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# Tavohep (Taurocholic Acid)
## Overview
Tavohep is a synthetic bile acid that acts as a choleretic, increasing bile flow and aiding in fat digestion and absorption.
## Primary Indications
* Management of primary biliary cholangitis (PBC) in adults who have not responded adequately to ursodeoxycholic acid (UDCA).
## Adult Dosing
* **PBC:** The recommended starting dose is 13-15 mg/kg/day orally, administered in three divided doses.
* Dose may be titrated up to a maximum of 16-18 mg/kg/day based on patient response and tolerability, under the guidance of a specialist.
* Specific titration schedules and target doses depend on local protocols and individual patient response.
## Pediatric Dosing
* Dosing in pediatric populations is not established.
## Dose Adjustments
* **Hepatic Impairment:** Use with caution in patients with severe hepatic impairment. Dose adjustments may be necessary, and initiation of therapy should be under specialist supervision.
* **Renal Impairment:** No specific dose adjustments are routinely recommended, but caution is advised in severe renal impairment.
## Contraindications
* Hypersensitivity to taurocholic acid or any component of the formulation.
* Biliary obstruction.
* Severe liver disease.
## Adverse Effects
* **Common:** Diarrhea, nausea, abdominal pain, gastrointestinal discomfort.
* **Less Common:** Headache, fatigue, pruritus, rash.
* **Rare:** Hepatotoxicity (monitor liver function).
## Key Drug Interactions
* **Bile Acid Sequestrants (e.g., cholestyramine, colestipol):** May bind to and reduce the absorption of Tavohep. Separate administration by at least 2-4 hours.
* **Antacids:** May reduce the absorption of Tavohep. Separate administration.
* **Medications absorbed primarily in the distal small intestine or colon:** Tavohep may increase the absorption of these medications.
## Monitoring
* Liver function tests (ALT, AST, bilirubin, alkaline phosphatase) at baseline and periodically during treatment.
* Symptom assessment (e.g., pruritus, fatigue).
* Bowel habit monitoring for diarrhea.
## Clinical Pearls
* Tavohep is typically used as an add-on therapy for patients with inadequate response to UDCA in PBC.
* Gradual titration is recommended to improve gastrointestinal tolerability.
* Adequate hydration is important, especially if diarrhea occurs.
* Consider alternative therapies if significant diarrhea or other gastrointestinal adverse effects persist.
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*Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and a qualified healthcare provider for diagnosis and treatment.*
