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Generic Name: obeticholic acid (oh BET i KOE lik AS id)
Brand Names: Ocaliva
Ocaliva (obeticholic acid) is used to treat primary biliary cholangitis (PBC). Includes Ocaliva side effects, interactions and indications.
  • Prescription Settings

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Drug Information:
Ocaliva (obeticholic acid) is a prescription medicine used to treat primary biliary cholangitis (PBC). This medicine is sometimes used together with another drug called ursodeoxycholic acid (UDCA). Primary biliary cholangitis (PBC) is a chronic liver disease that gradually destroys bile ducts in the liver. These ducts deliver bile to the small intestines, to help your body digest fats and nutrients. When PBC destroys these ducts, the bile stays in your liver and damages its cells. This can lead to cirrhosis (scarring of the liver) and liver failure. PBC is a progressive disease that may have no symptoms for many years. Treating PBC can help keep the liver functioning normally. Learn more

Ocaliva Side Effects

Ocaliva Side Effects

Note: This document contains side effect information about obeticholic acid. Some of the dosage forms listed on this page may not apply to the brand name Ocaliva.

In Summary

Common side effects of Ocaliva include: severe pruritus, eye pruritus, pruritic rash, pruritus, pruritus ani, skin rash, vulvovaginal pruritus, decreased hdl cholesterol, macular eruption, maculopapular rash, miliaria, papular rash, urticaria, and pruritus of ear. See below for a comprehensive list of adverse effects.

For the Consumer

Applies to obeticholic acid: oral tablet


Oral route (Tablet)

Warning: Hepatic Decompensation and Failure in Incorrectly Dosed PBC Patients with Child-Pugh Class B or C or Decompensated CirrhosisIn postmarketing reports, hepatic decompensation and failure, in some cases fatal, have been reported in patients with primary biliary cholangitis (PBC) with decompensated cirrhosis or Child-Pugh Class B or C hepatic impairment when obeticholic acid was dosed more frequently than recommended.The recommended starting dosage of obeticholic acid is 5 mg once weekly for patients with Child-Pugh Class B or C hepatic impairment or a prior decompensation event.

Along with its needed effects, obeticholic acid (the active ingredient contained in Ocaliva) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking obeticholic acid:

More common

  • Fever
  • severe itching skin

Incidence not known

  • Chills
  • clay-colored stools
  • dark urine
  • dizziness
  • headache
  • loss of appetite
  • nausea
  • rash
  • stomach pain and bloating
  • unpleasant breath odor
  • unusual tiredness or weakness
  • vomiting of blood
  • yellow eyes or skin

Some side effects of obeticholic acid may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common

  • Bloating or swelling of the face, arms, hands, lower legs, or feet
  • difficulty having a bowel movement
  • difficulty with moving
  • fast, irregular, pounding, or racing heartbeat or pulse
  • muscle pain or stiffness
  • pain in the joints
  • rapid weight gain
  • sore throat
  • tingling of the hands or feet
  • unusual weight gain or loss

Less common

  • Skin rash, encrusted, scaly and oozing

For Healthcare Professionals

Applies to obeticholic acid: oral tablet


The most commonly reported side effects include pruritus, fatigue, and abdominal pain/discomfort.


Pruritus occurred most frequently in patients given 10 mg than in patients titrated to 10 mg and in those given placebo; these patients were more likely to develop pruritus within the first month. Discontinuation due to pruritus was also more common in patients given 10 mg.

Severe pruritus includes skin eruptions, prurigo, pruritus, pruritus generalized, eye pruritus, ear pruritus, anal pruritus, vulvovaginal pruritus, and rash pruritus.

Rash includes urticaria, rash, rash macular/papular/maculopapular, heat rash, and urticaria cholinergic.

Very common (10% or more): Pruritus (up to 70%), rash (up to 10%)

Common (1% to 10%): Eczema

Frequency not reported: Cholinergic urticaria, generalized pruritus, heat rash, macular rash, maculopapular rash, papular rash, prurigo, pruritic rash, skin eruptions, urticaria


Very common (10% or more): Fatigue (up to 25%)

Common (1% to 10%): Pyrexia

Frequency not reported: Asthenia, ear pruritus, tiredness

Fatigue includes fatigue, tiredness, and asthenia.


Very common (10% or more): High-density lipoprotein-cholesterol (HDL-C) reduction (up to 20%)


Very common (10% or more): Abdominal pain/discomfort (up to 19%)

Common (1% to 10%): Constipation, oropharyngeal pain

Frequency not reported: Abdominal tenderness, anal pruritus, ascites, gastrointestinal pain, lower abdominal pain, new/worsening ascites, upper abdominal pain, variceal bleeding

Abdominal pain/discomfort includes upper/lower abdominal pain, abdominal pain, abdominal discomfort, abdominal tenderness, and gastrointestinal pain.


Common (1% to 10%): Palpitations, peripheral edema

Nervous system

Dizziness includes dizziness, syncope, and presyncope.

Common (1% to 10%): Dizziness

Frequency not reported: Hepatic encephalopathy, presyncope, syncope

Postmarketing reports: New/worsening hepatic encephalopathy


Common (1% to 10%): Thyroid function abnormality

Frequency not reported: Decreased free thyroxine, hypothyroidism, increased blood thyroid stimulating hormone

Thyroid function abnormality includes thyroxine free decreased, blood thyroid stimulating hormone increased, and hypothyroidism.


Common (1% to 10%): Arthralgia


Frequency not reported: Hepatic decompensation, liver failure, liver-related adverse reactions

Postmarketing reports: increased direct bilirubin, increased total bilirubin, new onset cirrhosis, new/worsening jaundice


Frequency not reported: Vulvovaginal pruritus


Frequency not reported: Eye pruritus

Editorial References and Review

Medically reviewed by BestRx Medical Team Last updated on 1/1/2020.

Source: Drugs.com Ocaliva