The Food and Drug Administration is requiring a boxed warning on the label for obeticholic acid (Ocaliva) to highlight the correct weekly dosing regimen after incorrect daily dosing caused severe liver injury in patients with moderate to severe primary biliary cholangitis (PBC).

“FDA is adding a new Boxed Warning, FDA’s most prominent warning, to highlight this information in the prescribing information of the drug label,” FDA officials said in a statement Feb. 1. “To ensure correct dosing and reduce the risk of liver problems, FDA is clarifying the current recommendations for screening, dosing, monitoring, and managing PBC patients with moderate to severe liver disease taking Ocaliva.”

The warning is an update to a Sept. 2017 MedWatch notice on the increased risk for patients from excessive dosing of obeticholic acid.

FDA recommends that “health care professionals should follow the Ocaliva dosing regimen in the drug label. … Dosing higher than recommended in the drug label can increase the risk for liver decompensation, liver failure, and sometimes death. Routinely monitor all patients for biochemical response, tolerability, and PBC progression, and reevaluate Child-Pugh classification to determine if dosage adjustment is needed.”

Manufacturer Intercept Pharmaceuticals was required to continue studying obeticholic acid in patients with advanced PBC as a condition of its FDA approval. Results from these studies are expected in 2023, FDA noted.

To report adverse medication events and side effects to the FDA, access the MedWatch program.