Cholesterol-Lowering Drugs
IABLE
Medications and Anesthesia Cholesterol-Lowering Drugs

Cholesterol-Lowering Drugs

Lowering of the serum cholesterol in infants is considered inadvisable because cholesterol is necessary for myelinization in the central nervous system. Although it has never been shown that cholesterol-lowering drug in milk adversely affect the infant or lower their cholesterol, most sources recommend avoiding absorbable drugs like statins during breastfeeding. This concern limits the options for mothers who need to lower their serum cholesterol. Measurement of low levels of pravastatin and rosuvastatin (the two most water-soluble stains) in milk in a few mothers found the amounts in milk to be low. Atorvastatin has not been measured in milk, but 11 infants have reportedly been breastfed during maternal therapy with no adverse outcomes. Lost time on statins during pregnancy and lactation can result in a poor maternal control of hyperlipidemia.

Alternatives to statins are the modestly effective resins such as cholestyramine, colesevelam, and colestipol, which are not absorbed. Ezetimibe is absorbed, but poorly. It may be a second-choice alternative. Alirocumab and evolocumab are monoclonal antibodies that are potent cholesterol-lowering drugs. They are given by injection, but very poorly excreted into milk because of their large molecular size, partially destroyed in the infant’s gastrointestinal tract and poorly absorbed orally by infants. Although no experience has been reported with these drugs in breastfeeding, they are not contraindicated during nursing.

References

  1. Holmsen ST, Bakkebo T, Seferowicz M, et al. Statins and breastfeeding in familial hypercholesterolaemia. Tidsskr Nor Laegeforen 2017;137:686-7. PMID: 28551957
  2. Anderson PO. Treating hyperlipidemia during breastfeeding. Breastfeed Med 2020;15:189-90. PMID: 31986062
  3. Klevmoen M., Bogsrud M. P., Retterstøl K., et al. Loss of statin treatment years during pregnancy and breastfeeding periods in women with familial hypercholesterolemia. Atherosclerosis 2021;335:8-15. PMID: 34520888