Safety of Ezetimibe During Pregnancy

Guideline Recommendations

• The American College of Cardiology recommends that all lipid-lowering drugs, including ezetimibe, should be avoided during pregnancy and nursing 1, 2, 3
• Lifestyle interventions should be considered during pregnancy and nursing as general management for dyslipidemia, as recommended by the American College of Cardiology 1, 2

Clinical Context and Risk-Benefit Considerations

• Women on lipid-lowering drugs for primary prevention should discontinue therapy at least 1 month and preferably 3 months before attempted conception, or immediately if already pregnant, according to the American College of Cardiology 4, 5
• For very high-risk patients with established ASCVD, multiple risk factors, or homozygous familial hypercholesterolemia (HoFH), individual discussions with healthcare professionals are advised to consider ongoing therapeutic needs during pregnancy, as recommended by the American College of Cardiology 4, 5

Alternative Management During Pregnancy

• Bile acid sequestrants are the only lipid-lowering agents approved for use during pregnancy if treatment is absolutely necessary, according to the American College of Cardiology 4, 5
• Intensive lifestyle modifications and dietary interventions should be the primary management strategy during pregnancy, as recommended by the American College of Cardiology 1, 2
• Referral to a lipid specialist and registered dietitian is strongly recommended for high-risk pregnant patients, according to the American College of Cardiology 4, 5

Key Clinical Pitfalls to Avoid

• The American College of Cardiology advises against continuing ezetimibe in women planning pregnancy without careful risk-benefit assessment and discussion 1, 3
• Preconception counseling in women of childbearing age taking lipid-lowering therapy is necessary, as recommended by the American College of Cardiology 4, 5