Usage
Brivaracetam can be used as add on treatment for partial and bilateral convulsive seizures.
Brivaracetam is similar to levetiracetam in its mechanism of action.
PBS Indication: focal seizures with or without secondary generalisation from 4 years of age.
Resources
Side Effects
Possible side effects:
- Drowsiness and fatigue
- Dizziness
- Irritability/Agitation
- Gastrointestinal symptoms – nausea, vomiting, constipation
- Anxiety
- Depression
- Insomnia
Rare Side-effects
- Hypersensitivity (bronchospasm and angioedema)
- Neutropenia
- Aggression
For a complete list of adverse effects, appropriate formularies should be consulted.
Dosing
- The below initiation and escalation doses are only a guide and need to be individualised based on patient (age, weight, co-morbidities), disease (seizure type, frequency, duration) and medication (metabolism, interactions, side-effect profile) characteristics.
- Situations that require more careful consideration include children with higher weights, polytherapy, or multiple co-morbidities. Consultation with appropriate formularies or a paediatric neurologist may be required in specific circumstances.
> 4 years and < 50kgs:
- Common initial dose: 0.5mgs/kg twice daily
- A common maintenance dose is 1mg/kg twice daily.
- Dose adjustment may be titrated according to response, with adjustment each 2 weeks.
- Based on physician assessment, if a quicker therapeutic effect is required, may start 1mg/kg twice daily, titrate as above to 2mg/kg twice daily.
Adolescents > 50kgs:
- Common initial dose: 25 mgs twice daily
- A common maintenance dose is 50mgs twice daily
- On physician assessment, may start at 50mgs twice daily and titrate as above to 100mgs twice daily.
Preparations
- Tablets: 25mg, 50mg, 75mg, 100mg
- Oral liquid: 10mg/mL
Interactions | Precautions
Drug Interactions
- Carbamazepine, phenobarbitone and phenytoin decrease brivaracetam levels.
- Brivaracetam may increase carbamazepine epoxide and phenytoin levels.
- Brivaracetam does not decrease the efficacy of the contraceptive pill.
Precautions
- Brivaracetam has 15-30 times greater affinity for SV2A and faster brain permeability than levetiracetam.
- Generally advised not to use levetiracetam and brivaracetam together as it could lead to competitive binding of SV2A ligand.
- If there is a behavioural adverse effect with levetiracetam, there is some literature to support a switch to brivaracetam (Neuropsychiatric Disease and Treatment: 2019:15 2587-2600)
- Switching from levetiracetam to brivaracetam at a ratio of 10:1- 15:1 is feasible as an immediate overnight switch (Neuropsychiatric Disease and Treatment: 2019:15 2587-2600).
- Dosing adjustment is needed for patients with hepatic impairment.
Weaning
- Wean over weeks, not abruptly.
Pregnancy
- There is limited data regarding brivaracetam during pregnancy and usage in pregnancy needs to be discussed with a neurologist.
Information last reviewed: 3/05/2023.