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Obeticholic acid for Primary Biliary Cholangitis: What is it? How does it work? Dosage? Safety? Tablet or syrup or IV? Side effects? Research studies?

Primary Biliary Cholangitis (commonly referred to as PBC) is an autoimmune disorder where your body gradually destroys the bile ducts within your liver. It is a chronic liver disease. The disease primarily affects middle aged women. In PBC, your immune system mistakenly attacks those liver bile ducts, causing inflammation, fibrosis, and eventual cirrhosis and death of the cells involved. This leads to impaired flow of bile, a liquid crucial for digestion. When the bile flow is obstructed, it builds up in the liver, and causes liver failure over time. Symptoms of PBC include: fatigue, itching (called pruritus in medical terms), jaundice (yellow eyes and skin) and hepatomegaly (an abnormally large liver caused from the buildup of bile.) 

To treat PBC, a medication called obeticholic acid (OCA) is used. Obeticholic acid is an agonist (i.e. stimulator) of a certain receptor called FXR, which is involved in regulation of the synthesis of bile, transport of bile and metabolism. OCA actives the FXR, decreasing the production of bile and also helping the body remove it from blood. OCA also reduces inflammation and fibrosis by a complex series of autoimmune actions. The effects of OCA lead to improved flow of bile and reduced bile acid toxicity in the liver. This protects the liver cells from any further damage.

It is typically administered in dosages of 5mg daily, and sometimes risen up to 10mg based on the individual's body response. It is orally administered in the form of a tablet, preferably after food. It is then monitored in regular intervals, to assess the efficacy of the treatment.

People who have severe impairments in their liver because of heavy cirrhosis tend to be advised not to take OCA, since OCA can sometimes damage the rest of the body as well due to lower bile production. And in people with complete blockage of the bile ducts, it is typically too late to administer OCA since there will be no effect, and so it is not provided. 

Side effects of OCA tend to be quite irritating: it tends to worsen most symptoms but lead to better healing in the long run. It tends to intensify itching and increases fatigue and weakness. In some people it also leads to increased levels of liver enzymes and pain in the abdominal region. 

However, OCA has immense value in the world of liver treatment. A study conducted by Lancet in 2016 found that OCA, significantly improved liver function tests and reduced bile acid levels; in fact, even better than other medicines like UDCA. 


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