Microplastics and Misinformation: What Science Really Says
November 12, 2025
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Brand Name :
Livmarli
(United States) [Available]Synonyms :
maralixibat
Class :
ASBT inhibitors, Bile acid transport inhibitors, GI drugs
Dosage Forms & Strengths
oral solution
9.5mg/mL
Days 1 to 7: take 190 mg/kg one time in a day
Up to 380 mcg/kg on Day 8 as tolerated and patients over 70 kg should not receive more than 28.5 mg/day
Administer 30 minutes prior to first meal of the day
Dosage Modifications
Gastrointestinal adverse effects
If you have nausea, vomiting, or diarrhoea, you should think about cutting back on your dosage
Consider halting the dose if the diarrhoea is severe or persistent and is accompanied by vomiting, dehydration, fever, and bloody stools
After the issue is resolved, start over at 190 mcg/kg/day and gradually raise the dose
Consider stopping if symptoms return after reintroduction
Hepatic impairment
Patients with poor liver function at baseline were included in clinical investigations
Effectiveness and safety have not been proven in patients with clinically severe portal hypertension or decompensated cirrhosis
Renal impairment
Minimally elimination in urine
Pharmacokinetics were not studied in patients with impaired renal function, including those with ESRD or those on hemodialysis
Dosage Forms & Strengths
oral solution
9.5mg/mL
For ≥3 months old:
Days 1 to 7: take 190 mg/kg one time in a day
Up to 380 mcg/kg on Day 8 as tolerated and patients over 70 kg should not receive more than 28.5 mg/day
Administer 30 minutes before your first meal of the day
Dosage Modifications
Gastrointestinal adverse effects
If you have nausea, vomiting, or diarrhoea, you should think about cutting back on your dosage
Consider halting the dose if the diarrhoea is severe or persistent and is accompanied by vomiting, dehydration, fever, and bloody stools
After the issue is resolved, start over at 190 mcg/kg/day and gradually raise the dose
Consider stopping if symptoms return after reintroduction
Hepatic impairment
Effectiveness and safety have not been proven in patients with clinically severe portal hypertension or decompensated cirrhosis
Renal impairment
Minimally excreted in urine
refer adult dosing
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
It may diminish the serum concentration when combined with bile acid sequestrants
may enhance the serum concentration when combined with tolvaptan
It may enhance serum concentration when combined with CYP3A4 Inhibitors (Moderate)
CYP3A4 Inhibitors (Moderate) may increase the serum concentration when combined with Zanubrutinib
may enhance the serum concentration when combined
may enhance the concentration of serum when combined with lemborexant
may enhance the concentration of serum when combined with lomitapide.
may enhance the concentration of serum when combined with lonafarnib
may enhance the concentration of serum when combined with ubrogepant
may enhance the serum concentrations of the active metabolites
may enhance the serum concentration when combined
may enhance the concentration of serum when combined with istradefylline
may diminish the concentration of serum when combined with fexinidazole
may enhance the concentration of serum when combined with alfentanil
may enhance the concentration of serum when combined with astemizole
may enhance the concentration of serum when combined with avanafil
may enhance the concentration of serum when combined with avapritinib
may enhance the concentration of serum when combined with brigatinib
may enhance the concentration of serum when combined with bromocriptine
budesonide inhaled/formoterol/glycopyrrolate inhaledÂ
may enhance the concentration of serum when combined with budesonide
may enhance the concentration of serum when combined with cilostazol
may enhance the concentration of serum when combined with cisapride
may enhance the concentration of serum when combined with cobimetinib
may enhance the concentration of serum when combined with colchicine
may enhance the concentration of serum when combined with dapoxetine
may enhance the concentration of serum when combined with daridorexant
may enhance the concentration of serums when combined with deflazacort
may enhance the concentration of serum when combined with eliglustat
may enhance the concentration of serum when combined with encorafenib
may enhance the concentration of serum when combined with entrectinib
may enhance the concentration of serum when combined with eplerenone
may enhance the concentration of serum when combined with fentanyl
may enhance the concentration of serum when combined with guanfacine
may enhance the concentration of serum when combined with ibrutinib
may enhance the concentration of serum when combined with elacestrant
may enhance the concentration of serum when combined with adagrasib
may enhance the QTc-prolonging effect of each other when combined
