Your doctor may recommend a combination of medications, dietary supplements, and lifestyle changes to help manage primary biliary cholangitis (PBC). Some people eventually need a liver transplant to treat liver failure resulting from PBC.

PBC is an autoimmune condition that damages and eventually destroys the small bile ducts in the liver. This causes bile to build up in the liver, which leads to liver damage.

If you have PBC, the right treatment may help slow liver damage and potentially prevent or delay complications.

Liver damage from PBC may cause liver scarring, which can eventually lead to liver failure. Scarring in your liver may also reduce blood flow and cause gastroesophageal varices, which are enlarged veins in your stomach or esophagus. These veins may burst and cause potentially severe bleeding.

PBC also raises your risk of:

  • high blood cholesterol levels
  • osteoporosis, or low bone mass
  • nutrient deficiencies, including low levels of vitamins A, D, E, and K

Your doctor will order tests to monitor your liver health and check for signs of complications.

They may adjust your treatment plan if your condition changes.

Read on to learn about your treatment options.

Your doctor may recommend one or more of the following medications to help manage PBC.

Ursodeoxycholic acid (UDCA)

UDCA is currently the first-line therapy when it comes to treating PBC. It’s also known as ursodiol and is available under multiple brand names in the United States, including:

  • Actigall
  • Reltone
  • Urso 250
  • Urso Forte

UDCA is a synthetic bile acid derivative. It helps improve bile flow, reduces inflammation, and protects cells from damage in your liver. It’s also linked with reduced LDL (bad) cholesterol levels.

Obeticholic acid (Ocaliva)

Ocaliva is a synthetic bile acid derivative that helps reduce inflammation, liver damage, and scarring from PBC.

Your doctor may prescribe Ocaliva alone or in combination with UDCA or other treatments.

Ocaliva is not recommendedif you have advanced or decompensated cirrhosis, which is severe liver scarring that stops your liver from working properly. Some potential symptoms of decompensated cirrhosis include:

  • yellow-tinted skin or eyes
  • swollen abdomen
  • confusion or other mental changes

Elafibranor (Iqirvo)

Iqirvo is a peroxisome proliferator-activated receptor (PPAR) agonist. It changes how cells in the liver metabolize and carry fats. In people with PBC, it appears to reduce signs of cholestasis, which happens when bile flow is slowed or stopped.

The Food and Drug Administration (FDA) granted accelerated approval for Iqirvo to treat PBC in 2024. Researchers continue to study its long-term effects, and new findings might change the FDA approval status.

Your doctor may prescribe Iqirvo on its own or in combination with UDCA.

Iqirvo is not recommended if you have decompensated cirrhosis.

Seladelpar (Livdelzi)

Livdelzi is a PPAR-delta agonist. It appears to improve markers of liver health and reduce symptoms of itch in people with PBC.

The FDA granted accelerated approval for Livdelzi to treat PBC in 2024. Investigators continue to study its long-term effects, and new research results might affect the FDA approval status.

Your doctor may prescribe Livdelzi alone or in combination with UDCA.

Livdelzi is not recommended if you have decompensated cirrhosis.

Fibrates

Fibrates are PPAR agonists. They reduce triglycerides and increase HDL (good) cholesterol in your blood.

Bezafibrate and fenofibrate are two types of fibrates that have also shown promise for treating PBC. A 2023 research review found that combining bezafibrate or fenofibrate with UDCA may improve markers of liver health and reduce symptoms of itch in people with PBC.

The FDA has not approved bezafibrate or fenofibrate for treating PBC, but your doctor might prescribe a fibrate off-label to help treat PBC. Off-label prescribing is when a doctor prescribes a treatment in a way that the FDA hasn’t approved.

The American Association for the Study of Liver Diseases (AASLD) stated in a 2021 practice guidance update that fibrates may be considered as an off-label treatment for PBC when UDCA alone hasn’t worked well enough to treat the condition.

The AASLD does not recommend fibrates if you have decompensated liver disease.

Budesonide

Budesonide is a corticosteroid that helps reduce inflammation.

Long-term use of corticosteroids often causes side effects, which may be challenging to tolerate.

