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      Drugs & Diseases

      brivaracetam (Rx)

      Brand and Other Names:Briviact
      • Print

      Dosing & Uses

      AdultPediatricGeriatric

      Dosage Forms & Strengths

      tablet: Schedule V

      • 10mg
      • 25mg
      • 50mg
      • 75mg
      • 100mg

      oral solution: Schedule V

      • 10mg/mL

      injection, solution: Schedule V

      • 50mg/5mL single-dose vial

      Partial-Onset Seizures

      Indicated for partial-onset seizures

      50 mg PO/IV q12hr initially; based on individual patient tolerability and therapeutic response, adjust dose between to 25-100 mg PO/IV BID (50-200 mg/day)

      Injection may be used for patients when oral administration is temporarily not feasible; clinical study experience with injection is limited to 4 consecutive days of treatment

      Dosage Modifications

      Hepatic impairment

      • All stages: Decrease starting dose to 25 mg BID and do not exceed 75 mg BID (150 mg/day)

      Renal impairment

      • Mild-to-moderate: No dose adjustment required
      • ESRD undergoing dialysis: Not studied

      Coadministration with rifampin

      • Increase dose by 100% (ie, double dose)

      Dosing Considerations

      IV injection may be used when PO administration is temporarily not feasible; injection should be administered at the same dosage and same frequency as tablets or oral solution; clinical trials limited IV administration to 4 consecutive days

      Dosage Forms & Strengths

      tablet: Schedule V

      • 10mg
      • 25mg
      • 50mg
      • 75mg
      • 100mg

      oral solution: Schedule V

      • 10mg/mL

      injection, solution: Schedule V

      • 50mg/5mL

      Partial Onset Seizures

      Tablets or oral solution

      • Indicated for partial-onset seizures in children and adolescents ≥4 years
      • <1 month : Safety and efficacy not established

      • ≥1 month to <16 years

        • <11 kg: 0.75-1.5 mg/kg PO/IV BID (1.5-3 mg/kg/day) initially; based on individual patient tolerability and therapeutic response, adjust dose between 0.75-3 mg/kg PO/IV BID (1.5-6 mg/kg/day)
        • 11 to <20 kg: 0.5-1.25 mg/kg PO/IV BID (1-2.5 mg/kg/day) initially; based on individual patient tolerability and therapeutic response, adjust dose between 0.5-2.5 mg/kg PO/IV BID (1-5 mg/kg/day)
        • 20 to <50 kg: 0.5-1 mg/kg PO/IV BID (1-2 mg/kg/day) initially; based on individual patient tolerability and therapeutic response, adjust dose between 0.5-2 mg/kg PO/IV BID (1-4 mg/kg/day)
        • ≥50 kg: 25-50 mg PO/IV BID (50-100 mg/day) initially; based on individual patient tolerability and therapeutic response, adjust dose between 25-100 mg PO/IV BID (50-200 mg/day)

      • ≥16 years

        • 50 mg PO/IV BID (100 mg/day) initially; based on individual patient tolerability and therapeutic response, adjust dose between to 25-100 mg PO/IV BID (50-200 mg/day)

      Dosage Modifications

      Hepatic impairment

      • Starting dose adjustments
        • <11 kg: Start at 0.75 mg/kg PO/IV BID (1.5 mg/kg/day)
        • 11 to <50 kg: Start at 0.5 mg/kg PO/IV BID (1 mg/kg/day)
        • ≥50 kg: Start at 25 mg PO/IV BID (50 mg/day)
      • Maximum dose with hepatic impairment
        • <11 kg: Not to exceed 2.25 mg/kg PO/IV BID (4.5 mg/kg/day)
        • 11 to <20 kg: Not to exceed 2 mg/kg PO/IV BID (4 mg/kg/day)
        • 20 to <50 kg: Not to exceed 1.5 mg/kg PO/IV BID (3 mg/kg/day)
        • ≥50 kg: Not to exceed 75 mg PO/IV BID (150 mg/day)

      Renal impairment

      • Mild-to-moderate: No dose adjustment required
      • ESRD undergoing dialysis: Not studied

      Coadministration with rifampin

      • Increase dose by 100% (ie, double dose)

      Dosing Considerations

      IV injection may be used when PO administration is temporarily not feasible; injection should be administered at the same dosage and same frequency as tablets or oral solution; clinical trials limited IV administration to 4 consecutive days