lurasidone: they may enhance the serum concentration of CYP3A4 Inhibitors
CYP3A4 Inhibitors: they may enhance the serum concentration of mavacamten
pemigatinib: they may enhance the serum concentration of CYP3A4 Inhibitors
omaveloxolone: they may enhance the serum concentration of CYP3A4 Inhibitors
pexidartinib: they may enhance the serum concentration of CYP3A4 Inhibitors
selpercatinib: they may enhance the serum concentration of CYP3A4 Inhibitors
selumetinib: they may enhance the serum concentration of CYP3A4 Inhibitors
sonidegib: they may enhance the serum concentration of CYP3A4 Inhibitors
tazemetostat: they may enhance the serum concentration of CYP3A4 Inhibitors
vardenafil: they may enhance the serum concentration of CYP3A4 Inhibitors
venetoclax: they may enhance the serum concentration of CYP3A4 Inhibitors
voclosporin: they may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the risk of side effects when combined
cimetropium: they may enhance the serum concentration of CYP3A4 Inhibitors
inhibitors of the cytochrome P450 enzyme system, like ketoconazole and clarithromycin, have the potential to enhance the exposure and toxicity of rimonabant since it undergoes liver metabolism mediated by this enzyme system
they increase the concentration of ergot derivatives in serum
may enhance the serum concentration when combined with hormonal contraceptives
may enhance the serum concentration when combined with hormonal contraceptives
may enhance the serum concentration when combined with hormonal contraceptives
may enhance the serum concentration when combined with hormonal contraceptives
may enhance the serum concentration when combined with hormonal contraceptives
may enhance the serum concentration when combined with hormonal contraceptives
may enhance the serum concentration when combined with hormonal contraceptives
may diminish the serum concentration when combined with nintedanib
CYP3A4 Inhibitors (Moderate) may increase the serum concentration when combined with Sertindole
CYP3A4 Inhibitors (Moderate) may decrease serum concentrations when combined with the active metabolite(s) when combined with Infigratinib
CYP3A4 Inhibitors (Moderate) may increase the serum concentration when combined with methysergide
CYP3A4 Inhibitors (Moderate) may increase the serum concentration when combined with Pacritinib
may enhance serum concentrations of the active metabolites
may enhance the serum concentration when combined
may enhance the concentration of serum when combined with pimozide
The use of strong CYP3A4 inhibitors may lead to elevated levels of acalabrutinib
The serum concentration of alfuzosin can be increased by strong CYP3A4 inhibitors
may enhance the serum concentration when combined
may diminish the concentration of serum when combined with CYP3A4 substrates
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with ergot derivatives
may enhance the concentration of serum when combined with aprepitant
may enhance the concentration of serum when combined with asunaprevir
may enhance the concentration of serum when combined with bosutinib
may enhance the concentration of serum when combined with budesonide
may enhance the concentration of serum when combined with isavuconazonium sulfate
may enhance the concentration of serum when combined with domperidone
may enhance the concentration of serum when combined with eletriptan
may enhance the concentration of serum when combined with fosaprepitant
may enhance the concentration of serum when combined with ivabradine
may increase the serum concentration of each other when combined
nisoldipine: they may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 inhibitors
may enhance the serum concentration of CYP3A4 inhibitors
may enhance the serum concentration of CYP3A4 inhibitors
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may decrease the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the serum concentration
may increase the serum concentration
bazedoxifene/conjugated estrogens
may increase the serum concentration
synthetic conjugated estrogens, a
may increase the serum concentration
synthetic conjugated estrogens, b
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
bazedoxifene/conjugated estrogens
may increase the serum concentration
synthetic conjugated estrogens, a
may increase the serum concentration
synthetic conjugated estrogens, b
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the QTc-prolonging effect
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentrations
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
acetaminophen and phenyltoloxamine
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
acetaminophen and phenyltoloxamine
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
acetaminophen and phenyltoloxamine
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
acetaminophen and phenyltoloxamine
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
may increase the levels of serum concentration
