AI Summary Livmarli (maralixibat) is a prescription IBAT inhibitor that lowers bile acid levels to treat cholestatic pruritus in eligible people with PFIC or Alagille syndrome.
Medically reviewed.
Livmarli (maralixibat) is a prescription oral medicine called an ileal bile acid transporter (IBAT) inhibitor. It is used to treat cholestatic pruritus, which is severe itching caused by cholestatic liver disease, in eligible people with progressive familial intrahepatic cholestasis (PFIC) or Alagille syndrome. By reducing bile acid reabsorption in the intestine, it lowers circulating bile acid levels and helps relieve severe itching. Treatment decisions should always be individualized and guided by a healthcare professional.
This page covers Livmarli's role in PFIC and Alagille syndrome care: how it works, who may be prescribed it, how it is used, benefits, side effects, and monitoring. You can also connect with a liver specialist near you for personalized guidance.
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ABOUT LIVMARLI TREATMENT
Livmarli is the brand name of maralixibat, a prescription medicine in a class called ileal bile acid transporter (IBAT) inhibitors. It comes as an oral solution, which is a liquid you swallow.
Bile helps your body digest fats. In Alagille syndrome, the bile ducts are fewer, narrower, and malformed, so bile builds up in the liver. Cholestatic liver diseases such as PFIC and Alagille syndrome can cause severe itching, also called pruritus.
Livmarli is used to treat this cholestatic pruritus in eligible people with PFIC or Alagille syndrome. It is a long-term therapy that fits into a broader plan of nutrition, skin care, and regular follow-up with a liver specialist, including tests such as Liver Function Tests (LFTs).
A related medicine, Bylvay (odevixibat), is also an IBAT inhibitor and is used for PFIC.
WHO LIVMARLI MAY BE SUITABLE FOR
Your healthcare provider may prescribe Livmarli if you have PFIC, if you have Alagille syndrome with cholestatic pruritus, if you have severe itching caused by cholestatic liver disease, or if you need treatment to reduce bile acid buildup.
PFIC is a group of rare inherited liver disorders that start in childhood. Alagille syndrome is a rare genetic disorder that affects about 1 in 70,000 infants. It usually becomes evident in infancy or early childhood, and the itching typically starts after 3 months of age.
Every patient's health profile is different. The decision to use Livmarli belongs to a qualified healthcare professional, who will consider your diagnosis, your symptoms, and your overall health.
ELIGIBILITY OVERVIEW
A provider may prescribe Livmarli for people with the following conditions or treatment needs:
Livmarli is used in eligible patients only. Your care team decides whether it fits, and may review these areas with you:
HOW LIVMARLI CAN HELP
Livmarli blocks the ileal bile acid transporter (IBAT), a protein in the last part of the small intestine that pulls bile acids back into the body. Bile acids normally recycle this way.
When the transporter is blocked, less bile acid is reabsorbed and more leaves the body in the stool. Circulating bile acid levels fall. In cholestatic liver disease, high bile acid levels are linked to severe itching, so lowering them helps relieve pruritus.
Livmarli treats the itching and bile acid buildup. It is used alongside nutrition support, skin care, and regular monitoring with your liver specialist.
LIVER BENEFITS
Livmarli blocks the ileal bile acid transporter (IBAT), a protein in the intestine that normally pulls bile acids back into the body. In cholestatic liver disease, bile acids build up, so limiting how many are reabsorbed is the first step in easing that buildup.
With less reabsorption, more bile acids leave the body in the stool. This steady removal lowers circulating bile acid levels and reduces bile acid accumulation, which is the main way Livmarli supports people living with cholestatic liver disease.
High bile acid levels in cholestatic liver disease are linked to severe itching, called pruritus. By lowering these levels, Livmarli helps relieve pruritus in eligible people with PFIC or Alagille syndrome.
In Alagille syndrome, the bile ducts are fewer, narrower, and malformed, so bile builds up in the liver. The itching that results typically starts after 3 months of age and can be severe. In eligible people with Alagille syndrome, Livmarli lowers circulating bile acid levels and helps relieve this cholestatic pruritus.
Livmarli lowers bile acid levels to relieve severe itching and may support liver health in eligible people with PFIC or Alagille syndrome. It should be started and monitored only under the guidance of a qualified healthcare professional.
TREATMENT PROCESS
Livmarli is supplied as an oral solution, which is a liquid medicine. Use the oral dosing device that comes with it.
For PFIC, the recommended starting dose is 285 mcg/kg once daily. It may be increased to 570 mcg/kg once daily based on clinical response and tolerability. Your healthcare provider sets your dose, and you should not change it on your own.
Take Livmarli once daily, about 30 minutes before the first meal of the day, using the supplied oral dosing device. It is a liquid taken by mouth, not an injection.
