Brivaracetam

As an anticonvulsant, Brivaracetam is used as an adjunctive therapy for the treatment of partial-onset seizures in adults and children with epilepsy.

Overview:

As a chemical analog of Levetiracetam with anticonvulsant properties, Brivaracetam is used to prevent seizures in epileptic patients. It is currently marketed in the US as Briviact by the pharmaceutical company UCB.

It is typically prescribed to those suffering from partial-onset seizures, with or without secondary generalization, in combination with a number of other anticonvulsant medications. In terms of its mechanism of action, Brivaracetam is believed to act by binding to the synaptic vesicle glycoprotein 2A, in much the same with Levetiracetam does – only with a 20-fold larger affinity. It is thought that Brivaracetam helps to reduce the release of the excitatory neurotransmitter while enhancing synaptic depression during high-frequency activity believed to occur during bouts of epilepsy.

Brivaracetam is absorbed rapidly and completely after intravenous administration, and has an elimination half-life of approximately 7 to 8 hours, with a plasma protein binding of around 20 per cent. It is metabolized mainly via hydrolysis of the acetamides, with the remainder mediated via the liver enzyme CYP2C19. Brivaracetam is eliminated through the urine, typically within 72 hours of intravenous administration.

Conditions treated:

  • Control of partial-onset epileptic seizures

Type of medicine:

  • - Anticonvulsant

Side effects:

Along with the desired effects, Brivaracetam can also cause some unwanted side effects. The most common side effects reported by patients undergoing treatment with this medicine include: changes in behavior, chest pain or discomfort, light-headedness, dizziness, anxiety, double vision, dry mouth, drowsiness, a general feeling of illness or discomfort, hyperventilation, irritability, loss of or lack of strength, loss of balance, nausea, restlessness, spinning sensation, sleepiness or unusual drowsiness, difficulty sleeping, unusually long sleep duration, unusually deep sleep, unusual tiredness or feeling of sluggishness.

As the patient continues to take Brivaracetam as prescribed by a doctor, most (if not all) of these side effects should lessen. In the event that any of these side effects persist over a prolonged period or appear to get worse over time, the patient should consult with their doctor as soon as possible. For minor side effects, such as dry mouth, a doctor might recommend the consumption of sugar-free rock candy, chewing or sucking on ice chips, chewing sugarless gum or drinking plenty of water.

The majority of patients will only experience minor side effects during treatment with Brivaracetam. In most instances, the benefits of the use of this medicine will outweigh the minor side effects, and therefore doctors will recommend that patients continue treatment, even if experiencing low-level side effects.

Other side effects which are experienced incredibly rarely, albeit often enough to warrant a mention, include coughing, fever, hives, swelling of the face, eyelids, tongue, lips, throat, legs, feet and/or sex organs, noisy breathing, a reddening of the skin (particularly around the ears), change in taste, loss of taste, pain at the injection site, vomiting and/or difficulty in having a bowel movement.

Another rare side effect caused by Brivaracetam concerns the way the medicine can affect the psychology of the patient. Those undergoing treatment with Brivaracetam can potentially experience extreme mood swings, memory problems, hallucinations, confusion, new incidences of or worsening incidences of depression, panic attacks, impulsive behavior, increases in activity (mania) and/or suicidal thoughts. Patients who experience any of these symptoms are advised to contact their healthcare provider immediately, or their local emergency room. In patients with a history of mental illness, caution should be taken to ensure that the patient is not provided with excessive amounts of the drug which could be harmful when taken in doses large enough to constitute an overdose. This should not be an issue when patients are receiving intravenous doses at a clinic, as administered by a physician or healthcare professional, and only concerns patients who self-administer Brivaracetam.

Dosage:

As with all medications, it is incredibly important that Brivaracetam is taken only as prescribed by a qualified doctor. This means that patients should avoid taking any more of this medication than advised, both in terms of dosage and frequency of use. In addition to this, patients should know they should cease use of Brivaracetam as and when advised to do so by a doctor, even if they still have a supply of the medicine remaining.

Adult dosage for the treatment of epilepsy:

Adults should receive an initial dose of 50mg intravenously twice a day – once in the morning and once in the evening, totaling 100mg in a day. This dosage may be adjusted down to 25mg intravenously twice a day (50mg per day in total) or up to 100mg intravenously twice a day (200mg per day in total). Adjustments to the maintenance dose should be made by a qualified physician, based on the response and tolerability of the patient.

Patients and doctors should be aware that:

Gradual escalation of dosage is not required

If intravenous administration is not feasible, the drug can be administered orally at the same frequency and dose size as the oral solution.

The intravenous formulation should be administered over a period of 2-15 minutes.

If the patient misses a dose, they are recommended to take a single dose as soon as is feasible, followed by the next dose at the same time as normal in the following morning or evening. It is important to continue regular use of Brivaracetam in order to prevent plasma concentration of the drug falling below the efficacy level. In the event of this happening, breakthrough seizures may occur.