Your doctor might add budesonide to your treatment plan if other treatments haven’t worked well for you. They can help you understand the potential benefits and risks.

Other medication

Your doctor may recommend or prescribe additional medications to help ease symptoms of PBC.

For example, they may recommend:

  • medications to reduce skin itch
  • lubricating eye drops or other treatments for dry eye
  • moisturizing mouthwash

Your doctor may also prescribe medications to help treat potential complications of PBC.

For example, they may prescribe:

  • beta-blockers to reduce blood pressure and help prevent bleeding from varices
  • statins or other medication to help treat high cholesterol
  • alendronate (Fosamax) or other medication to treat osteoporosis

Researchers continue to develop medications to treat PBC and potential complications.

Sometimes your doctor might recommend an off-label treatment or encourage you to take part in a clinical trial to get an experimental treatment that the FDA has not approved. They can help you understand the potential benefits and risks.

Your doctor or dietitian may encourage you to take certain dietary supplements to help prevent or treat potential complications from PBC, such as osteoporosis or vitamin deficiencies.

For example, they may recommend:

  • calcium supplements
  • vitamin A supplements
  • vitamin D supplements
  • vitamin E supplements
  • vitamin K supplements

Always talk with your doctor before you start taking a new dietary supplement. They can help you learn about the potential benefits and risks and how much of the supplement to take.

Your doctor may recommend a liver transplant if you develop advanced cirrhosis, which can cause life threatening liver failure.

Liver transplantation is a surgery that replaces your damaged liver with a donor liver from another person. It’s potentially lifesaving but also carries risks.

You will need to take medication after a liver transplant to stop your body from rejecting the donor liver. Your doctor may also recommend other treatments or lifestyle changes to help protect your new liver.

PBC sometimes returns after a liver transplant.

Your doctor may encourage you to make the following lifestyle changes to help protect your liver, manage your risk of complications, and support your overall health and well-being with PBC.

Limit or avoid alcohol

Limiting alcohol consumption is important for minimizing liver damage.

Your doctor will likely encourage you to avoid alcohol altogether, especially if you have cirrhosis. They may recommend behavioral counseling, medication, or both if you find it challenging to adjust your alcohol intake.

Eat a well-balanced diet

Eating a well-balanced and nutrient-rich diet is important for supporting your general health and lowering your risk of certain complications from PBC, including high cholesterol, osteoporosis, and vitamin deficiencies.

Your doctor may encourage you to eat certain foods and limit or avoid others. Their recommended eating plan will depend on your specific needs. They may refer you to a registered dietitian for support.

Your doctor or dietitian may encourage you to adjust your calorie intake to support weight management.

Other changes

Your doctor may recommend lifestyle changes to help manage certain symptoms of PBC.

For example, you might find it helpful to:

  • avoid tight or itchy clothing, wash your skin with lukewarm rather than hot water, and apply moisturizer to dry skin to help limit skin itch
  • use eyelid massage to help reduce dry eye
  • take frequent sips of water to reduce dry mouth

Here are some other lifestyle strategies that can help support your overall health and well-being with PBC:

  • getting regular physical activity
  • getting enough high quality sleep
  • taking steps to manage stress
  • avoiding cigarettes and other tobacco products
  • attending regular checkups with your doctor and dentist

Talk with your doctor to learn whether they recommend any lifestyle changes for you.

Your doctor can also help you learn whether there are support programs or complementary therapies that might help you manage the challenges of PBC.

For example, a 2023 study found that an online mind-body program improved mental health and quality of life in people with PBC. This program incorporated guided meditation, forms of mindful movement such as yoga, and short videos on managing chronic disease.

Your doctor may prescribe one or more medications to help treat PBC, reduce symptoms, and prevent or manage potential complications. They may also encourage you to take certain dietary supplements, such as calcium or vitamins A, D, E, or K.

Making certain lifestyle changes may help support your liver health and overall well-being with PBC. Your doctor might encourage you to adjust your alcohol intake, diet, or other lifestyle habits.

Your treatment needs may change if you develop complications from PBC or side effects from treatment.

You may need a liver transplant if you develop severe liver scarring that stops your liver from working properly.

Talk with your doctor to learn more about your treatment options and outlook with PBC.