In reference to the use of atorvastin(Lipitor) or any HMG CoA reducatase inhibitor
that inhibits the production of hepatic cholesterol,  my main objective to the use
of these products is:   1) we do not have a single paper nor any clinical
experience as to the effect of these on an infant, and 2) as Dr. Newman states,
they are simply not worth the risk.

Basically this family of drugs have a long clinical effect, sometimes several days,
and they are potent inhibitors of this most important enzyme in the liver(some have
proposed using them every other day rather than daily).  While the plasma half-life
is rather short (14 hours),  inhibition of the enzyme lasts much longer due to the
presence of active metabolites.  So I am a little concerned that even minute levels
could suppress cholesterol production in the young infant, particularly with these
really new potent ones (atorvastin).

Because cholesterol is terribly important to a growing infant, and because we don't
have the slightest idea as to how an infant's HMG CoA reductase would respond to
even low levels of these drugs,  I am somewhat reserved in recommending them.
While it may be true only minute levels are transferred via milk,  remember 85 % of
cholesterol is synthesized in the liver, and only 15% or less is derived from the
diet.  The effect of  using such drugs 'could' potentially lower cholesterol levels
in an infant significantly, and could be detrimental to its long-term development.
While this is theoretical, we do know that certain lipids are terribly important
for neural development and this includes cholesterol.

Atherosclerosis is not an acute problem, but requires many years for development.
Withdrawing from these medications for a one or two year breastfeeding experience
won't effect the long-term lifespan of  a young mother at all.  So why expose the
infant to these drugs,  its simply not worth it.

Regards

Tom Hale, Ph.D.

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