No data is available regarding the treatment of patients under the age of 16 with Brivaracetam. However, a doctor may decide to treat patients under 16 with this medication at his or her discretion. In this instance, patients are advised to follow the dosage advice of their doctor as opposed to recommendations printed on the literature the drug is provided with. This is because patient physiology will differ in minors, and as such a smaller dose may be required.

If the patient experiences any signs of overdose (extremely fast or slow heartbeat, difficulty breathing, loss of consciousness, flushed skin or seizures), he or she, or their caregiver, should contact their local poison control center on 1800-222-122 or the emergency services on 911 immediately.

Patients with hepatic impairment should take no more than 150mg of Brivaracetam per day (over two 75mg doses). The recommended starting dose for those with liver dysfunction is 50mg per day (25mg taken twice per day). Patients undergoing dialysis treatment are advised to avoid taking Brivaracetam and should consult with a doctor who may be able to recommend an alternative treatment.

Interactions:

All drugs have the potential to interact with other chemicals or medicines within the body, and these interactions can cause the effects of certain medicines to change. In some instances, this can mean that a medication becomes ineffective. In other instances, interactions can cause serious or potentially fatal side effects. Because of this, it is imperative that patients provide their doctor with a full, detailed list of all medicines they are currently taking. This extends to herbal supplements, complementary medicines, vitamins and over the counter remedies as well as prescribed medications.

Below is a partial list of some drugs known to interact negatively with Brivaracetam. Patients who are currently undergoing treatment with any of these medications are strongly advised to inform their doctor prior to beginning treatment with Brivaracetam intravenous solution:

  • Abilify
  • Abieraterone
  • Allercon
  • Fentanyl
  • Acetaminophen
  • Alprazolam
  • Acetylcarbromal
  • Amiodarone
  • Amobarbital
  • Amoxicillin
  • Albatussin
  • Alfentanil
  • Asenapine
  • Balminil
  • Bromfed
  • Belsomra
  • Bromaline
  • Bydramine
  • Clozapine
  • Cocet
  • Codeine
  • Colfed
  • Cetirizine
  • Condrin
  • Darvon
  • Dytuss
  • Diflucan
  • Estazolam
  • Endep
  • Flexoject
  • Flucanozole
  • Fluoxetine
  • Fortabs
  • Gablofen
  • Inderal
  • Iodipine
  • Ketamine
  • Lithium
  • Lodrane
  • Lomotil
  • Nexium
  • Oxazepam
  • Orap
  • Paliperidone
  • PC-CAP
  • Propoxyphene
  • Ramelteon

Warnings:

Before taking Brivaracetam, patients should make their doctor aware of any existing medical conditions, including the following:

  • Depression, suicidal thoughts or mood problems
  • Liver issues such as liver disease or hepatitis
  • A dependence on prescription medicines, alcohol or recreational drugs

Because Brivaracetam can affect clarity, coordination and motor skills, patients are advised to avoid driving or operating heavy machinery until they are fully aware of how the medication affects them. Patients are also advised against using alcohol when undergoing treatment with Brivaracetam as this can increase side effects of confusion, lack of coordination and euphoria and/or mania.

Patients who receive Brivaracetam via intravenous injection are more likely to experience hematologic abnormalities in comparison with those who take the drug orally. Other reported adverse events that occurred in at least 3 per cent of patients who received the medication intravenously included euphoric mood, a feeling of drunkenness, dysgeusia and pain at the site of infusion.

Storage:

Brivaracetam is available as a 10/ml solution, packaged in a glass vial. It should be stored at room temperature, out of the reach of children. In addition to this, the manufacturer recommends that this medication is stored away from moisture, heat and direct sunlight. Ideally, it should be stored in a locked medicine cabinet.

When this medicine has been diluted ready for intravenous administration, it is considered stable for up to 24 hours. It should be stored in a PVC or polyolefin bag at a temperature not exceeding 25 degrees C.

After 24 hours, this medicine should be discarded safely and hygienically, although disposal should be taken care of by the healthcare provider in a clinical setting. For more information on how to safely dispose of unwanted medicines, patients are advised to contact their local pharmacy.

Summary:

While Brivaracetam is incredibly effective in preventing partial-onset seizures in patients suffering from epilepsy, it can potentially pose a risk for patients who fail to communicate with their healthcare provider in terms of the drugs they are currently using.

Because it is absorbed rapidly and offers greater uptake than other anticonvulsants, Brivaracetam delivered intravenously is a great choice for patients who have recently been diagnosed with epilepsy without having ever undergone treatment for the condition. Some doctors may decide to move patients onto an oral version of this medication after treatment with an initial intravenous dose over the course of a couple of weeks, when the patient is moved onto a maintenance dose.

When administered properly, as directed by a physician, Brivaracetam can help the patient to live a much more fulfilled lifestyle free from seizures. Patient and doctor should work together in order to find out the most appropriate maintenance dose to gain the most from this medication.

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Last Reviewed:
December 24, 2017
Last Updated:
December 22, 2017
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