      Avoid abrupt withdrawal in order to minimize the risk of increased seizure frequency and status epilepticus

      Absence Epilepsy (Orphan)

      Orphan designation for treatment of juvenile or childhood absence epilepsy

      Sponsor

      • UCB, Inc; 1950 Lake Park Drive, Building 2100; Smyrna, Georgia

      In general, dose selection for an elderly patient should be judicious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy

      Refer to Adult Dosing

      Next:

      Interactions

      Interaction Checker

      and brivaracetam

      No Results

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                 activity indicator 

                Contraindicated (1)

                • thalidomide

                  brivaracetam and thalidomide both increase sedation. Contraindicated.

                Serious - Use Alternative (21)

                • alfentanil

                  brivaracetam and alfentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • buprenorphine

                  brivaracetam and buprenorphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • buprenorphine buccal

                  brivaracetam and buprenorphine buccal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • buprenorphine subdermal implant

                  brivaracetam and buprenorphine subdermal implant both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • buprenorphine transdermal

                  brivaracetam and buprenorphine transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • buprenorphine, long-acting injection

                  brivaracetam and buprenorphine, long-acting injection both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • fentanyl

                  brivaracetam and fentanyl both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • fentanyl intranasal

                  brivaracetam and fentanyl intranasal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • fentanyl iontophoretic transdermal system

                  brivaracetam and fentanyl iontophoretic transdermal system both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • fentanyl transdermal

                  brivaracetam and fentanyl transdermal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • fentanyl transmucosal

                  brivaracetam and fentanyl transmucosal both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • hydrocodone

                  brivaracetam and hydrocodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • hydromorphone

                  brivaracetam and hydromorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • lonafarnib

                  lonafarnib will increase the level or effect of brivaracetam by affecting hepatic enzyme CYP2C19 metabolism. Avoid or Use Alternate Drug. Lonafarnib may increase the AUC and peak concentration of CYP2C19 substrates. If coadministration unavoidable, monitor for adverse reactions and reduce the CYP2C19 substrate dose in accordance with its approved product labeling.

                • methadone

                  brivaracetam and methadone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • metoclopramide intranasal

                  brivaracetam, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

                • morphine

                  brivaracetam and morphine both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • oxycodone

                  brivaracetam and oxycodone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • oxymorphone

                  brivaracetam and oxymorphone both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • remifentanil

                  brivaracetam and remifentanil both increase sedation. Avoid or Use Alternate Drug. Limit use to patients for whom alternative treatment options are inadequate

                • selinexor

                  selinexor, brivaracetam. unspecified interaction mechanism. Avoid or Use Alternate Drug. Patients treated with selinexor may experience neurological toxicities. Avoid taking selinexor with other medications that may cause dizziness or confusion.

                Monitor Closely (170)

                • acetaminophen/phenyltoloxamine

                  brivaracetam and acetaminophen/phenyltoloxamine both increase sedation. Use Caution/Monitor.

                • acrivastine

                  acrivastine and brivaracetam both increase sedation. Use Caution/Monitor.

                • alprazolam

                  brivaracetam and alprazolam both increase sedation. Use Caution/Monitor.

                • amisulpride

                  amisulpride and brivaracetam both increase sedation. Use Caution/Monitor.

                • amitriptyline

                  brivaracetam and amitriptyline both increase sedation. Use Caution/Monitor.

                • amobarbital

                  brivaracetam and amobarbital both increase sedation. Use Caution/Monitor.

                • amoxapine

                  brivaracetam and amoxapine both increase sedation. Use Caution/Monitor.

                • aripiprazole

                  brivaracetam and aripiprazole both increase sedation. Use Caution/Monitor.

                • asenapine

                  asenapine and brivaracetam both increase sedation. Use Caution/Monitor.

                • asenapine transdermal

                  asenapine transdermal and brivaracetam both increase sedation. Use Caution/Monitor.

                • avapritinib

                  avapritinib and brivaracetam both increase sedation. Use Caution/Monitor.

                • baclofen

                  brivaracetam and baclofen both increase sedation. Use Caution/Monitor.

                • benzhydrocodone/acetaminophen

                  benzhydrocodone/acetaminophen and brivaracetam both increase sedation. Use Caution/Monitor.

                • brexanolone

                  brexanolone, brivaracetam. Either increases toxicity of the other by sedation. Use Caution/Monitor.

