Brivaracetam oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations of brivaracetam.
Drugs List
Therapeutic Indications
Uses
Epilepsy-partial seizures with/without secondary generalisation-adjunctive
Dosage
The physician should prescribe the most appropriate formulation and strength according to weight and dose.
Adults
Initial: 25mg to 50mg twice a day (morning and evening).
Maintenance: 25mg to 100mg twice a day (morning and evening).
Children
Children aged 2 to 18 years weighing 50kg or more:
Initial: 25mg to 50mg twice a day (morning and evening).
Maintenance: 25mg to 100mg twice a day (morning and evening). The recommended maintenance dose is 50mg twice a day.
Children aged 2 to 18 years weighing between 20 and 50kg:
Initial: 0.5mg/kg to 1mg/kg twice a day (morning and evening).
Maintenance: 0.5mg/kg to 2mg/kg twice a day (morning and evening). The recommended maintenance dose is 1mg/kg twice a day.
Children aged 2 to 18 years weighing between 10 and 20kg:
Initial: 0.5mg/kg to 1.25mg/kg twice a day (morning and evening).
Maintenance: 0.5mg/kg to 2.5mg/kg twice a day (morning and evening). The recommended maintenance dose is 1.25mg/kg twice a day.
Patients with Hepatic Impairment
Adults
Initial: 25mg twice a day.
Maintenance: Maximum dose of 75mg twice a day.
Children aged 2 to 18 years weighing 50kg or more:
Initial: 25mg twice a day.
Maintenance: Maximum dose of 75mg twice a day.
Children aged 2 to 18 years weighing between 20 and 50kg:
Initial: 0.5mg/kg twice a day.
Maintenance: Maximum dose of 1.5mg/kg twice a day.
Children aged 2 to 18 years weighing between 10 and 20kg:
Initial: 0.5mg/kg twice a day.
Maintenance: Maximum dose of 2mg/kg twice a day.
Additional Dosage Information
Missed dose
If one or more doses are missed, a single dose should be taken as soon as the patient remembers. The next dose should follow at the usual morning or evening time.
Discontinuation
Withdraw by 50mg per day on a weekly basis. After 1 week of treatment at 50mg per day, a final week of treatment at the dose of 20mg per day is recommended.
Contraindications
Children under 2 years
Children weighing less than 10kg
Breastfeeding
End stage renal disease
Renal dialysis
Precautions and Warnings
Females of childbearing potential
Suicidal ideation
Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
Lactose intolerance
Pregnancy
Reduce dose in patients with hepatic impairment
Advise ability to drive/operate machinery may be affected by side effects
Advise patient not to drive until they know how the medicine affects them
Oral liquid contains hydroxybenzoate: caution in hypersensitivity
Oral liquid contains propylene glycol
Presentations with sorbitol unsuitable in hereditary fructose intolerance
Some formulations contain lactose
Monitor for signs of suicide ideation or behaviour
Progressive withdrawal recommended
Advise patient to seek advice at first indications of pregnancy
Advise patient not to take St John's wort concurrently
Advise patient to avoid alcohol during treatment
Advise patient/carers to report signs of suicide ideation or behaviour
Pregnancy and Lactation
Pregnancy
Use brivaracetam with caution during pregnancy.
The manufacturer does not recommend using brivaracetam during pregnancy unless the benefit to the mother clearly outweighs the risk to the foetus. At the time of writing there is limited published information regarding the use of brivaracetam during pregnancy. Potential risks are unknown.
Women with epilepsy treated during pregnancy have shown a two to three times greater risk of teratogenic effects. However, discontinuing anti-epileptic medication during pregnancy may increase risk of the disease. Evaluate the benefits and risks of continuing anti-epileptic therapy throughout pregnancy.
Lactation
Brivaracetam is contraindicated during breastfeeding.
The manufacturer advises that the patient either discontinues brivaracetam or discontinues breastfeeding. Animal data reports significant levels of brivaracetam in the breast milk, however presence in human breast milk is unknown. Effects on exposed infants are unknown. LactMed (2020) states treatment with brivaracetam is not a reason to discontinue breastfeeding, however exposed infants should be monitored for drowsiness, agitation and adequate weight gain.
Side Effects
Aggression
Agitation
Anxiety
Constipation
Convulsions
Cough
Decreased appetite
Depression
Dizziness
Fatigue
Hypersensitivity reactions
Influenza
Insomnia
Irritability
Nausea
Neutropenia
Psychomotor hyperactivity
Psychotic disorder
Somnolence
Suicidal tendencies
Upper respiratory tract infection
Vertigo
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: April 2021
Reference Sources
Summary of Product Characteristics: Briviact film coated tablets. UCB Pharma Limited. Revised November 2020.
Summary of Product Characteristics: Briviact 10mg/ml oral solution. UCB Pharma Limited. Revised November 2020.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 06 December 2022
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Brivaracetam Last revised: 21 September 2020
Last accessed: 07 April 2021
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.