may enhance the levels of serum concentration
may enhance the levels of serum concentration
may enhance the levels of serum concentration
may enhance the levels of serum concentration
may reduce the levels of serum concentration
may reduce the levels of serum concentration
may reduce the levels of serum concentration
may reduce the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
it increases the concentration of CYP3A4 substrates in the serum
it increases the concentration of CYP3A4 substrates in the serum
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may increase the serum concentration
may enhance the serum concentration of dexamethasone
may increase the QTc prolonging effect of QTc prolonging agents
CYP3A4 Inhibitors (Moderate) may increase the serum concentration when combined with Abemaciclib
CYP3A4 Inhibitors (Moderate) may increase the serum concentration when combined with Zopiclone
CYP3A4 Inhibitors (Moderate) may increase the serum concentration when combined with Vilazodone
It may enhance serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may increase serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may increase the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
It may enhance the serum concentration when combined with CYP3A4 Inhibitors (Moderate)
may enhance the serum concentration when combined with ziprasidone
methylprednisolone hemisuccinateÂ
may increase the levels of serum concentration
may increase the levels of serum concentration
may decrease the levels of serum concentration
It may enhance the serum concentration when combined with dexamethasone
may enhance the concentration of serum when combined with alprazolam
may enhance the concentration of serum when combined with carbamazepine
may enhance the concentration of serum when combined with cyclosporine
may enhance the concentration of serum when combined with dofetilide
may enhance the concentration of serum when combined with finerenone
may enhance the concentration of serum when combined with flibanserin
may enhance the concentration of serum when combined with ixabepilone
may enhance the concentration of serum when combined with midazolam
may enhance the concentration of serum when combined with nimodipine
may enhance the concentration of serum when combined with simvastatin
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
bazedoxifene/conjugated estrogens
may increase the levels of serum concentration
synthetic conjugated estrogens, a
may increase the levels of serum concentration
synthetic conjugated estrogens, b
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
bazedoxifene/conjugated estrogens
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
may increase the levels of serum concentration
buprenorphine,long-acting injectionÂ
may enhance the serum concentration of Buprenorphine
may enhance the concentration of serum when combined with sirolimus
It may enhance the serum concentration when combined with CYP3A4 Inhibitors
Strong inhibitors of CYP3A4 have the potential to increase the serum concentration of alosetron
The serum concentration of amlodipine can be increased by strong inhibitors of CYP3A4
The use of strong CYP3A4 inhibitors may elevate the serum concentration of benidipine
it may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
it may increase the levels of serum concentration
may enhance the serum concentration when combined with dexamethasone
may enhance the concentration of serum when combined with tacrolimus
fusidic acid and betamethasoneÂ
may enhance the serum concentration when combined
may enhance the concentration of serum when combined with alitretinoin
may enhance the concentration of serum when combined with amiodarone
may enhance the concentration of serum when combined with aripiprazole
may enhance the concentration of serum when combined with aripiprazole lauroxil
may enhance the concentration of serum when combined with atogepant
may enhance the concentration of serum when combined with atorvastatin
may enhance the concentration of serum when combined with avacopan
may enhance the concentration of serum when combined with axitinib
may enhance the concentration of serums when combined with bedaquiline
benzhydrocodone/acetaminophenÂ
may enhance the concentration of serum when combined with benzhydrocodone
may enhance the concentration of serum when combined with bortezomib
may enhance the concentration of serum when combined with brexpiprazole
may enhance the concentration of serum when combined with buprenorphine
may enhance the concentration of serum when combined with buspirone
may enhance the serum concentration when combined
may enhance the serum concentration when combined
may diminish the serum concentration of each other when combined
may enhance the concentration of serum when combined with methylprednisolone
framycetin, dexamethasone, and gramicidinÂ
may enhance the serum concentration when combined
