Brivaracetam

Usage

Brivaracetam is used as add on treatment for partial and bilateral convulsive seizures from 4 years of age.

Resources

 

Side Effects

For a complete list of side effects, consult MIMS.

Common side effects:

  • Drowsiness
  • Dizziness
  • Vertigo
  • Fatigue
  • Irritability
  • Gastrointestinal symptoms
  • Anxiety
  • Depression
  • Insomnia

Rare Side-effects

  • Hypersensitivity
  • Neutropenia
  • Aggression
  • Agitation

Dosing

> 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.

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

  • Usage in pregnancy needs to be discussed with a neurologist.