Simvastatin

Statins work by blocking cholesterol synthesis.

At latest update no published data on breastfeeding were found.

A high plasma protein-binding capacity makes it unlikely its passage into milk.
Their low oral bioavailability hinders the passage toward infant’s plasma from ingested mother’s milk, except in preterm infants and immediate neonatal period, in which the infant may have an increased intestinal permeability.

It is unknown whether it is capable of altering the lipid composition of milk, albeit it is known and that the infants need to ingest high amounts of cholesterol because it is essential for a proper development of cell membranes of the nervous system and as a precursor of various hormones and vitamins.

It is prudent to avoid its use, at least while breastfeeding is exclusive. Atorvastatin is possibly the safest statin drug, for its high molecular weight makes it even more difficult the passage into the milk. With Pravastatin a poor secretion into milk has been reported. Simvastatin is the one with lowest oral bioavailability.

Discontinuing the treatment of hypercholesterolemia during lactation with such kind of drugs will not likely alter the long-term outcome of the disease. A low-fat diet should be recommended.

Alternatives

• Atorvastatin Calcium (High Risk probable)
• Pravastatin (High Risk probable)
• Colesevelam Hydrochloride (Very Low Risk)
• Ezetimibe (Low Risk probable)
• Colestipol (Very Low Risk)
• Colestyramine (Very Low Risk)