                • brexpiprazole

                  brexpiprazole and brivaracetam both increase sedation. Use Caution/Monitor.

                • brimonidine

                  brimonidine and brivaracetam both increase sedation. Use Caution/Monitor.

                  brivaracetam and brimonidine both increase sedation. Use Caution/Monitor.

                • brompheniramine

                  brivaracetam and brompheniramine both increase sedation. Use Caution/Monitor.

                • buprenorphine subdermal implant

                  buprenorphine subdermal implant and brivaracetam both increase sedation. Use Caution/Monitor.

                • butabarbital

                  brivaracetam and butabarbital both increase sedation. Use Caution/Monitor.

                • butalbital

                  brivaracetam and butalbital both increase sedation. Use Caution/Monitor.

                • butorphanol

                  brivaracetam and butorphanol both increase sedation. Use Caution/Monitor.

                • carbamazepine

                  carbamazepine will decrease the level or effect of brivaracetam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Brivaracetam plasma concentration decreased by 26%.

                  brivaracetam, carbamazepine. decreasing metabolism. Use Caution/Monitor. Brivaracetam reversibly inhibits epoxide hydrolase resulting in an increased concentration of carbamazepine epoxide, an active metabolite of carbamazepine. The carbamazepine epoxide plasma concentration increased up to 198%. May require carbamazepine dose reduction. .

                • carbinoxamine

                  brivaracetam and carbinoxamine both increase sedation. Use Caution/Monitor.

                • cariprazine

                  brivaracetam and cariprazine both increase sedation. Use Caution/Monitor.

                • carisoprodol

                  brivaracetam and carisoprodol both increase sedation. Use Caution/Monitor.

                • cenobamate

                  cenobamate, brivaracetam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • cetirizine

                  brivaracetam and cetirizine both increase sedation. Use Caution/Monitor.

                • chlordiazepoxide

                  brivaracetam and chlordiazepoxide both increase sedation. Use Caution/Monitor.

                • chlorpheniramine

                  brivaracetam and chlorpheniramine both increase sedation. Use Caution/Monitor.

                • chlorpromazine

                  brivaracetam and chlorpromazine both increase sedation. Use Caution/Monitor.

                • chlorzoxazone

                  brivaracetam and chlorzoxazone both increase sedation. Use Caution/Monitor.

                • clemastine

                  brivaracetam and clemastine both increase sedation. Use Caution/Monitor.

                • clobazam

                  brivaracetam and clobazam both increase sedation. Use Caution/Monitor.

                • clomipramine

                  brivaracetam and clomipramine both increase sedation. Use Caution/Monitor.

                • clonazepam

                  brivaracetam and clonazepam both increase sedation. Use Caution/Monitor.

                • clonidine

                  brivaracetam and clonidine both increase sedation. Use Caution/Monitor.

                • clorazepate

                  brivaracetam and clorazepate both increase sedation. Use Caution/Monitor.

                • clozapine

                  brivaracetam and clozapine both increase sedation. Use Caution/Monitor.

                • codeine

                  brivaracetam and codeine both increase sedation. Use Caution/Monitor.

                • cyclobenzaprine

                  brivaracetam and cyclobenzaprine both increase sedation. Use Caution/Monitor.

                • cyproheptadine

                  brivaracetam and cyproheptadine both increase sedation. Use Caution/Monitor.

                • dantrolene

                  brivaracetam and dantrolene both increase sedation. Use Caution/Monitor.

                • daridorexant

                  brivaracetam and daridorexant both increase sedation. Use Caution/Monitor.

                • desflurane

                  brivaracetam and desflurane both increase sedation. Use Caution/Monitor.

                • desipramine

                  brivaracetam and desipramine both increase sedation. Use Caution/Monitor.

                • deutetrabenazine

                  brivaracetam and deutetrabenazine both increase sedation. Use Caution/Monitor.

                • dexbrompheniramine

                  brivaracetam and dexbrompheniramine both increase sedation. Use Caution/Monitor.

                • dexchlorpheniramine

                  brivaracetam and dexchlorpheniramine both increase sedation. Use Caution/Monitor.

                • diazepam

                  brivaracetam and diazepam both increase sedation. Use Caution/Monitor.

                • difenoxin hcl

                  brivaracetam and difenoxin hcl both increase sedation. Use Caution/Monitor.

