To      : Keitha
Re      : Pravachol(pravastatin)

Seems I get this question quite often. Pravachol belongs to the HMG-CoA
reducatase family, of which there are about a dozen now.  They specifically
inhibit the enzyme which makes cholesterol in the liver. It is important to
remember that about 85% of our cholesterol is manufactured in the
liver...only 15% is derived from the diet.

As one may surmise, this family could also inhibit this enzyme in a
breastfed infant which could be detrimental(cholesterol is a major building
block in our biochemistry and of particular importance to a growing infant).
We have no data on the transfer of any of these products into breastmilk.

But this drug falls into the category of products whose use are simply not
justified in a breastfeeding mom.  First, atherogenesis is a life-long
problem, generally requiring 30 years to really become dangerous.  One or
two years of moderate hypercholesterolemia in a young woman carries only a
negligible health risk,  whereas one or two years of breastfeeding is
incredibly important to an infant. (This of course would depend on how high
her cholesterol actually is, relatively high,  or incredibly dangerous).

For this reason I always suggest to moms that they opt to NOT take the
anticholesterol drug until they have quit breastfeeding.  This drug family
in my opinion is less  important than breastfeeding, so lets not even expose
the infant to this drug class.  Why take the risk to the infant when the
gain to the mom from this drug is minimal over this time interval.

But as to the question "Is there a safe alternative?",  I would suggest that
this drug family, is probably the safest of the anticholesterol families,
with perhaps exception of cholestyramine.

Regards
Tom Hale Ph.D.