Brivaracetam (Oral)

Brivaracetam is an anti-epileptic from the racetam family of drugs.

Overview

Racetams are a class of drug which all share a similar pyrrolidone nucleus. They tend to be psychoactive and a handful of them are commonly used as nootropics. The precise nature of brivaracetam's anti-epileptic properties is unknown. However, it is understood that brivaracetam binds to the synaptic vesicle glycoprotein 2A which can depress synaptic activity during high activity periods (such as during seizures). This is thought to at least contribute to its antiepileptic qualities. The action is similar to the drug levetiracetam, but brivaracetam is around 20 times more effective at binding to the synaptic vesicle glycoprotein 2A than levetiracetam.

Brivaracetam was approved by the FDA in 2016 as a treatment for epilepsy. The drug is not intended to cure epilepsy, but has been shown to be effective at controlling seizures in some patients, so long as the patient is taking it. Brivaracetam is sold under the brand name Briviact in tablets of 10 mg, 25 mg, 50 mg, 75 mg, and 100 mg concentrations. Brivaracetam is also available in solution form, also to be taken orally. The oral solution is sold under the same brand name of Briviact.

Conditions Treated

Type of Medicine

  • Anticonvulsant

Side Effects

Brivaracetam can cause a whole host of different side effects. Patients may not experience all (or any) of these effects. However, if a patient begins to experience these effects after beginning to take brivaracetam, they should contact their doctor immediately. The following side effects require medical attention:

  • Anxiety
  • Behavioral changes
  • Hallucinations
  • Delusions
  • Pain or other sensations in the chest
  • Dizziness
  • Lightheadedness
  • Double vision
  • Dry mouth
  • Generalized feelings of illness or discomfort
  • Hyperventilation
  • Arrhythmia or incidents of irregular heartbeat
  • Irritability
  • Nausea
  • Restlessness
  • Spinning sensations
  • Drowsiness
  • Suicidal ideation
  • Difficulty sleeping
  • Unusually deep sleep
  • Unusually long sleep
  • Other changes in sleeping patterns
  • Shakiness
  • Unsteadiness
  • Irregular or uncontrollable eye movements
  • Coughing
  • Difficulty breathing
  • Unusually labored or noisy breathing
  • Difficulty swallowing
  • Fever
  • Hives
  • Unusual hive-like swelling of the extremities or the groin
  • Reddened skin (especially around the ears)
  • Swelling or redness of the face

Not all side effects of brivaracetam necessarily require immediate medical attention. Brivaracetam can place a heavy load on a patient's body, and it can take time for the patient's body to adapt to it. In some cases, this can cause vomiting. Constipation can also result from this. Patients who experience vomiting or constipation should consult with their doctor to determine the best way to mitigate these side effects.

This is not necessarily a complete list of side effects. Patients should report any new or worsening symptoms to their doctor. Patients can report new side effects to the FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

Dosage

Patients should take the dose prescribed to them by their doctor. Tablets of brivaracetam should be taken with a glass of water. Whether or not the patient takes the tablet with food or on an empty stomach is usually left up to the patient's preference.

Patients who are taking brivaracetam in tablet form should always take the tablet whole. Under no circumstances should the patient crush, mangle, or otherwise damage the tablet before taking it.

Patients who are taking brivaracetam in the solution form should carefully measure their dose using a special dose-measuring syringe, measuring spoon, or medicine cup. If the patient lacks any of these things they should ask their pharmacist or doctor for one. Patients should be sure they have measured the correct dose of the brivaracetam oral solution before they take it.

Brivaracetam is usually taken twice a day - once in the morning and once at night. The initial dose is typically a 50 mg tablet taken twice a day. That dosage may be tweaked as low as 25 mg twice a day or as high a dose as 100 mg twice a day depending on the patient's needs. Patients should take direction from their doctor for dosage adjustments.

Patients taking brivaracetam should never double dose. If a patient forgets to take their dose they should take it as soon as they remember. If it is nearly time for their next dose they should simply wait to take their next dose as usual.

Overdose on brivaracetam is possible. Patients who suspect they may have taken too much brivaracetam should contact their local poison control as quickly as possible.

Patients should not abruptly stop taking brivaracetam. Brivaracetam is effective only as long as it is taken. Abruptly terminating brivaracetam usage will return the patient to their pre-medication risk of seizures, and often times heighten their risk of seizures. Abruptly terminating brivaracetam usage may result in punishing withdrawal symptoms.

Interactions

Drugs can interact in different ways inside every patient's body. Before beginning to take brivaracetam patients should disclose a full list of the medications, drugs, and supplements they are taking to their doctor. Brivaracetam is known to react with other antiepileptic medications (especially Carbatrol, Epitol, Equetro, Tegretol, and Dilantin) and most depressants (including cannabis and benzodiazepines). Patients should avoid taking some anti-epileptic medications and all depressants while they are taking brivaracetam.

Brivaracetam has the potential to be abused. Patients with a history of substance abuse should exercise caution when considering taking brivaracetam.

Brivaracetam is chemically similar to levetiracetam; a drug which also binds to the synaptic vesicle glycoprotein 2A. Patients should not take levetiracetam while they are taking brivaracetam. No additional therapeutic effects will be felt, while the patient's risk of side effects will be heightened.

Brivaracetam can exacerbate depression and other mood disorders. Patients with a history of depression, suicidal ideation, suicidal actions, or other mood disorders should exercise extreme caution when considering taking brivaracetam. Patients with such a history who decide to take brivaracetam should be aware that changes in these conditions may be the result of brivaracetam, and can be stopped by taking brivaracetam. Patients should not stop taking brivaracetam cold turkey, but should look to their doctor to determine the best way to stop taking it.