                • dimenhydrinate

                  brivaracetam and dimenhydrinate both increase sedation. Use Caution/Monitor.

                • diphenhydramine

                  brivaracetam and diphenhydramine both increase sedation. Use Caution/Monitor.

                • diphenoxylate hcl

                  brivaracetam and diphenoxylate hcl both increase sedation. Use Caution/Monitor.

                • doxepin

                  brivaracetam and doxepin both increase sedation. Use Caution/Monitor.

                • doxylamine

                  brivaracetam and doxylamine both increase sedation. Use Caution/Monitor.

                • droperidol

                  brivaracetam and droperidol both increase sedation. Use Caution/Monitor.

                • efavirenz

                  brivaracetam and efavirenz both increase sedation. Use Caution/Monitor.

                • entacapone

                  brivaracetam and entacapone both increase sedation. Use Caution/Monitor.

                • esketamine intranasal

                  esketamine intranasal, brivaracetam. Either increases toxicity of the other by sedation. Modify Therapy/Monitor Closely.

                • estazolam

                  brivaracetam and estazolam both increase sedation. Use Caution/Monitor.

                • eszopiclone

                  brivaracetam and eszopiclone both increase sedation. Use Caution/Monitor.

                • ethanol

                  ethanol, brivaracetam. Other (see comment). Use Caution/Monitor. Comment: Coadministration with ethanol may enhance CNS depressant effects (eg, decreases in saccadic peak velocity, smooth pursuit, adaptive tracking performance, and Visual Analog Scale (VAS) alertness).

                  brivaracetam and ethanol both increase sedation. Use Caution/Monitor.

                • ethosuximide

                  brivaracetam and ethosuximide both increase sedation. Use Caution/Monitor.

                • ethotoin

                  brivaracetam and ethotoin both increase sedation. Use Caution/Monitor.

                • felbamate

                  brivaracetam and felbamate both increase sedation. Use Caution/Monitor.

                • fenfluramine

                  brivaracetam and fenfluramine both increase sedation. Use Caution/Monitor.

                • fexinidazole

                  fexinidazole will increase the level or effect of brivaracetam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor.

                • fexofenadine

                  brivaracetam and fexofenadine both increase sedation. Use Caution/Monitor.

                • flibanserin

                  brivaracetam and flibanserin both increase sedation. Use Caution/Monitor.

                • fluphenazine

                  brivaracetam and fluphenazine both increase sedation. Use Caution/Monitor.

                • flurazepam

                  brivaracetam and flurazepam both increase sedation. Use Caution/Monitor.

                • gabapentin

                  brivaracetam and gabapentin both increase sedation. Use Caution/Monitor.

                • ganaxolone

                  brivaracetam and ganaxolone both increase sedation. Use Caution/Monitor.

                • guanfacine

                  brivaracetam and guanfacine both increase sedation. Use Caution/Monitor.

                • haloperidol

                  brivaracetam and haloperidol both increase sedation. Use Caution/Monitor.

                • hydroxyzine

                  brivaracetam and hydroxyzine both increase sedation. Use Caution/Monitor.

                • iloperidone

                  brivaracetam and iloperidone both increase sedation. Use Caution/Monitor.

                • imipramine

                  brivaracetam and imipramine both increase sedation. Use Caution/Monitor.

                • isoflurane

                  brivaracetam and isoflurane both increase sedation. Use Caution/Monitor.

                • ketamine

                  brivaracetam and ketamine both increase sedation. Use Caution/Monitor.

                • ketotifen, drug-eluting contact lens

                  brivaracetam and ketotifen, drug-eluting contact lens both increase sedation. Use Caution/Monitor.

                • lamotrigine

                  brivaracetam and lamotrigine both increase sedation. Use Caution/Monitor.

                • lasmiditan

                  lasmiditan, brivaracetam. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

                • lemborexant

                  lemborexant, brivaracetam. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

                • levetiracetam

                  brivaracetam, levetiracetam. Other (see comment). Use Caution/Monitor. Comment: Coadministration provided no added therapeutic benefit and may cause additive/synergistic adverse effects.

                  brivaracetam and levetiracetam both increase sedation. Use Caution/Monitor.

                • levocetirizine

                  brivaracetam and levocetirizine both increase sedation. Use Caution/Monitor.

                • levorphanol

                  brivaracetam and levorphanol both increase sedation. Use Caution/Monitor.

