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Briviact
brivaracetam
Adult Dosing .
Dosage forms: TAB: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg; SOLUTION: 10 mg per mL; INJ: various
partial seizures
- [25-100 mg PO/IV bid]
- Start: 50 mg PO/IV bid; Max: 200 mg/day; Info: consider lower dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab; taper dose gradually to D/C
renal dosing
- [see below]
- renal impairment: no adjustment; ESRD: not defined
- HD/PD: not defined
hepatic dosing
- [adjust dose amount]
- hepatic impairment: start 25 mg bid, max 150 mg/day
Peds Dosing .
- Dosage forms: TAB: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg; SOLUTION: 10 mg per mL; INJ: various
partial seizures
- [1 mo-15 yo, <11 kg]
- Dose: 0.75-3 mg/kg/dose PO/IV bid; Start: 0.75-1.5 mg/kg/dose PO/IV bid; Max: 6 mg/kg/day; Info: consider lower dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab; taper dose gradually to D/C
- [1 mo-15 yo, 11-19.9 kg]
- Dose: 0.5-2.5 mg/kg/dose PO/IV bid; Start: 0.5-1.25 mg/kg/dose PO/IV bid; Max: 5 mg/kg/day; Info: consider lower dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab; taper dose gradually to D/C
- [1 mo-15 yo, 20-49.9 kg]
- Dose: 0.5-2 mg/kg/dose PO/IV bid; Start: 0.5-1 mg/kg/dose PO/IV bid; Max: 4 mg/kg/day; Info: consider lower dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab; taper dose gradually to D/C
- [1 mo-15 yo, >50 kg]
- Dose: 25-100 mg PO/IV bid; Start: 25-50 mg PO/IV bid; Max: 200 mg/day; Info: consider lower dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab; taper dose gradually to D/C
- [16 yo and older]
- Dose: 25-100 mg PO/IV bid; Start: 50 mg PO/IV bid; Max: 200 mg/day; Info: consider lower dose in CYP2C19 poor metabolizers; do not cut/crush/chew tab; taper dose gradually to D/C
renal dosing
- [see below]
- renal impairment: no adjustment; ESRD: not defined
- HD/PD: not defined
hepatic dosing
- [<11 kg]
- hepatic impairment: start 0.75 mg/kg/dose bid, max 4.5 mg/kg/day
- [11-19.9 kg]
- hepatic impairment: start 0.5 mg/kg/dose bid, max 4 mg/kg/day
- [20-49.9 kg]
- hepatic impairment: start 0.5 mg/kg/dose bid, max 3 mg/kg/day
- [>50 kg]
- hepatic impairment: start 25 mg bid, max 150 mg/day
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- abrupt withdrawal
- caution: CNS depressant use, concurrent
- caution: alcohol use, concurrent
- caution: CYP2C19 poor metabolizers
- caution: hepatic impairment
- caution: psychiatric disorder
Drug Interactions .
