July 20, 2026
ByJulie Corliss,
Executive Editor, Harvard Heart Letter
- Reviewed byRobert H. Shmerling, MD,
Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
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A new pill that dramatically lowers harmful LDL cholesterol may be a good option for people who can’t tolerate statins or who haven’t lowered their LDL enough despite their current treatment with cholesterol-lowering drugs
Approved by the FDA in July 2026, enlicitide (Lipfendra) is the first oral version of a class of drugs known as PCSK9 inhibitors. These drugs work by mimicking the effect of a naturally occurring variant in the PCSK9 gene that leads to very low LDL levels. But the original drugs — which are given by injection once or twice a month — aren’t widely used. Some people aren’t comfortable giving themselves an injection. Also, most insurance companies won’t cover the cost (which range from $200 to $500 or more per month) until a person has tried other therapies without success.
Enlicitide is a daily pill that must be taken on an empty stomach with a sip of water, black coffee, or plain tea. It lowers LDL by nearly 60%, which is similar to the injectable PCSK9 drugs. Less than 10% of users experienced either dizziness or diarrhea, the two most common side effects. A month’s supply will cost about $300; for now, insurance coverage remains unclear
The drug might be especially helpful for people whose LDL remains above recommended levels, despite taking cholesterol-lowering drug such as statins. The 2026 cholesterol guidelines recommend that people who’ve had a heart attack or stroke should aim for an LDL cholesterol of less than 55 milligrams per deciliter
The injectable PCSK9 drugs, alirocumab (Praluent) and evolocumab (Repatha), have been shown to reduce the incidence of heart attacks, strokes, and death from cardiovascular disease by up to 20% among people at high risk, over periods of up to at least five years. A similar study is currently underway to see if enlicitide offers the same benefit, with results expected in several years
Image: © zeljkosantrac/Getty Images
About the Author
Julie Corliss,
Executive Editor, Harvard Heart Letter
Julie Corliss has been the executive editor of the Harvard Heart Letter since 2013. She also writes for the Harvard Health Letter, Harvard Women’s Health Watch, and Harvard Men’s Health Watch, as well as for Harvard …
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About the Reviewer
Robert H. Shmerling, MD,
Senior Faculty Editor, Harvard Health Publishing; Editorial Advisory Board Member, Harvard Health Publishing
Dr. Robert H. Shmerling is the former clinical chief of the division of rheumatology at Beth Israel Deaconess Medical Center (BIDMC), and is a current member of the corresponding faculty in medicine at Harvard Medical School. …
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View all posts by Robert H. Shmerling, MD
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