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What is this information about?
This information is about a medicine called Obeticholic Acid, also called OCA. It is used to treat a condition called Primary Biliary Cholangitis, also called PBC.
This information explains how you take OCA, and what you need to do before you start taking it; possible side effects, and what you should do if you experience them; and who to contact for further help and advice.
What is Primary Biliary Cholangitis, or PBC?
Your liver produces bile. This is a yellow-green fluid that helps digestion and gets rid of certain substances, including fat, from your body. Bile is carried out of your liver by tubes called bile ducts and is stored in your gallbladder, which then releases it into your small intestine as needed.
PBC is a condition in which the body’s own immune system mistakes the bile duct cells in the liver as foreign objects (something that isn’t meant to be there). It attacks them, and this leads to toxic build-up of bile acids. This damages the liver.
What is OCA?
OCA is a medicine that has been licensed to treat PBC. OCA works by reducing bile production, improving bile flow and reducing inflammation in the liver.
OCA is used either in combination with a medicine called ursodeoxycholic acid (UDCA) or on its own, it you cannot take UDCA.
What will happen before I start OCA?
You will need several blood tests to make sure the medicine is right for you and that it is safe for you to take it.
What vaccinations are recommended while I am taking OCA?
Unless there is a medical reason that you cannot have them, we recommend that you have the following:
- the flu vaccine (every year)
- the vaccine against strains of pneumonia
- the Covid vaccine (as per current national schedule)
If you are over 50 years old and have had prednisolone at 10mg or more a day for more than four weeks in the past three months, we recommend that you join the non-live shingles (Shingrix) vaccine programme. Your GP practice can arrange this for you.
If you need vaccinations for travel, check with your specialist liver team first.
How do I take OCA?
OCA is a medicine that you swallow (an oral medicine). It is taken once a day. It can be taken with or without food.
It is important you take regularly and at about the same time each day.
Usually, you will be started on 5mg once a day. After six months, this will be reviewed. After this, your dose may be increased to 10mg once a day.
Can I stop taking OCA at any time?
No. Stopping OCA suddenly will increase the risk of PBC flare. Do not stop taking OCA unless your specialist team tells you to.
How long will I be taking OCA?
As long as OCA is right for you, you are likely to take OCA for all your life.
Stopping OCA will increase the risk of a PBC flare. Do not stop taking OCA unless your specialist team tells you to.
Does OCA interfere with other medicines?
OCA can interfere with other medicines. Please let your healthcare team know about all the medicines that you are taking, including:
- anything prescribed for you
- any medicines you bought from a pharmacy or shop
- any alternative (herbal, homeopathic, vitamins) medicines that you buy yourself
before you start treatment with OCA.
When you have started treatment, you should always check with your doctor or pharmacist before starting any new medicines.
Common examples of other medicines that might interfere with OCA are:
- Bile acid binding resins
- Theophylline
- Tizanidine
- Warfarin
Can I drink alcohol while taking OCA?
Any amount of alcohol can damage the liver, especially if you have an underlying condition such as PBC.
Your specialist team may ask you to avoid alcohol completely.
If you are allowed to drink alcohol, it is recommended that you keep well within the national recommended limits of alcohol consumption. This is a maximum of 14 units per week. Please see Alcoholic drinks and units | Drinkaware for more information.
Any amount of alcohol can damage the liver, especially if you have an underlying condition such as autoimmune hepatitis.
What if I forget to take a dose?
Skip the missed dose and take your next dose when you would normally take it.
Do not take a double dose to make up for the forgotten tablet.
What if I take too many tablets or capsules?
Get help immediately:
- From your specialist team, Monday to Friday, 9am to 4pm. Contact details are below.
- Outside of these hours, please contact NHS 111, an out of hours GP, or attend an emergency department (A&E) if you are very unwell.
Is OCA safe in pregnancy and breastfeeding?
If you are:
- breastfeeding
- planning on becoming pregnant and breastfeeding
- planning on fathering a child
please discuss this with your specialist team (details below).
Are there any side effects to OCA?
Yes. Common side effects (affects 1 in 10 people or more) include:
| Side effect | What should I do? |
| Stomach pain | Tell your specialist team so they can help you manage it |
| Itchy skin (Pruritus) | Moisturise dry skin Avoid hot baths and showers that dry out your skin Wear loose-fitting cotton clothing and underwear Tell your specialist team so they can help you manage it |
| Feeling tired (Fatigue) | Take regular breaks so you can manage tasks in smaller chunks Try gentle, daily aerobic exercise, such as walking or swimming, to keep fit without feeling exhausted Know your energy levels: adjust your hobbies and daily activities to match what you can realistically do |
Other common side effects include:
| Which part of my body could this effect? | Very common | Common |
| Skin | Pruritus (itching) | Eczema, rash |
| Endocrine system | Thyroid function abnormality | |
| Nervous system | Dizziness | |
| Cardiac (heart) system | Palpitations (fast or irregular heartbeat) | |
| Respiratory (breathing) and organs inside your chest. | Oropharyngeal pain (pain in the mouth and throat) | |
| Gastrointestinal (digestive system) system | Abdominal (stomach) pain and discomfort | Constipation |
| Musculoskeletal and connective tissue system (bones and muscles) | Arthralgia (pain in your joints) | |
| General health and wellbeing (administration site conditions- what is this?) | Fatigue (tiredness) | Oedema (swelling in the hands and feet), pyrexia (fever) |
What monitoring do I need while I am on OCA?
We will monitor your blood tests to make sure that the OCA is working correctly. It is important you do your bloods when you are asked to. This will help to keep you safe.
Your specialist team will let you know what bloods are needed and when. They are needed at least every six months once you are stable.
OCA can also affect your lipid levels (the amount of cholesterol and other fats in your blood), so this will be monitored too.
You may also need liver scans. Your specialist team will tell you about these.
How do I get a repeat prescription?
The hospital will supply the OCA. It does not come from your GP.
You will not be able to get a prescription unless you have done your blood tests.
If you are running out of OCA between appointments, then please email the liver pharmacy team to get more. You can find their email at the bottom of this page.
Where can I find more information?
More information can be found here:
How do I contact my specialist liver team?
If you have any questions or concerns about your PBC, please contact the hepatology (specialist liver team) team via the secretaries on [email protected].
If you have questions about your liver medication (including repeat prescriptions), contact the liver pharmacy team via email on [email protected].
This information is intended for patients receiving care in Brighton & Hove or Haywards Heath.
The information here is for guidance purposes only and is in no way intended to replace professional clinical advice by a qualified practitioner.