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
may have an increased QTc-prolonging effect when combined with QT-prolonging agents
clindamycin: they may enhance the serum concentration of CYP3A4 Inhibitors
clozapine: they may enhance the serum concentration of CYP3A4 Inhibitors
copanlisib: they may enhance the serum concentration of CYP3A4 Inhibitors
conivaptan: they may enhance the serum concentration of CYP3A4 Inhibitors
crizotinib: they may enhance the serum concentration of CYP3A4 Inhibitors
darifenacin: they may enhance the serum concentration of CYP3A4 Inhibitors
erythromycin: they may enhance the serum concentration of CYP3A4 inhibitors
eszopiclone: they may enhance the serum concentration of CYP3A4 inhibitors
fluticasone furoate: they may enhance the serum concentration of CYP3A4 inhibitors
halofantrine: they may enhance the serum concentration of CYP3A4 inhibitors
isradipine: they may enhance the serum concentration of CYP3A4 inhibitors
levamlodipine: they may enhance the serum concentration of CYP3A4 Inhibitors
naldemedine: they may enhance the serum concentration of CYP3A4 Inhibitors
nilotinib: they may enhance the serum concentration of CYP3A4 Inhibitors
oliceridine: they may enhance the serum concentration of CYP3A4 Inhibitors
palovarotene: they may enhance the serum concentration of CYP3A4 Inhibitors
panobinostat: they may enhance the serum concentration of CYP3A4 Inhibitors
piperaquine: they may enhance the serum concentration of CYP3A4 Inhibitors
pirtobrutinib: they may enhance the serum concentration of CYP3A4 Inhibitors
quetiapine: they may enhance the serum concentration of CYP3A4 Inhibitors
ribociclib: they may enhance the serum concentration of CYP3A4 Inhibitors
rifabutin: they may enhance the serum concentration of CYP3A4 Inhibitors
saxagliptin: they may enhance the serum concentration of CYP3A4 Inhibitors
silodosin: they may enhance the serum concentration of CYP3A4 Inhibitors
tadalafil: they may enhance the serum concentration of CYP3A4 Inhibitors
terfenadine: they may enhance the serum concentration of CYP3A4 Inhibitors
udenafil: they may enhance the serum concentration of CYP3A4 Inhibitors
ulipristal: they may enhance the serum concentration of CYP3A4 Inhibitors
valbenazine: they may enhance serum concentrations of CYP3A4 Inhibitors
vemurafenib: they may enhance the serum concentration of CYP3A4 Inhibitors
vorapaxar: they may enhance the serum concentration of CYP3A4 Inhibitors
finerenone: they may enhance the serum concentration of CYP3A4 Inhibitors
fosphenytoin: they may enhance the serum concentration of CYP3A4 Inhibitors
lidocaine: they may enhance the serum concentration of CYP3A4 Inhibitors
porfimer: they may enhance the serum concentration of CYP3A4 Inhibitors
phenytoin: they may enhance the serum concentration of CYP3A4 Inhibitors
aliskiren: they may enhance the serum concentration of CYP3A4 Inhibitors
voriconazole: they may enhance the serum concentration of CYP3A4 Inhibitors
tizanidine: they may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of each other when combined
betamethasone + salicylic acidÂ
may enhance the serum concentration of each other when combined
eluxadoline: they may enhance the serum concentration of CYP3A4 Inhibitors
oxatomide: they may enhance the serum concentration of CYP3A4 Inhibitors
revefenacin: they may enhance the serum concentration of CYP3A4 Inhibitors
tiotropium: they may enhance the serum concentration of CYP3A4 Inhibitors
glucagon: they may enhance the serum concentration of CYP3A4 Inhibitors
itopride: they may enhance the serum concentration of CYP3A4 Inhibitors
mianserin: they may enhance the serum concentration of CYP3A4 Inhibitors
topiramate: they may enhance the serum concentration of CYP3A4 Inhibitors
may enhance the serum concentration of CYP3A4 inhibitor
may enhance the serum concentration of CYP3A4 inhibitor
may enhance the serum concentration of CYP3A4 inhibitor
may enhance the serum concentration of CYP3A4 inhibitor
may enhance the serum concentration of CYP3A4 inhibitor
ketamine: it may increase the risk of adverse effects with CYP3A4 inhibitors
decamethonium: it may increase the risk of adverse effects with CYP3A4 inhibitors
ketamine: it may increase the risk of adverse effects with CYP3A4 inhibitors
levobetaxolol: it may increase the risk of adverse effects with CYP3A4 inhibitors
mefloquine: it may increase the risk of adverse effects with CYP3A4 inhibitors
memantine: it may increase the risk of adverse effects with CYP3A4 inhibitors
almotriptan serum concentration may also be increased by CYP3A4 inhibitors (strong)
Actions and Spectrum:
The action of maralixibat is as an IBAT inhibitor. By blocking IBAT, maralixibat reduces the amount of bile acids that are reabsorbed into the liver and intestine. This leads to a decrease in the concentration of bile acids in the body, which in turn reduces cholestasis (a buildup of bile acids in the liver) and its associated symptoms.
