Clinical Inquiries

What precautions should we use with statins for women of childbearing age?

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References

Consider initial pregnancy tests and inform all women of childbearing age of the possibility of fetal injury before starting statin therapy.2 Highly lipophilic statins—such as simvastatin, atorvastatin (Lipitor), and lovastatin—achieve embryoplacental concentrations similar to those of maternal plasma. For this reason, if statin therapy is needed, these agents should be avoided. Pravastatin (Pravachol) is the most hydrophilic statin and has no reports of abnormal pregnancy outcomes, even in animal research.3

Recommendations from others

The National Cholesterol Education Program Expert Panel and the American Heart Association make no specific recommendations regarding precautions with statin use for women of childbearing age who require treatment for hypercholesterolemia or coronary heart disease.6,7 The American College of Obstetrics and Gynecologists makes no distinction regarding recommendations for pharmacological treatment of hyperlipidemia for women aged 20 to 45 years.8

The US Preventive Services Task Force makes no recommendations on treatment with statins; they only address screening for hypercholesterolemia.9 The Food and Drug Administration has given statin agents a pregnancy category of X (risks involved in use of the drug by pregnant women clearly outweigh potential benefits).

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Evidence-based answers from the Family Physicians Inquiries Network

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