                • loratadine

                  brivaracetam and loratadine both increase sedation. Use Caution/Monitor.

                • lorazepam

                  brivaracetam and lorazepam both increase sedation. Use Caution/Monitor.

                • loxapine

                  brivaracetam and loxapine both increase sedation. Use Caution/Monitor.

                • lumateperone

                  brivaracetam and lumateperone both increase sedation. Use Caution/Monitor.

                • lurasidone

                  brivaracetam and lurasidone both increase sedation. Use Caution/Monitor.

                • maprotiline

                  brivaracetam and maprotiline both increase sedation. Use Caution/Monitor.

                • mavacamten

                  brivaracetam will increase the level or effect of mavacamten by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Inititiation of weak CYP2C19 inhibitors may require decreased mavacamten dose.

                • meclizine

                  brivaracetam and meclizine both increase sedation. Use Caution/Monitor.

                • meperidine

                  brivaracetam and meperidine both increase sedation. Use Caution/Monitor.

                • meprobamate

                  brivaracetam and meprobamate both increase sedation. Use Caution/Monitor.

                • metaxalone

                  brivaracetam and metaxalone both increase sedation. Use Caution/Monitor.

                • methocarbamol

                  brivaracetam and methocarbamol both increase sedation. Use Caution/Monitor.

                • methohexital

                  brivaracetam and methohexital both increase sedation. Use Caution/Monitor.

                • methsuximide

                  brivaracetam and methsuximide both increase sedation. Use Caution/Monitor.

                • midazolam

                  brivaracetam and midazolam both increase sedation. Use Caution/Monitor.

                • midazolam intranasal

                  midazolam intranasal, brivaracetam. Either increases effects of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

                • mirtazapine

                  brivaracetam and mirtazapine both increase sedation. Use Caution/Monitor.

                • molindone

                  brivaracetam and molindone both increase sedation. Use Caution/Monitor.

                • nalbuphine

                  brivaracetam and nalbuphine both increase sedation. Use Caution/Monitor.

                • nitrous oxide

                  brivaracetam and nitrous oxide both increase sedation. Use Caution/Monitor.

                • nortriptyline

                  brivaracetam and nortriptyline both increase sedation. Use Caution/Monitor.

                • olanzapine

                  brivaracetam and olanzapine both increase sedation. Use Caution/Monitor.

                • oliceridine

                  brivaracetam and oliceridine both increase sedation. Use Caution/Monitor.

                • olopatadine intranasal

                  brivaracetam and olopatadine intranasal both increase sedation. Use Caution/Monitor.

                • opicapone

                  brivaracetam and opicapone both increase sedation. Use Caution/Monitor.

                • opium tincture

                  brivaracetam and opium tincture both increase sedation. Use Caution/Monitor.

                • orphenadrine

                  brivaracetam and orphenadrine both increase sedation. Use Caution/Monitor.

                • oxazepam

                  brivaracetam and oxazepam both increase sedation. Use Caution/Monitor.

                • paliperidone

                  brivaracetam and paliperidone both increase sedation. Use Caution/Monitor.

                • pentazocine

                  brivaracetam and pentazocine both increase sedation. Use Caution/Monitor.

                • pentobarbital

                  brivaracetam and pentobarbital both increase sedation. Use Caution/Monitor.

                • perampanel

                  brivaracetam and perampanel both increase sedation. Use Caution/Monitor.

                • perphenazine

                  brivaracetam and perphenazine both increase sedation. Use Caution/Monitor.

                • pheniramine

                  brivaracetam and pheniramine both increase sedation. Use Caution/Monitor.

                • phenobarbital

                  phenobarbital will decrease the level or effect of brivaracetam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Brivaracetam plasma concentration decreased by 19%.

                  brivaracetam and phenobarbital both increase sedation. Use Caution/Monitor.

                • phenytoin

                  phenytoin will decrease the level or effect of brivaracetam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Brivaracetam plasma concentration decreased by 21%.

                  brivaracetam increases levels of phenytoin by decreasing metabolism. Use Caution/Monitor. Up to 20% increase in phenytoin plasma concentrations observed. Monitor phenytoin levels when brivaracetam is coadministered or discontinued from ongoing phenytoin therapy. .

                • pimozide

                  brivaracetam and pimozide both increase sedation. Use Caution/Monitor.

                • pomalidomide

                  brivaracetam and pomalidomide both increase sedation. Use Caution/Monitor.

