Ocaliva (obeticholic acid) is a medication for the treatment of primary biliary cholangitis (PBC).

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Obeticholic acid is indicated for the treatment of primary biliary cholangitis (PBC) in combination with ursodeoxycholic acid (UDCA) in adults with an inadequate response to UDCA, or as monotherapy in adults unable to tolerate UDCA

PBC is a chronic or long-lasting disease that causes the small bile ducts in the liver to become inflamed, damaged and ultimately destroyed.This causes bile to remain in the liver, damaging liver cells over time and resulting in cirrhosis, or scarring of the liver. As cirrhosis progresses and the amount of scar tissue in the liver increases, the liver loses its ability to function. Obeticholic acid, given orally, binds to the farnesoid X receptor (FXR), a receptor found in the nucleus of cells in the liver and intestines. FXR is a key regulator of bile acid metabolic pathways.

Obeticholic acid increases bile flow from the liver and suppresses bile acid production in the liver, thus reducing the exposure of the liver to toxic levels of bile acids[