Livmarli is a long-term therapy for chronic cholestatic liver diseases such as PFIC and Alagille syndrome. Treatment generally continues as long as it helps and you tolerate it. Do not stop without talking to your healthcare provider.
Store Livmarli at room temperature, following the manufacturer's recommendations.
Your care team will regularly check liver function tests, fat-soluble vitamin levels, and how well treatment is working. In children, they will also monitor growth. Report any side effects or unusual symptoms to your healthcare provider.
BENEFITS AND SAFETY
Livmarli helps reduce the severe itching linked to PFIC and Alagille syndrome. It lowers circulating bile acid levels and may improve manifestations of cholestatic liver disease. It is taken as a once-daily liquid. How much it helps varies from person to person.
Like any medicine, Livmarli can cause side effects. The most common ones are digestive symptoms, low levels of fat-soluble vitamins, and raised liver enzymes. Your healthcare provider will monitor your liver tests, vitamin levels, and, in children, growth, and will decide whether Livmarli remains a suitable option for you.
BENEFITS
Livmarli helps reduce the severe itching associated with PFIC and Alagille syndrome. Relieving this itching is the main purpose of treatment.
By blocking bile acid reabsorption in the intestine, Livmarli increases bile acid elimination through the stool and lowers circulating bile acid levels.
Livmarli may improve manifestations of cholestatic liver disease. Individual results vary, and your care team checks liver function tests and treatment response regularly.
Livmarli is a once-daily liquid taken by mouth about 30 minutes before the first meal of the day, so it does not require injections. It is a long-term therapy, generally continued as long as it helps and you tolerate it.
Your care team will monitor liver tests, fat-soluble vitamin levels, and growth in children. Tell your healthcare provider about any side effect or unusual symptom.
SUPPORTING YOUR RESULTS
Livmarli works best as part of a broader care plan. That plan includes adequate nutrition, fat-soluble vitamin supplementation as directed, skin care for itching, and regular hepatology follow-up.
Avoiding overheating can help, because heat may make itching worse. Sleep and hydration strategies may also help with symptom control.
Areas that may support treatment:
Common Questions
Livmarli (maralixibat) is used to treat cholestatic pruritus, which is severe itching caused by cholestatic liver disease. It is prescribed for eligible people with progressive familial intrahepatic cholestasis (PFIC) or Alagille syndrome. Your provider may consider it if you have one of these conditions, severe itching, or a need to reduce bile acid buildup. Only a qualified healthcare professional can decide whether Livmarli fits your diagnosis, symptoms, and overall health, so talk with your care team about your options.
Livmarli relieves itching by lowering bile acid levels in the body. Maralixibat blocks the ileal bile acid transporter (IBAT), a protein in the small intestine that pulls bile acids back into the body. With less reabsorption, more bile acids leave in the stool, and circulating levels fall. In cholestatic liver disease, high bile acid levels are linked to severe itching. Ask your healthcare provider how much relief to expect, since results vary from person to person.
Take Livmarli once daily, about 30 minutes before the first meal of the day. It is an oral solution, a liquid you swallow, and you measure it with the supplied oral dosing device. It is not an injection. Store it at room temperature, following the manufacturer's recommendations. Your healthcare provider sets your dose, so follow their directions exactly and do not change it on your own. Ask your care team if you have questions about taking the medicine.
The most common side effects are diarrhea, abdominal pain, vomiting, fat-soluble vitamin deficiency, and elevated liver enzymes. To watch for these effects, your care team checks liver tests and fat-soluble vitamin levels, and monitors growth in children. Tell your healthcare provider about any side effect or unusual symptom, and do not stop Livmarli on your own. Your provider can help you weigh benefits and side effects and decide whether treatment remains a suitable option for you.
Livmarli is a long-term therapy. It is used for chronic cholestatic liver diseases such as PFIC and Alagille syndrome, and treatment generally continues as long as it helps and you tolerate it. Do not stop Livmarli without talking to your healthcare provider first. Your liver specialist reviews how well treatment is working over time and can explain what to expect in your situation, based on your diagnosis, symptoms, and response to the medicine.
Regular monitoring is recommended during Livmarli treatment. Your care team checks liver function tests, fat-soluble vitamin levels, and how well treatment is working. In children, they also monitor growth. Keeping regular follow-up visits with your liver specialist helps them track your response and adjust your plan. Ask your healthcare provider how often you will need tests and visits, since the schedule depends on your own health and treatment response.
Both Livmarli and Bylvay (odevixibat) are IBAT inhibitors that lower bile acid levels and relieve itching. Livmarli is an oral solution taken once daily before the first meal of the day, for PFIC and Alagille syndrome. Bylvay comes as capsules or pellets taken once daily in the morning, with or without food, for PFIC. Your healthcare provider can explain which option may suit you, based on your diagnosis and overall health.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.
