brivaracetam (Rx)

Brand and Other Names:Briviact
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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

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Interactions

Interaction Checker

and brivaracetam

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

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             activity indicator 

            Contraindicated (0)

              Serious - Use Alternative (3)

              • 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.

              • 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.

              • 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 (16)

              • brexanolone

                brexanolone, brivaracetam. Either increases toxicity of the other by 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. .

              • cenobamate

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

              • deutetrabenazine

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

              • esketamine intranasal

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

              • 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).

              • fexinidazole

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

              • 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.

              • 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%.

              • 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. .

              • 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.

              • 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.

              • 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.

              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%)

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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 in pregnant women

                In animal studies, brivaracetam produced evidence of developmental toxicity at plasma exposures greater than clinical exposure

                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

                Unknown if distributed in human breast milk

                Studies in rats have shown excretion in milk

                Because many drugs are excreted into human milk, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother

                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

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                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.

                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.