                • pregabalin

                  brivaracetam and pregabalin both increase sedation. Use Caution/Monitor.

                • primidone

                  brivaracetam and primidone both increase sedation. Use Caution/Monitor.

                • prochlorperazine

                  brivaracetam and prochlorperazine both increase sedation. Use Caution/Monitor.

                • promethazine

                  brivaracetam and promethazine both increase sedation. Use Caution/Monitor.

                • propofol

                  brivaracetam and propofol both increase sedation. Use Caution/Monitor.

                • protriptyline

                  brivaracetam and protriptyline both increase sedation. Use Caution/Monitor.

                • pyrilamine

                  brivaracetam and pyrilamine both increase sedation. Use Caution/Monitor.

                • quazepam

                  brivaracetam and quazepam both increase sedation. Use Caution/Monitor.

                • quetiapine

                  brivaracetam and quetiapine both increase sedation. Use Caution/Monitor.

                • ramelteon

                  brivaracetam and ramelteon both increase sedation. Use Caution/Monitor.

                • remimazolam

                  brivaracetam and remimazolam both increase sedation. Use Caution/Monitor.

                • reserpine

                  brivaracetam and reserpine both increase sedation. Use Caution/Monitor.

                • rifampin

                  rifampin will decrease the level or effect of brivaracetam by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. The dose of brivaracetam should be increased up to 100% (ie, double the dosage) in patients while receiving concomitant treatment with rifampin.

                • risperidone

                  brivaracetam and risperidone both increase sedation. Use Caution/Monitor.

                • rucaparib

                  rucaparib will increase the level or effect of brivaracetam by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP2C19 substrates, if clinically indicated.

                • scopolamine

                  brivaracetam and scopolamine both increase sedation. Use Caution/Monitor.

                • sevoflurane

                  brivaracetam and sevoflurane both increase sedation. Use Caution/Monitor.

                • sodium oxybate

                  brivaracetam and sodium oxybate both increase sedation. Use Caution/Monitor.

                • sparsentan

                  sparsentan will decrease the level or effect of brivaracetam by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Sparsentan (a CYP2C19 inducer) decreases exposure of CYP2C19 substrates and reduces efficacy related to these substrates.

                • stiripentol

                  stiripentol, brivaracetam. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

                • sufentanil

                  brivaracetam and sufentanil both increase sedation. Use Caution/Monitor.

                • sufentanil SL

                  brivaracetam and sufentanil SL both increase sedation. Use Caution/Monitor.

                • suvorexant

                  brivaracetam and suvorexant both increase sedation. Use Caution/Monitor.

                • tapentadol

                  brivaracetam and tapentadol both increase sedation. Use Caution/Monitor.

                • tasimelteon

                  brivaracetam and tasimelteon both increase sedation. Use Caution/Monitor.

                • temazepam

                  brivaracetam and temazepam both increase sedation. Use Caution/Monitor.

                • tetrabenazine

                  brivaracetam and tetrabenazine both increase sedation. Use Caution/Monitor.

                • thioridazine

                  brivaracetam and thioridazine both increase sedation. Use Caution/Monitor.

                • thiothixene

                  brivaracetam and thiothixene both increase sedation. Use Caution/Monitor.

                • tiagabine

                  brivaracetam and tiagabine both increase sedation. Use Caution/Monitor.

                • tizanidine

                  brivaracetam and tizanidine both increase sedation. Use Caution/Monitor.

                • tolcapone

                  brivaracetam and tolcapone both increase sedation. Use Caution/Monitor.

                • topiramate

                  brivaracetam and topiramate both increase sedation. Use Caution/Monitor.

                • tramadol

                  brivaracetam and tramadol both increase sedation. Use Caution/Monitor.

                • trazodone

                  brivaracetam and trazodone both increase sedation. Use Caution/Monitor.

                • triazolam

                  brivaracetam and triazolam both increase sedation. Use Caution/Monitor.

                • trifluoperazine

                  brivaracetam and trifluoperazine both increase sedation. Use Caution/Monitor.

                • triprolidine

                  brivaracetam and triprolidine both increase sedation. Use Caution/Monitor.

                • valproic acid

                  brivaracetam and valproic acid both increase sedation. Use Caution/Monitor.

                • vigabatrin

                  brivaracetam and vigabatrin both increase sedation. Use Caution/Monitor.

