Zetia (Ezetimibe) Should Be Discontinued During Pregnancy
No, patients should not take Zetia (ezetimibe) during pregnancy—the American College of Cardiology recommends that all lipid-lowering drugs, including ezetimibe, should be avoided during pregnancy. 1
Timing of Discontinuation
Women on lipid-lowering drugs for primary prevention should discontinue ezetimibe at least 1 month and preferably 3 months before attempted conception, or immediately upon discovering pregnancy. 1
The FDA drug label states that ezetimibe should be discontinued when pregnancy is recognized unless the benefits of therapy outweigh the potential risks to the fetus, though there are no available data on use in pregnant women to evaluate for drug-associated risks. 2
Management During Pregnancy
Lifestyle interventions should be the primary management strategy during pregnancy for dyslipidemia. 1
Bile acid sequestrants are the only lipid-lowering agents approved for use during pregnancy if treatment is absolutely necessary. 1
Intensive lifestyle modifications and dietary interventions should replace pharmacologic therapy in most cases. 1
Referral to a lipid specialist and registered dietitian is strongly recommended for high-risk pregnant patients. 1
Very High-Risk Patients Requiring Special Consideration
For extremely rare cases of very high-risk patients with established atherosclerotic cardiovascular disease (ASCVD), multiple risk factors, or homozygous familial hypercholesterolemia (HoFH), individual discussions with healthcare professionals are advised to consider ongoing therapeutic needs during pregnancy. 1
Even in these exceptional circumstances, the decision must weigh the potential risk of discontinuation against unknown fetal risks. 3
Preconception counseling in women of childbearing age taking lipid-lowering therapy is necessary to avoid these difficult clinical scenarios. 1
Key Clinical Pitfalls to Avoid
Do not continue ezetimibe in women planning pregnancy without careful risk-benefit assessment and discussion beforehand. 1
The American College of Cardiology explicitly advises against continuing ezetimibe without this preconception planning. 1
Recent evidence suggests that ezetimibe might be considered if benefits outweigh potential risks in selected cases, but this remains controversial and should only be considered in consultation with specialists. 4