With LIVMARLI, you can arm patients to...


Help relieve cholestatic pruritus.
LIVMARLI is the first and only FDA-approved medicine for cholestatic pruritus in patients with Alagille syndrome who are ≥3 months of age.1

*LIVMARLI, an ileal bile acid transporter (IBAT) inhibitor, interrupts recirculation of bile acids to the liver, increasing fecal excretion and reducing bile acid levels in the body. The complete mechanism by which LIVMARLI improves cholestatic pruritus in patients with Alagille syndrome is unknown.1-3


Hear from patients and families—and learn about the difference LIVMARLI has made in their lives.

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Significant improvements in cholestatic pruritus
Significant improvements in cholestatic pruritus
Significant improvements in cholestatic pruritus from baseline were achieved as early as Week 3 and maintained through 1 year (P<0.0001); for patients who remained on treatment with LIVMARLI in the open-label extension (n=15), cholestatic pruritus responses compared with baseline were durable through nearly 4 years.3,4
Check Out the Data
Backed by >5 years of safety data
Backed by >5 years of safety data
LIVMARLI has a well-characterized safety and tolerability profile for cholestatic pruritus in patients with Alagille syndrome.1,5
The majority of exposure occurred without a placebo control in open-label extensions.
View Safety
Proven mechanism of action
Proven mechanism of action
LIVMARLI is an ileal bile acid transporter (IBAT) inhibitor that reduces serum bile acid (sBA) levels in the body by interrupting recirculation of bile acids to the liver and increasing their excretion in feces.1-3
See How
Once-daily dosing
The recommended dose (380 mcg/kg) of LIVMARLI is administered orally once daily in the morning, 30 minutes before a meal in the morning.1
Learn More About Dosing
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Mirum Access Plus

Mirum Access Plus assists both you and your patients at every turn, helping you navigate the payer approval process—and beyond—with ease.

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Itch✓ App

Encourage patients to download the Itch✓ app to help them track symptom patterns over time and generate customized reports to share at appointments.


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Important Safety Information

Warnings and Precautions

Liver Test Abnormalities: Patients enrolled in clinical trials had abnormal liver tests at baseline. In the main clinical trial, treatment-emergent elevations or worsening of liver tests (ALT, AST or T/DB) relative to baseline were observed. Obtain baseline liver tests and monitor during treatment. Dose reduction or treatment interruption may be considered if abnormalities occur in the absence of other causes. For persistent or recurrent liver test abnormalities, consider treatment discontinuation. Discontinue permanently if a patient progresses to portal hypertension or experiences a hepatic decompensation event.

GI Adverse Reactions: Diarrhea, abdominal pain and vomiting were reported as the most common adverse reactions. If diarrhea, abdominal pain and/or vomiting occur and no other etiologies are found, consider reducing the dose or interrupting LIVMARLI. For diarrhea or vomiting, monitor for dehydration and treat promptly. Consider interrupting LIVMARLI dosing if a patient experiences persistent diarrhea or has diarrhea with accompanying signs and symptoms such as bloody stool, vomiting, dehydration requiring treatment, or fever. Restart LIVMARLI at 190 mcg/kg/day when diarrhea, abdominal pain or vomiting resolve, and increase the dose as tolerated. If they recur upon re-challenge, consider stopping LIVMARLI treatment.

Fat-Soluble Vitamin Deficiency: ALGS patients can have fat-soluble vitamin (FSV) deficiency (vitamins A, D, E, and K) at baseline, and LIVMARLI may affect absorption of FSV. In the main clinical trial, treatment emergent FSV deficiency was reported in 3 (10%) patients during 48 weeks of treatment. Obtain baseline serum levels and monitor during treatment, along with any clinical manifestations. Supplement if deficiency is observed. Consider discontinuing LIVMARLI if FSV deficiency persists or worsens despite adequate FSV supplementation.

Adverse Reactions

The most common adverse reactions (≥5%) are diarrhea, abdominal pain, vomiting, fat-soluble vitamin deficiency, liver test abnormalities, gastrointestinal bleeding and bone fractures.

Drug Interactions

Administer bile acid binding resins at least 4 hours before or 4 hours after administration of LIVMARLI.

A decrease in the absorption of OATP2B1 substrates (eg, statins) due to OATP2B1 inhibition by LIVMARLI in the GI tract cannot be ruled out. Consider monitoring the drug effects of OATP2B1 substrates as needed.

Dosing Information

LIVMARLI should be taken 30 minutes before a meal in the morning. The provided oral dosing dispenser must be used to accurately measure the dose. Any remaining LIVMARLI should be discarded 100 days after first opening the bottle.

Please see full Prescribing Information for LIVMARLI.