Overview
brivaracetam
SV2A inhibitor
- CYP2C19 substrate
- epoxide hydrolase inhibitor
- affected by altered fat absorption
- antiepileptic agent
- CNS depression
Contraindicated
- amifampridine
- bupropion
- dalfampridine
Avoid/Use Alternative
- butalbital
- clonidine
- codeine
- doxylamine
- ethanol (alcoholic beverage)
- ethanol injection
- ginkgo
- haloperidol
- hydrocodone
- isocarboxazid
- kava
- kratom
- metaxalone
- metoclopramide
- midazolam
- oxybate
- phenelzine
- promethazine
- ropeginterferon alfa-2b
- scopolamine
- thalidomide
- tradipitant
- tranylcypromine
- trimethobenzamide
- zuranolone
Monitor/Modify Tx
- aldesleukin
- alfentanil
- alprazolam
- baclofen intrathecal
- buprenorphine
- butorphanol
- carbamazepine
- chlordiazepoxide
- chlorpromazine
- clobazam
- clonazepam
- clorazepate
- daridorexant
- desflurane
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- dihydrocodeine
- droperidol
- esketamine
- estazolam
- eszopiclone
- ethanol (in some formulations)
- etomidate
- fentanyl
- fluconazole
- fluoxetine
- fluphenazine
- flurazepam
- fluvoxamine
- gabapentin
- gabapentin enacarbil
- hydromorphone
- hydroxyzine
- ifosfamide
- isoflurane
- ketamine
- lemborexant
- levorphanol
- lorazepam
- meperidine
- methadone
- methohexital
- mirtazapine
- morphine
- nalbuphine
- nelarabine
- olanzapine
- oliceridine
- opicapone
- opium
- oxazepam
- oxybutynin
- oxycodone
- oxymorphone
- pentazocine
- pentobarbital
- perphenazine
- phenobarbital
- pregabalin
- primidone
- propofol
- quazepam
- remifentanil
- remimazolam
- rifampin
- sevoflurane
- sufentanil
- suvorexant
- tapentadol
- temazepam
- thioridazine
- thiothixene
- tramadol
- triazolam
- zaleplon
- ziconotide
- zolpidem
Caution Advised
- 5-HTP
- acyclovir
- allopurinol
- almotriptan
- amantadine
- aminophylline
- amitriptyline
- amoxapine
- amoxicillin
- amphetamine
- ampicillin
- apalutamide
- apomorphine
- apraclonidine ophthalmic
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- axicabtagene ciloleucel
- baclofen
- benzphetamine
- betamethasone
- brexpiprazole
- brexucabtagene autoleucel
- brimonidine ophthalmic
- brimonidine topical
- bromocriptine
- brompheniramine
- buspirone
- busulfan
- cannabidiol
- cannabis
- carbinoxamine
- cariprazine
- carisoprodol
- cefazolin
- cefepime
- cefiderocol
- ceftaroline
- ceftazidime
- ceftobiprole
- cenobamate
- cetirizine
- chamomile, German
- chlophedianol
- chlorambucil
- chlorcyclizine
- chloroquine
- chlorpheniramine
- chlorzoxazone
- ciltacabtagene autoleucel
- ciprofloxacin
- cisatracurium
- citalopram
- clemastine
- clomipramine
- clozapine
- cocaine
- cortisone
- cyclobenzaprine
- cycloserine
- cyclosporine
- cyproheptadine
- dantrolene
- darbepoetin alfa
- darifenacin
- darolutamide
- deflazacort
- delafloxacin
- desipramine
- desvenlafaxine
- deutetrabenazine
- dexamethasone
- dexbrompheniramine
- dexchlorpheniramine
- dexmethylphenidate
- dextroamphetamine
- dichlorphenamide
- dicloxacillin
- diethylpropion
- difelikefalin
- difenoxin
- dimenhydrinate
- diphenhydramine
- diphenoxylate
- domperidone
- donepezil
- doxepin
- doxepin topical
- dronabinol
- duloxetine
- efavirenz
- eletriptan
- elinzanetant
- elivaldogene autotemcel
- entacapone
- entrectinib
- enzalutamide
- ephedra
- epoetin alfa
- ertapenem
- escitalopram
- eslicarbazepine acetate
- ethosuximide
- felbamate
- fenfluramine
- fesoterodine
- flibanserin
- foscarnet
- foslevodopa
- fosphenytoin
- frovatriptan
- galantamine
- ganaxolone
- ganciclovir
- glofitamab
- glycopyrrolate
- goserelin
- guanfacine
- histrelin
- hydroxychloroquine
- hyoscyamine
- idecabtagene vicleucel
- iloperidone
- imipenem
- imipramine
- interferon beta 1a
- interferon beta 1b
- iohexol
- iopamidol
- isoniazid
- ketorolac
- lacosamide
- lamotrigine
- leuprolide
- levetiracetam
- levocarnitine
- levocetirizine
- levodopa
- levofloxacin
- levomilnacipran
- lidocaine
