Brivaracetam is used as add on treatment for partial and bilateral convulsive seizures from 4 years of age.
For a complete list of side effects, consult MIMS.
Common side effects:
- Gastrointestinal symptoms
> 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 assessment 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.
- Consult appropriate formularies for children with higher weights and in the adult range.
- These dosages are only a guide and appropriate formularies should be consulted as needed and tailored to the patient by the primary physician.
- Tablets: 25mg, 50mg, 75mg, 100mg
- Oral liquid: 10mg/mL
Interactions | Precautions
- 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.
- 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.
- Wean over weeks, not abruptly.
- Usage in pregnancy needs to be discussed with a neurologist.