Additional information relating to breastfeeding

To be used in conjunction with individual drug entries for specific information and guidance.

There is limited evidence for the use of lipid regulating drugs in lactation. Their mechanism of action could lead to a detrimental effect on cholesterol biosynthesis, which is essential for neonatal development, although there is no clinical evidence for this in breast-fed infants. Discontinuation of these drugs is unlikely to have a negative impact on the management of maternal hypercholesterolaemia in the short-term.

Statins

(HMG CoA reductase inhibitors)

If statin therapy is required, rosuvastatin, pravastatin and atorvastatin are preferred, since some evidence is available to support their use.

The pharmacokinetic properties (high protein binding, relatively high molecular weights, and poor oral bioavailability) would make significant transfer to a breastfeeding infant unlikely. Side-effects, or any clinical effect on the infant’s cholesterol level, are not expected.

Precautionary monitoring of infant growth and weight gain is recommended.

Fibrates

There is no evidence on the safe use of fibrates (including gemfibrozil), which probably carry the same risks as statins.

Bile acid sequestrants

Bile acid sequestrants (colesevelam, colestyramine, colestipol) are resins which have no or minimal absorption from the mother’s GI tract and are therefore unlikely to appear in breast milk. They may decrease maternal absorption of fat soluble vitamins (A, D, E, K) leading to reduced vitamin availability to the infant from breast milk, although there is no clinical evidence to support this.

Other lipid lowering medicines

Omega-3 fatty acids (marine/fish oils) principally contain components normally found in breast milk—eicosapentaenoic acid and docosahexaenoic acid.

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