- lidocaine topical
- linezolid
- linvoseltamab
- lisdexamfetamine
- lisocabtagene maraleucel
- lithium
- lofexidine
- lorlatinib
- loxapine
- lumateperone
- lurasidone
- magnesium citrate
- mavacamten
- meclizine
- mefloquine
- melatonin
- meprobamate
- meropenem
- methamphetamine
- methocarbamol
- methotrexate
- methoxy polyethylene glycol-epoetin beta
- methsuximide
- methyldopa
- metronidazole
- metyrapone
- metyrosine
- mexiletine
- milnacipran
- milsaperidone
- mitotane
- molindone
- mosunetuzumab
- moxifloxacin
- mycophenolate mofetil
- nafarelin nasal
- nafcillin
- naltrexone
- naratriptan
- nefazodone
- nortriptyline
- obecabtagene autoleucel
- ofloxacin
- orphenadrine
- oxacillin
- oxcarbazepine
- pacritinib
- paliperidone
- paroxetine
- passion flower
- peginterferon beta 1a
- penicillin G
- penicillin V
- perampanel
- phendimetrazine
- pheniramine
- phentermine
- phenytoin
- pimozide
- piperacillin
- polyethylene glycol
- polyethylene glycol/electrolytes
- pramipexole
- procarbazine
- prochlorperazine
- protriptyline
- pyridostigmine
- pyrilamine
- pyrimethamine
- quetiapine
- quinine
- ramelteon
- rasagiline
- regadenoson
- repotrectinib
- risperidone
- rivastigmine
- rizatriptan
- ropinirole
- rotigotine transdermal
- rufinamide
- safinamide
- selegiline
- selegiline transdermal
- selinexor
- sertraline
- sodium picosulfate
- solifenacin
- stiripentol
- sulfate bowel prep
- sumatriptan
- tacrolimus
- tasimelteon
- teclistamab
- terbutaline
- tetrabenazine
- theophylline
- thiotepa
- tiagabine
- tinidazole
- tipranavir
- tisagenlecleucel
- tizanidine
- tolcapone
- tolterodine
- topiramate
- tranexamic acid
- trazodone
- treosulfan
- triamcinolone
- trifluoperazine
- trihexyphenidyl
- trimipramine
- triprolidine
- triptorelin
- trospium
- vadadustat
- valacyclovir
- valbenazine
- valerian
- valganciclovir
- valproic acid
- varenicline
- venlafaxine
- vigabatrin
- vilazodone
- viloxazine
- ziprasidone
- zolmitriptan
- zonisamide
Adverse Reactions .
Serious Reactions
- suicidality
- psychosis
- hallucinations
- aggressive behavior
- depression
- hypersensitivity reaction
- bronchospasm
- angioedema
- leukopenia
- neutropenia
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- withdrawal seizures if abrupt D/C
Common Reactions
- somnolence
- sedation
- dizziness
- fatigue
- nausea
- vomiting
- irritability
- ataxia
- balance disorder
- impaired coordination
- nystagmus
- dysgeusia (IV use)
- euphoria (IV use)
- intoxicated feeling (IV use)
- infusion site pain (IV use)
- constipation
Safety/Monitoring .
Monitoring Parameters
signs/symptoms of depression, behavior changes, suicidality
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; inadequate human data available; no known risk of fetal harm based on animal data at 4x MRHD
Pregnancy Registry
encourage patients to enroll in North American Antiepileptic Drug Pregnancy Registry at 1-888-233-2334 or www.aedpregnancyregistry.org
Lactation
Clinical Summary
weigh risk/benefit while breastfeeding; inadequate human data available to assess risk of infant harm, though drug excreted into milk; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for brivaracetam: hydrolysis primarily, hydroxylation; CYP450: 2C19 substrate
Excretion: for brivaracetam: urine 95% (<10% unchanged), feces <1%; Half-life: 9h
Subclass: Seizure Disorders
Mechanism of Action
for brivaracetam: exact mechanism of action unknown; selectively binds synaptic vesicle protein 2A in the brain
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: UCB Pharma, Inc.
DEA/FDA: Schedule V
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
oral tablet:
- 10 mg (60 ea): $1,249.00
- 25 mg (60 ea): $1,249.00
- 50 mg (60 ea): $1,249.00
- 75 mg (60 ea): $1,249.00
- 100 mg (60 ea): $1,249.00
oral liquid:
- 10 mg/mL (2 bottle of oral solution, 300 mL): $2,488.00
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