Statins and Anti-Cholesterol Drugs During Breastfeeding

Primary Recommendation

• The European Society of Cardiology explicitly states that statins should not be prescribed during breastfeeding since their harmlessness is not proven, and disadvantages to the mother are not expected by temporary interruption of therapy 1, 2
• The International Atherosclerosis Society recommends that statins and other systemically absorbed cholesterol-lowering drugs should ideally be discontinued during lactation 3, 4

Safe Alternative: Bile Acid Sequestrants

• Bile acid sequestrants are the only lipid-lowering medications considered safe during breastfeeding because they are not systemically absorbed 5
• The European Society of Cardiology and the International Atherosclerosis Society suggest that these agents can be used during lactation if cholesterol management is necessary 3, 4, 5
• Monitor for vitamin K deficiency when using bile acid sequestrants during breastfeeding, as well as malabsorption of other fat-soluble vitamins and folate 3, 4, 5

Other Cholesterol-Lowering Medications

• The American College of Cardiology and the International Atherosclerosis Society recommend that ezetimibe, PCSK9 inhibitors, bempedoic acid, fibrates, and niacin should all be avoided during breastfeeding due to insufficient safety data 3, 4, 5, 6

When to Resume Therapy

• The American College of Cardiology recommends that lipid-lowering therapy may be resumed after completion of breastfeeding, allowing mothers to breastfeed for the desired duration while managing their cardiovascular risk appropriately afterward 5, 6

Extremely High-Risk Patients

• The American College of Cardiology suggests that for the rare patient with homozygous familial hypercholesterolemia and established atherosclerotic cardiovascular disease at very high risk for heart attack or stroke, individual risk-benefit assessment may be considered, and these patients should be counseled on intensive lifestyle modifications and referred to a lipid specialist 5, 6

Common Pitfalls to Avoid

• The European Society of Cardiology and the International Atherosclerosis Society advise against failing to counsel women of childbearing age on reliable contraception while taking statins, and not switching to bile acid sequestrants before conception in women who require ongoing lipid management 3, 4, 5
• The American College of Cardiology recommends monitoring for vitamin K deficiency when bile acid sequestrants are used during lactation, and avoiding unnecessary discontinuation of breastfeeding when bile acid sequestrants would be an appropriate alternative 3, 4, 5, 6