                • zaleplon

                  brivaracetam and zaleplon both increase sedation. Use Caution/Monitor.

                • ziconotide

                  brivaracetam and ziconotide both increase sedation. Use Caution/Monitor.

                • ziprasidone

                  brivaracetam and ziprasidone both increase sedation. Use Caution/Monitor.

                • zolpidem

                  brivaracetam and zolpidem both increase sedation. Use Caution/Monitor.

                • zonisamide

                  brivaracetam and zonisamide both increase sedation. Use Caution/Monitor.

                Minor (0)

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                  Adverse Effects

                  >10%

                  Somnolence and sedation (16%)

                  Dizziness (12%)

                  1-10%

                  Fatigue (9%)

                  Nausea and vomiting (5%)

                  Cerebellar coordination and balance disturbances (3%)

                  Irritability (3%)

                  Constipation (2%)

                  Postmarketing Reports

                  Dysgeusia, euphoric mood, feeling drunk, infusion site pain, decreased appetite

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                  Warnings

                  Contraindications

                  Hypersensitivity; bronchospasms and angioedema have occurred

                  Cautions

                  May cause psychiatric adverse reactions, including nonpsychotic and psychotic symptoms; advise patients and caregivers/families to be alert for these behavioral changes and report them to their physician immediately

                  Hypersensitivity reactions reported, including bronchospasm and angioedema; if a patient develops hypersensitivity reactions after treatment, the drug should be discontinued

                  If discontinued, withdraw drug gradually because of the risk of increased seizure frequency and status epilepticus; if withdrawal is needed because of a serious adverse event, consider rapid discontinuation

                  Suicidal Behavior

                  • Antiepileptic drugs increase the risk of suicidal behavior and ideation; monitor for the emergence or worsening of depression, unusual changes in mood or behavior, or suicidal thoughts, behavior, or self-harm; advise patients and caregivers/families to be alert for these behavioral changes and report them to their physician immediately
                  • Anyone considering prescribing an antiepileptic drug, such as this one, must balance risk of suicidal thoughts or behaviors with risk of untreated illness; epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behavior
                  • Should suicidal thoughts and behavior emerge during treatment, consider whether the emergence of these symptoms in any given patient may be related to the illness being treated

                  Drug interactions overview

                  • CYP2C19 poor metabolizers and patients using inhibitors of CYP2C19 may require dose reduction
                  • Strong CYP2C19 inducers (eg, rifampin) require dose increase (see Dosage Modifications)
                  • Coadministration with carbamazepine may increase exposure to carbamazepine-epoxide, the active metabolite of carbamazepine; though data did not reveal any safety concerns, if tolerability issues arise when coadministered, consider carbamazepine reducing the dose
                  • Because brivaracetam can increase plasma concentrations of phenytoin, monitor phenytoin levels in patients when concomitant brivaracetam is added to or discontinued from ongoing phenytoin therapy
                  • No added therapeutic benefit to levetiracetam when the two drugs were coadministered
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                  Pregnancy & Lactation

                  Pregnancy

                  No adequate and well-controlled studies on pregnant women

                  Available data from North American Antiepileptic Drug (NAAED) pregnancy registry, a prospective cohort study, case reports, and a case series are insufficient to identify a risk of major birth defects, miscarriage, or other maternal or fetal outcomes associated with use during pregnancy

                  Animal data

                  • In animal studies, brivaracetam produced evidence of developmental toxicity (increased embryofetal mortality and decreased fetal body weights in rabbits; decreased growth, delayed sexual maturation, and long-term neurobehavioral changes in rat offspring) at maternal plasma exposures greater than clinical exposures

                  Pregnancy Registry

                  • Recommend that pregnant patients enroll in the North American Antiepileptic Drug Pregnancy Registry; this can be done by calling the toll-free number 1-888-233-2334, and must be done by patients themselves
                  • Information on the registry can also be found at the Web site http://www.aedpregnancyregistry.org/

                  Lactation

                  Data from published literature indicate that the drug is present in human milk; there is insufficient information on effects on breastfed infant or on milk production

                  The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for therapy and any potential adverse effects on breastfed infant from therapy or from underlying maternal condition

                  Pregnancy Categories

                  A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                  B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                  C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                  D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                  X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                  NA: Information not available.

