primary prevention above 4.0, or heterozygous FH persistently high. We map your numbers against the actual guidance.
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Inclisiran or an antibody?
Repatha and Praluent may fit better for some patients. Twice-yearly vs fortnightly is a real trade-off — and worth having discussed.
The journey
From first injection to twice-yearly maintenance — how the year looks.
Load at day 0, top up at three months, then a single injection every six months. Two visits a year, indefinitely.
Phase 1 · Before your first dose
Eligibility, workup, consultation
Phase 2 · Loading
Two injections, three months apart
Phase 3 · Maintenance
Every 6 months, ongoing
- 01
Before
You send us your lipid history
A short, confidential form. Current LDL, statin history, any intolerance, cardiovascular events, family history — the pieces NICE actually asks about.
- 02
Before
We come back with a recommendation
Within one working day: whether inclisiran is likely to be funded, whether a PCSK9 antibody or bempedoic acid fits better, and what to bring to consultation.
- 03
Before
Lipid consultation and eligibility check
A consultant lipidologist reviews meds, LDL trend, and NICE TA733/TA810 criteria. Baseline lipid panel and liver function if not recent.
- 04
Loading
First injection (loading dose)
A single 300mg subcutaneous injection in the abdomen, upper arm or thigh — under a minute, given by a trained nurse. Home straight after.
- 05
Loading
Three-month top-up
Second loading dose at 3 months. A repeat lipid panel confirms LDL response — typically around a 50 per cent drop.
- 06
After
Twice-yearly maintenance
One injection every 6 months thereafter. That is it — two visits a year to hold LDL down.
- 07
After
Six-monthly lipid review
A lipid panel around each dose to confirm sustained response. Your statin continues alongside — inclisiran is added to, not a replacement for, statin therapy.
Typical LDL response: around 50 per cent reduction at 3 months, sustained through 18 months in ORION trials.
When it helps
Who inclisiran is really for.
The NICE-eligible groups, the practical situations where it earns its place, and the one condition where it does not work.
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LDL still high on maximum statin
A high-intensity statin at the maximum tolerated dose, plus ezetimibe, and the LDL still will not come down enough for your cardiovascular risk.
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Established cardiovascular disease
Prior heart attack, stroke, TIA, peripheral arterial disease or coronary revascularisation, with LDL persistently above 2.6 mmol/L on optimised therapy.
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Heterozygous familial hypercholesterolaemia
Genetically confirmed or clinically diagnosed HeFH with LDL persistently above target despite maximum-tolerated statin and ezetimibe.
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Statin intolerance — genuine, documented
Two or more statins tried at low dose, with a proper rechallenge protocol, and side effects that could not be worked around. Not a shortcut past statin therapy.
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Adherence has been the problem
Daily tablets have not stuck. Twice-a-year dosing removes the compliance barrier that quietly ends most lipid-lowering plans.
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Primary prevention, very high LDL
No prior cardiovascular event, but LDL above 4.0 mmol/L on optimised therapy and a high 10-year CV risk — the NICE TA810 group.
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Preference over fortnightly PCSK9-mAb
Evolocumab or alirocumab work, but need injection every two to four weeks. Twice a year suits some patients — and some clinicians — better.
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Not for: homozygous FH
HoFH responds poorly to inclisiran because LDL receptor function is severely impaired. Lomitapide, evinacumab, LDL apheresis or transplant are the routes there.
Alternatives
Where inclisiran sits in the lipid pathway.
The full toolkit for lowering LDL and cardiovascular risk — statin first, then ezetimibe, then a PCSK9 agent for the right patients, per NICE NG238 (2023 update).
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Inclisiran (Leqvio) — siRNA
A small interfering RNA that silences PCSK9 messenger RNA inside liver cells. Twice-yearly injection. NICE-approved (TA733, TA810).
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Evolocumab (Repatha) — PCSK9 mAb
A monoclonal antibody that binds circulating PCSK9. Injected every two to four weeks. NICE-approved (TA394), often self-administered at home.
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Alirocumab (Praluent) — PCSK9 mAb
Also a PCSK9 monoclonal antibody. Fortnightly or monthly injection. NICE-approved (TA393). Cardiovascular outcome data from ODYSSEY.
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High-intensity statin
Atorvastatin 40–80mg or rosuvastatin 20–40mg — the first-line backbone of LDL lowering. Cheap, oral, and the evidence base every other agent is added to.
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Ezetimibe
Blocks cholesterol absorption in the gut. Added to statin (or used alone if statin-intolerant). Modest LDL reduction, complementary mechanism.
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Bempedoic acid (Nilemdo)
An ATP-citrate lyase inhibitor — oral, daily. NICE TA694. Useful when statin is not tolerated and further LDL reduction is needed.
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Icosapent ethyl (Vazkepa)
Purified EPA. NICE TA805 — for patients with high triglycerides on statin and established CV disease. Not an LDL agent.
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LDL apheresis (specialist centres)
Physical removal of LDL from plasma. Reserved for HoFH or severe refractory disease. A handful of UK centres offer it.
Our vetted UK network
A small panel of lipidologists, we picked them.
Consultant lipidologists across NHS specialist centres and the London private sector. Introductions made privately once your case is understood.
Selection criteria
How we choose every lipid specialist in our network.
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Consultant lipidologists, not general clinicians running a lipid clinic on the side
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NICE TA733 and TA810 criteria applied properly — no off-label prescribing
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Alternatives (statin optimisation, ezetimibe, PCSK9-mAb, bempedoic acid) offered fairly
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Delivery via a trained nurse in clinic or in the community — including your GP surgery where NHS-funded
Safety and monitoring
What to expect on inclisiran — honestly.
A well-tolerated injection in the ORION trials, with a simple monitoring schedule. Cardiovascular outcome data still maturing — worth knowing that up front.
