Brivaracetam

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.