Things you need to know about Livmarli (Maralixibat)

Some children, especially those with a rare condition called Alagille syndrome, can experience unbearable itching of the skin. There are no words to describe the discomfort they experience. So, one special medicine that doctors prescribe in such cases is Maralixibat, which is often sold under the brand name Livmarli. If you or your child has been prescribed this medicine, you may have many concerns and questions about it. Let's talk about all of this simply and kindly today.

Simply put, what happens with this Maralixibat drug?

Okay, the medical name for this one may sound a bit complicated. Maralixibat is a drug that belongs to a class of drugs called ileal bile acid transporter (IBAT) inhibitors. Now, don't get confused, I'll explain it simply.

Imagine, the bile produced by the liver in our body contains something called bile acids. In Alagille syndrome, these bile acids do not get properly excreted from the body and instead accumulate in the blood. When the level of bile acids in the blood increases, severe itching occurs on the skin.

So what this Maralixibat medicine does is control the absorption of these bile acids back into the body from the intestines. To be precise, it blocks that process. Then the amount of bile acids in the blood decreases, and gradually that annoying skin itching is also controlled. Do you understand?

Things you need to tell your doctor before starting medication

It is very important for your doctor to be aware of your complete health status before prescribing this medication. Therefore, if you have any of the following conditions, be sure to tell your doctor.

• If you have previously been diagnosed with low levels of vitamins A, D, E, or K in your blood.
• If you are pregnant, or are hoping to become pregnant in the near future.
• If you are a mother who is breastfeeding a child.

Based on this information, the doctor will determine the most appropriate treatment plan for you.

How exactly do I use this medicine?

This is an oral solution. To get the most out of the medicine, it is important to use it correctly.

• Time: This should be taken at the same time every day, 30 minutes before the first meal of the day.
• Measurement: Use only the special oral syringe, spoon, or dropper that comes with this medicine to measure it. Do not use regular teaspoons or soup spoons at home for any reason, as they will not measure the exact dose.
• With other medications: If you are taking other medications (bile acid binding resins) such as cholestyramine or colesevelam, you should leave a minimum of 4 hours between taking them and Maralixibat. This means that you should take the other medication either 4 hours after taking Maralixibat or 4 hours before. Talk to your doctor about this and clarify further.
• Instructions for Use: Read the INSTRUCTIONS FOR USE that comes with the medicine carefully. If there is anything you do not understand, ask your doctor.

What if I miss a dose of medication?

With the busyness of life, it is possible to forget to take a dose of medicine. If that happens, take it as soon as you remember. However, if it is more than 12 hours late from the time you usually take it, skip the missed dose. Take the next dose at the scheduled time. Never take two doses at once to make up for a missed dose.

What do you do if you take too much medicine?

If you think you have taken too much medicine, do not panic and immediately go to the nearest hospital Emergency Treatment Unit (ETU). Or call the National Poisons Information Centre at the Colombo National Hospital for advice.

Possible side effects when taking the medicine

As with any medication, there are some possible side effects when taking Maralixibat. Some of these can be serious, so it is important to be aware of them.

Other things that may interact with the medication

Some other medications you are taking may affect the way Maralixibat works. Therefore, it is important to tell your doctor about all the medications you are taking (including vitamins, herbal remedies, and supplements). Be especially careful with the following medications:

• Bile acid binding resins: For example, cholestyramine, colesevelam, colestipol.
• Some medications used to lower cholesterol: for example, atorvastatin, lovastatin, simvastatin.

How do you store and remove the medicine?

• Storage: Keep the medicine bottle in a safe place out of reach of children and pets. Store at room temperature (between 20-25 degrees Celsius). Most importantly, discard any remaining medicine 45 days after opening the bottle.
• Disposal: Ask your pharmacy or hospital about a program to take back expired or unwanted medications. If not, check the label to see if it is okay to throw the medication in the trash. Never flush medications down the toilet without first checking with your doctor. If you are throwing the medication in the trash, remove the medication from the bottle, mix it with used coffee grounds, a little soil, or cat litter, and place it in a tightly sealed bag.

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