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Injection-site reactions are the commonest issue
Around 5–10 per cent of patients notice bruising, redness or a small ache at the injection site. Self-limiting, resolves within days, does not usually recur.
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No statin-style muscle signature
Inclisiran is a liver-targeted siRNA — it does not enter muscle cells. Myalgia is not a feature the way it can be with statins.
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Well-tolerated in the ORION trials
Across ORION-9, 10 and 11 the adverse-event profile matched placebo apart from injection-site reactions. Long-term follow-up continues in ORION-4.
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Cardiovascular outcome data pending
ORION-4, the cardiovascular outcomes trial, reports around 2027. Approval currently rests on LDL reduction as a surrogate, with the outcomes evidence still maturing.
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You keep taking your statin
Inclisiran is added on top of maximum-tolerated statin — not a replacement. Stopping the statin undoes most of the point.
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Not in pregnancy or breastfeeding
Reliable contraception is expected during treatment. Discuss timing with the lipid clinic if a pregnancy is planned.
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Severe hepatic impairment excluded
Child–Pugh C liver disease is a contraindication. Mild or moderate impairment is not.
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Monitoring is light
A baseline lipid panel, a repeat at three months to confirm response, then six-monthly with each dose. No routine liver or CK monitoring beyond your usual statin schedule.
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Red flags
Severe allergic reactions are rare but possible. Swelling of the face, tongue or throat, or difficulty breathing after an injection — 999, not a phone call to the clinic.
Reading your lipid clinic letter
Your clinic letter in four parts. Read the last one first.
Whichever specialist writes it, the letter keeps to the same shape.
A quiet reminder
Lipid numbers are precise but not always intuitive — we translate them for you.
If you would like us to talk you through the letter before your next dose, just ask.
- 01 Header
Indication and NICE pathway used
Which NICE technology appraisal your prescription sits under — TA733 (secondary prevention or HeFH) or TA810 (primary prevention, very high LDL).
- 02 Baseline
Lipid profile and prior therapy
The LDL you started at, your statin history and dose, ezetimibe trial, and any documented intolerance. The record NICE and your insurer will want to see.
- 03 Response
LDL response at 3 and 6 months
The three-month post-loading LDL — the number that tells you whether inclisiran is doing its job. Then the six-monthly trend on maintenance.
- 04 Plan
Next dose, next review, adherence to statin
Read this first: the date of your next injection, the date of your next lipid panel, and the reminder that your statin continues alongside.
Recognised by major UK insurers
Private cover for inclisiran varies by insurer and by indication — most funders follow NICE criteria. We confirm cover before booking, and always flag the NHS route when it is the better option.
Frequently asked
Everything we get asked about inclisiran.
Quick answers on eligibility, cost, comparison with statins and PCSK9 antibodies, and how NHS delivery works.
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What is inclisiran and how does it work?
Inclisiran (brand name Leqvio, made by Novartis) is a small interfering RNA that silences the PCSK9 gene inside liver cells. With less PCSK9 around, more LDL receptors sit on the liver surface pulling cholesterol out of the blood. The result is roughly a 50 per cent drop in LDL, sustained by an injection every six months.
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Who is eligible on the NHS?
NICE approves inclisiran for adults on maximum-tolerated statin plus ezetimibe whose LDL is still above 2.6 mmol/L with established cardiovascular disease (TA733), above 4.0 mmol/L in high-risk primary prevention (TA810), or persistently high in heterozygous familial hypercholesterolaemia. It is not for homozygous FH.
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How is inclisiran different from Repatha or Praluent?
Evolocumab (Repatha) and alirocumab (Praluent) are monoclonal antibodies that bind PCSK9 protein directly and are injected every two to four weeks. Inclisiran is an siRNA that stops the liver making PCSK9 in the first place, and is injected twice a year. LDL reductions are similar; the dosing frequency is the main practical difference.
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How much does inclisiran cost privately in the UK?
Roughly £1,900–£2,400 per injection privately, so around £3,800–£4,600 a year on maintenance. The NHS list price is £1,968 per dose but a confidential discount is in place under the Novartis–NHS commercial arrangement, so NHS-funded patients pay nothing at the point of care.
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Do I still need to take my statin?
Yes. Inclisiran is added on top of your statin, not a replacement for it. The NICE indications assume you are already on a maximum-tolerated statin — stopping it undoes most of the benefit.
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What are the side effects?
The commonest is a mild injection-site reaction (bruising, redness, aching) in about 5–10 per cent of patients, usually settling within days. Muscle aches, headache and mild respiratory infections have been reported but at rates close to placebo in trials. There is no statin-style myalgia signature.
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When will we know it prevents heart attacks and strokes, not just lowers LDL?
ORION-4, the cardiovascular outcomes trial, is due to report around 2027. Until then, approval rests on the substantial and sustained LDL reduction shown in ORION-9, 10 and 11 — and on the wider evidence that lowering LDL by this magnitude reduces cardiovascular events.
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Can I get inclisiran through my GP?
Yes — NHS England commissioned inclisiran for community delivery. Once a lipid clinic or GP with special interest confirms eligibility, the injections can be given at your GP surgery by a practice nurse, every six months. That is a large part of what makes it practical at scale.
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What if I have homozygous familial hypercholesterolaemia?
Inclisiran works poorly in HoFH because LDL receptor function is severely impaired to begin with. The options in that setting are lomitapide, evinacumab, LDL apheresis at a specialist centre, or, in selected cases, liver transplant.
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When should I see a GP or A&E urgently?
Severe allergic reactions after an injection — swelling of the face, tongue or throat, or difficulty breathing — need 999. New chest pain, weakness on one side, or sudden slurred speech are cardiovascular emergencies, not lipid-clinic problems.
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