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Deoxycholic Acid (Monograph)

Brand name: Kybella
Drug class: Other Miscellaneous Therapeutic Agents
VA class: 92:92
Chemical name: (3α,5β,12α)-3,12-Dihydroxy-cholan-24-oic acid
Molecular formula: C24H40O4
CAS number: 83-44-3

Medically reviewed by on Jan 26, 2024. Written by ASHP.


Cytolytic agent; causes focal adipocytolysis when injected into fat tissue.

Uses for Deoxycholic Acid

Submental Convexity/Fullness

Improvement in the appearance of moderate to severe convexity or fullness associated with submental fat (“double chin”) in adults.

Manufacturer states that efficacy and safety of deoxycholic acid for the treatment of sub-Q fat outside the submental region not established and that the drug is not recommended for such use.

Deoxycholic Acid Dosage and Administration



Sub-Q Administration

Do not dilute or admix deoxycholic acid injection with other compounds.

Vials are for single use only; discard any remaining drug in vial following administration of intended dose.

Prior to drug administration, outline the planned treatment area with a surgical pen and apply a 1-cm injection grid to mark the injection sites.

Inject deoxycholic acid only within the target submental fat treatment area. Do not inject drug above the inferior border of the mandible or within a region defined by a 1–1.5-cm line below the inferior border (from the angle of the mandible to the mentum). (See Marginal Mandibular Nerve Injury under Cautions.) Avoid injection into other tissues (e.g., muscle, salivary glands, lymph nodes).

Withdraw 1 mL of deoxycholic acid into a sterile 1-mL syringe using a large-bore needle; expel any air bubbles in the syringe barrel. Instruct the individual receiving the drug to tense the platysma. Pinch the submental fat and use a 30-gauge or smaller 0.5-inch needle to inject 0.2 mL of deoxycholic acid into the preplatysmal fat next to each of the marked injection sites.

Upon withdrawal of the needle, apply pressure to each injection site if needed to minimize bleeding; apply an adhesive dressing if needed.

Do not inject the drug too superficially or withdraw the needle from the sub-Q fat during injection, as this may increase risk of intradermal exposure and potential skin ulceration.

Avoid entry of deoxycholic acid into the postplatysmal fat by injecting the drug at a depth approximately mid-way into the sub-Q fat layer.

If resistance is met during insertion of the needle indicating the possibility of contact with fascial or nonfat tissue, withdraw the needle to an appropriate depth before administering the drug.



Submental Convexity/Fullness

2 mg/cm2.

Prescribing Limits


Submental Convexity/Fullness

May give up to 50 injections (0.2 mL each), or a total of 100 mg (10 mL), in a single treatment; may administer up to 6 single treatments at intervals of at least 1 month.

Special Populations

Hepatic Impairment

Manufacturer currently makes no dosage recommendations for patients with hepatic impairment.

Renal Impairment

Manufacturer currently makes no dosage recommendations for patients with renal impairment.

Geriatric Patients

Use caution in dosage selection, starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Cautions for Deoxycholic Acid



Marginal Mandibular Nerve Injury

Marginal mandibular nerve injury, manifested as an asymmetric smile or facial muscle weakness (paresis), reported in clinical trials; all such injuries in clinical trials resolved spontaneously. Do not inject deoxycholic acid into or in close proximity to the marginal mandibular branch of the facial nerve. (See Sub-Q Administration under Dosage and Administration.)


Dysphagia reported in clinical trials in the setting of administration-site reactions (e.g., pain, swelling, induration of the submental area) and resolved spontaneously.

Manufacturer states to avoid use of drug in individuals with current symptoms or history of dysphagia.

Injection-Site Hematoma/Bruising

Use caution in individuals with bleeding abnormalities and in those currently being treated with antiplatelet or anticoagulant therapy as excessive bleeding or bruising in the treatment area may occur.

Risk of Infection in Proximity to Vulnerable Anatomic Structures

To avoid potential tissue damage, do not inject into or near (within 1–1.5 cm) salivary glands, lymph nodes, or muscles.

Specific Populations


No adequate and well-controlled studies of deoxycholic acid in pregnant women.


Not known whether deoxycholic acid is distributed into milk.

Pediatric Use

Safety and efficacy not established in individuals <18 years of age; manufacturer states that drug is not intended for use in children or adolescents.

Geriatric Use

Insufficient experience in adults >65 years of age to determine whether geriatric individuals respond differently than younger adults. However, clinical experience generally has not revealed age-related differences.

Hepatic Impairment

Data are lacking on the use of deoxycholic acid in patients with hepatic impairment.

Common Adverse Effects

≥2% of deoxycholic acid recipients and more frequently than with placebo in 2 clinical trials: Injection-site reactions (edema/swelling, hematoma/bruising, pain, numbness, erythema, induration, paresthesia, nodule, pruritus, skin tightness, skin warmth, nerve injury), headache, oropharyngeal pain, hypertension, nausea, dysphagia.

>20% of deoxycholic acid recipients: Injection-site edema/swelling, hematoma, pain, numbness, erythema, induration.

Drug Interactions

Deoxycholic acid does not inhibit or induce CYP isoenzymes in vitro.

Deoxycholic acid does not inhibit P-glycoprotein (P-gp); breast cancer resistance protein (BCRP); multidrug resistance-associated protein (MRP) 4 or MRP2; organic anion transport proteins (OATP) 1B1, 2B1, or 1B3; organic cation transporter (OCT) 1 or OCT2; organic anion transporter (OAT) 1 or OAT3; sodium taurocholate co-transporting polypeptide (NTCP); or apical sodium-dependent bile acid transporter (ASBT).

Deoxycholic Acid Pharmacokinetics



Peak plasma deoxycholic acid concentrations achieved within a median of 18 minutes after single treatment dose of 100 mg.


Deoxycholic acid plasma levels returned to the endogenous range within 24 hours after injection.


Plasma Protein Binding

Extensively (98%) bound to plasma proteins.



Under normal conditions, deoxycholic acid is not substantially metabolized.

Elimination Route

Excreted intact in feces, along with endogenous deoxycholic acid.




Solution for Injection

20–25°C ; excursions between 15–30°C permitted.


Advice to Patients


Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Deoxycholic acid


Dosage Forms


Brand Names



For sub-Q injection

10 mg/mL

Kybella (available in single-use vials)

Kythera Biopharmaceuticals

AHFS DI Essentials™. © Copyright 2024, Selected Revisions February 5, 2018. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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