毒理性
◉ 母乳喂养期间使用总结：共识意见是，由于担心干扰婴儿脂质代谢，服用他汀类药物的妇女不应哺乳。然而，也有人认为，对于家族性高胆固醇血症的同型纯合子儿童，从1岁开始就使用他汀类药物，他汀类药物的口服生物利用度低，对哺乳婴儿的风险很低，尤其是使用罗苏伐他汀和普伐他汀。一些证据表明，阿托伐他汀可以由哺乳母亲服用，他们的婴儿没有明显的发展问题。在更多数据出现之前，可能会优先选择另一种药物，特别是在哺乳新生儿或早产儿时。
◉ 对哺乳婴儿的影响：在一项患有同型家族性高胆固醇血症的病例系列研究中，6名患者在产后重新开始服用他汀类药物后，哺乳了11名婴儿。这些妇女使用的特定他汀类药物没有报告，大多数服用他汀类药物的妇女使用的是阿托伐他汀，每日40或80毫克。所有后代的正常早期儿童发展得到了报告。孩子们在适当的年龄开始上学，没有报告学习困难。
◉ 对泌乳和母乳的影响：在接受阿托伐他汀治疗的男性中报告了男性乳房发育症。在一个测量了血清催乳素的案例中，催乳素水平正常。在另一个案例中，可能的罗苏伐他汀引起的男性乳房发育症在患者药物更换为阿托伐他汀后得到了解决。
◉ Summary of Use during Lactation:The consensus opinion is that women taking a statin should not breastfeed because of a concern with disruption of infant lipid metabolism. However, others have argued that children homozygous for familial hypercholesterolemia are treated with statins beginning at 1 year of age, that statins have low oral bioavailability, and risks to the breastfed infant are low, especially with rosuvastatin and pravastatin. Some evidence indicates that atorvastatin can be taken by nursing mothers with no obvious developmental problems in their infants. Until more data become available, an alternate drug may be preferred, especially while nursing a newborn or preterm infant.
◉ Effects in Breastfed Infants:In a case series of patients with homozygous familial hypercholesterolemia, 6 patients breastfed 11 infants after restarting statin therapy postpartum. The specific statin used by these women was not reported, most of the women on statin therapy were using atorvastatin, either 40 or 80 mg, daily. Normal early child development was reported for all offspring. Children started school at the appropriate age and no learning difficulties were reported.
◉ Effects on Lactation and Breastmilk:Gynecomastia has been reported in men taking atorvastatin. Serum prolactin was normal in one case where it was measured. In another case, possible rosuvastatin-induced gynecomastia resolved after the patient’s medication was changed to atorvastatin.
来源:Drugs and Lactation Database (LactMed)