Patients who are taking pain relievers based on buprenorphine should exercise extreme caution when deciding whether or not to take brivaracetam. Buprenorphine and brivaracetam can both be serious depressants on the central nervous system. When combined they produce extremely dangerous effects such as respiratory distress/depression, coma, or even death. Patients who are taking buprenorphine-based painkillers are generally advised not to take brivaracetam. Similarly, patients taking brivaracetam should not take buprenorphine-based pain killers.

Propoxyphene, also a pain killer, interacts negatively with brivaracetam. By taking the two medications concurrently the patient will put themselves at risk of increased side effects, such as dizziness, drowsiness, and difficulty concentrating. The two may also cause behavioral changes and impair decision making in the patient.

Similarly, patients who are taking sodium oxybate, a the active ingredient in some narcolepsy medications, are also at risk of increased side effects. Symptoms such as dizziness, impaired decision making, and loss of coordination may occur in patients who take sodium oxybate and brivaracetam concurrently. More serious side effects, such as coma or death, may occur. Patients should not take sodium oxybate and brivaracetam together. Alternatives which do not interact should be found.

Patients who are taking antibiotics based on rifampin should use caution when considering taking brivaracetam. Rifampin will reduce the blood concentration of brivaracetam, which will dull the medication's effectiveness. Patients should look to their doctor for guidance as how best to proceed if they are taking rifampin and need to begin taking brivaracetam.

Alcohol can interact negatively with brivaracetam. By drinking (or otherwise ingesting) alcohol while taking brivaracetam patients put themselves at greater risk of side effects, such as dizziness, impaired decision making, and impaired motor coordination. Patients should abstain from consuming alcohol while they are taking brivaracetam.

Brivaracetam can affect a patient's coordination, concentration, and decision making. Patient's who are taking brivaracetam should not operate a motor vehicle or heavy machinery until they fully understand how brivaracetam affects them.

This is not necessarily a complete list of interactions. Patients should ensure that their doctor is fully apprised of the medications and supplements they are taking and understands how they may or may not interact with brivaracetam.

Warnings

Brivaracetam is a schedule 5 drug in terms of abuse, meaning that some potential exists for abuse. Prescriptions for brivaracetam can only be filled so often. Patients with a history of substance abuse should exercise extreme caution while taking brivaracetam.

Brivaracetam is a class c drug for pregnancy, meaning that the effects of brivaracetam on human fetuses has not been established. Patients who are pregnant or who may become pregnant should exercise caution. Patients who become pregnant while taking brivaracetam should notify their doctor immediately. In some cases, pregnant patients may be placed on a pregnancy registry so the effect of brivaracetam on their baby can be observed.

It is not known whether or not brivaracetam is found in breast milk or if it can have an effect on a breastfeeding baby. Patients who are breastfeeding while taking brivaracetam should consult their doctor for guidance as to the best way to proceed.

Brivaracetam can exacerbate existing mental conditions, such as depression anxiety. Brivaracetam can also cause a host of different mental conditions, such as depression and anxiety. Patients with depression or anxiety should be aware that changes in their condition may be attributed to the drug.

Brivaracetam can cause suicidal ideation and suicidal actions. Patients experiencing these symptoms should be aware that they may be the result of the drug, not a true desire to end one's life. Patients who experience suicidal ideation or suicidal actions while taking brivaracetam should consult with their doctor to determine the best way to stop taking brivaracetam as quickly as possible. Patients may also benefit from counseling or other therapies to deal with these effects.

Abrupt cessation of brivaracetam may cause serious withdrawal effects, including a massive increase of seizure activity and intensity. Patients should never abruptly stop taking brivaracetam.

Brivaracetam has not been evaluated for use in patients under the age of sixteen. The FDA has not approved the use of brivaracetam for use in patients under the age of sixteen.

Brivaracetam affects a patient's ability to concentrate as well as their coordination and decision making. Patients taking brivaracetam should avoid operating a motor vehicle or heavy machinery.

Storage

Brivaracetam should be stored at a room temperature of 59 to 86 degrees Fahrenheit.

The oral solution of brivaracetam should never be frozen. The oral solution of brivaracetam is usually good for 5 months after the bottle is opened. After that date, the medicine should be safely disposed of.

Summary

Brivaracetam can bring relief to patients plagued by seizures. However, it will not cure epilepsy and is sometimes thought of as an additional treatment used to supplement other medicines that treat epilepsy.

Brivaracetam comes with risks, though. We do not fully understand how it functions, which may be off putting to prospective brivaracetam patients. Like many anti epileptic drugs it can have dire effects on the psyche, even causing patients to attempt suicide. As a result, brivaracetam is a drug that commands respect. Patients who are taking it should ensure they are consistently taking the dose prescribed to them (no more and no less). Patients should also hold in the back of their head that rogue thoughts or feelings may be the result of brivaracetam, not the result of their usual brain functions. Adding to the mix, it's dangerous to abruptly stop taking brivaracetam, which may force badly affected patients without the easy out of just not taking the medicine. Patients who are considering taking brivaracetam should bear in mind that as a medication it is designed to help, not hurt the patient. If side effects begin to outweigh the positives the patient should contact their doctor immediately to determine the best way to stop taking the medication.

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Last Reviewed:
December 24, 2017
Last Updated:
April 02, 2018
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