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                  Pharmacology

                  Mechanism of Action

                  Exact mechanism unknown

                  Displays a high and selective affinity for synaptic vesicle protein 2A (SV2A) in the brain, which may contribute to the anticonvulsant effect

                  Absorption

                  Highly permeable and is rapidly and almost completely absorbed after PO administration

                  Peak plasma time: 1 hr (without food); slower absorption with a high-fat meal

                  Distribution

                  Protein bound: ≤20%

                  Vd: 0.5 L/kg

                  Metabolism

                  Primarily metabolized by hydrolysis of the amide moiety to form the corresponding carboxylic acid metabolite and is mediated by hepatic and extra-hepatic amidase

                  Secondarily metabolized by hydroxylation on the propyl side chain to form the hydroxy metabolite that is mediated primarily by CYP2C19

                  An additional hydroxy acid metabolite is created by hydrolysis of the amide moiety on the hydroxy metabolite or hydroxylation of the propyl side chain on the carboxylic acid metabolite (mainly by CYP2C9)

                  The 3 metabolites are not pharmacologically active

                  Elimination

                  Half-life: 9 hr

                  Excretion

                  • Urine (>95%); feces (<1%)
                  • <10% of the dose is excreted unchanged in the urine
                  • 34% of the dose is excreted as the carboxylic acid metabolite in urine

                  Pharmacogenomics

                  In human subjects possessing genetic variations in CYP2C19, production of the hydroxy metabolite is decreased 2-fold or 10-fold, while the blood level of brivaracetam itself is increased by 22% or 42%, respectively, in individuals with one or both mutated alleles

                  CYP2C19 poor metabolizers and patients using inhibitors of CYP2C19 may require dose reduction

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                  Administration

                  Oral Administration

                  May take with or without food

                  Tablet

                  • Swallow whole; do not chew or crush

                  Oral solution

                  • Use a calibrated measuring device to measure and deliver the prescribed dose accurately
                  • No dilution is necessary
                  • May also be administered using an NT-tube or G-tube

                  IV Compatibilities

                  0.9% NaCl

                  Dextrose 5%

                  Lactated Ringer injection

                  IV Preparation

                  Inspect visually for particulate matter and discoloration prior to administration; product with particulate matter or discoloration should not be used

                  Vial is for single dose only

                  IV Administration

                  Can be administered IV without further dilution or may be mixed with diluents (see IV Compatibilities)

                  Infuse IV over 2-15 minutes

                  Discontinuation

                  Avoid abrupt withdrawal in order to minimize the risk of increased seizure frequency and status epilepticus

                  Storage

                  Oral

                  • Store at 25°C (77°F); excursions permitted between 15-30°C (59-86°F)
                  • Oral solution: Do not freeze; discard any unused oral solution remaining after 5 months of first opening the bottle

                  IV

                  • Unopened vials: Store at 25°C (77°F); excursions permitted between 15-30°C (59-86°F); do not freeze
                  • Diluted solution: Store at room temperature in PVC bag for up to 4 hr
                  • Discard any unused portion
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                  Images

                  BRAND FORM. UNIT PRICE PILL IMAGE
                  Briviact intravenous
                  -
                  		50 mg/5 mL vial
                  Briviact oral
                  -
                  		100 mg tablet
                  Briviact oral
                  -
                  		75 mg tablet
                  Briviact oral
                  -
                  		50 mg tablet
                  Briviact oral
                  -
                  		25 mg tablet
                  Briviact oral
                  -
                  		10 mg tablet
                  Briviact oral
                  -
                  		10 mg/mL solution

                  Copyright © 2010 First DataBank, Inc.

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                  Patient Handout

                  A Patient Handout is not currently available for this monograph.
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                  Formulary

                  FormularyPatient Discounts

                  Adding plans allows you to compare formulary status to other drugs in the same class.

                  To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

                  Create Your List of Plans

                  Adding plans allows you to:

                  • View the formulary and any restrictions for each plan.
                  • Manage and view all your plans together – even plans in different states.
                  • Compare formulary status to other drugs in the same class.
                  • Access your plan list on any device – mobile or desktop.

                  The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                  View explanations for tiers and restrictions
                  Tier Description
                  1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                  2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                  3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                  4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                  NC NOT COVERED – Drugs that are not covered by the plan.
                  Code Definition
                  PA Prior Authorization
                  Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                  QL Quantity Limits
                  Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
                  ST Step Therapy
                  Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
                  OR Other Restrictions
                  Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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                  Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.
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