The spectrum of maralixibat is limited to its use in the treatment of cholestatic pruritus in children with Alagille syndrome. It is not used to treat other conditions or symptoms, and its effectiveness in other populations has not been established.
Frequency defined
>10%
Diarrhea (55.8%)
Abdominal pain (53.5%)
Vomiting (40.7%)
Fat-soluble vitamin deficiency (25.6%)
ALT/AST increased (18.6%)
Gastrointestinal bleeding (10.4%)
1-10%
Bone fractures (9.3%)
Nausea (8.1%)
Black Box Warning:
maralixibat does not currently have a black box warning
Contraindication/Caution:
Â
Contraindication
Patients with a known hypersensitivity to maralixibat or any of its components should not take this medication.
Caution
maralixibat is not recommended for use in patients with severe liver disease, including cirrhosis.
Patients with a history of bowel obstruction or those at increased risk of bowel obstruction should use maralixibat with caution.
maralixibat has not been studied in pregnant or breastfeeding women, so caution should be exercised when using this medication in these populations.
maralixibat may interact with other medications, including bile acid sequestrants, cyclosporine, and some antifungal medications. Patients should inform their healthcare provider about all medications they are taking before starting maralixibat.
maralixibat may cause gastrointestinal side effects, including diarrhea, abdominal pain, and vomiting. Patients should be monitored for these side effects, and treatment should be adjusted if necessary.
maralixibat may also cause liver function abnormalities, so patients should have their liver function monitored during treatment.
Pregnancy consideration:
Pregnancy category: NA
Lactation: The excretion of drug into human milk is unknown
Â
Pregnancy Categories:Â Â Â Â Â
Category A:Â Studies that were well-controlled and met expectations revealed no risk to the fetus in either the first or second trimester.
Category B: There were lack of studies on pregnant women and no evidence of risk to the fetus in animal experiments.
Category C:Â there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.
Category D:Â adequate data available with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.
Category X:Â Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.
Category N:Â There is no data available for the drug under this category
Pharmacology:
maralixibat binds to the ileum’s IBAT protein and prevents the reabsorption of bile acids into the bloodstream. As a result, the amount of bile acid in the liver and intestine decreases, lowering the risk of cholestasis and its accompanying symptoms including pruritus (itching) and liver damage. maralixibat is predominantly eliminated in the faeces after being processed in the liver by cytochrome P450 enzymes.
Pharmacodynamics:
maralixibat lowers the amount of bile acids that are returned to the liver by blocking bile acid reabsorption in the ileum. As a result, the levels of bile acids in the liver and intestine are reduced, which reduces cholestasis and its accompanying symptoms. When compared to a placebo, clinical tests on children with Alagille syndrome showed that maralixibat lessens pruritus
Pharmacokinetics:
Absorption
maralixibat is administered orally and is rapidly absorbed after ingestion. The maximum concentration in the blood is reached within approximately 1 hour after dosing. The bioavailability of maralixibat is approximately 15%.
Distribution
maralixibat is extensively distributed throughout the body and is highly protein-bound (99.8%). The volume of distribution is approximately 20 L
Metabolism
Cytochrome P450 enzymes, mainly CYP3A4 and CYP2C9, predominantly metabolise maralixibat in the liver. M1, which is produced through oxidative metabolism, is the primary metabolite of maralixibat. M1 has a lower inhibitory potency for IBAT than the parent medication.
Elimination and Excretion
Only a small portion of maralixibat is excreted in the urine, with the majority being removed through the faeces. Maralixibat has a half-life of roughly 15 hours and a clearance rate of about 8 L/hour.
Administration:
maralixibat is a pill that must be swallowed to be taken by mouth. It is typically used once day, with or without food, and is available as a tablet.
Based on the patient’s body weight, maralixibat is prescribed at the following dosage for the treatment of Alagille syndrome-related pruritus: Individuals under 20 kg should receive 120 g/kg once daily, while those who weigh 20 kg or above should receive 10 mg once daily.
maralixibat pills should not be chewed or mashed; they should be ingested whole with a glass of water.
Patient information leaflet
Generic Name: maralixibat
Why do we use maralixibat?
The drug maralixibat is used to treat cholestatic pruritus in kids with Alagille syndrome. It functions by preventing the ileal bile acid transporter protein (IBAT), which lowers the levels of bile acids in the liver and gut and alleviates symptoms
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