Brivaracetam (Briviact) For Epilepsy
What is Brivaracetam?
Brivaracetam is a novel antiseizure drug effective in treating all kinds of epilepsy, focal and generalized. It is a very well-tolerated medication that belongs to the second generation of Levetiracetam.
What does it treat?
Brivaracetam is used for:
- Focal epilepsy
- Primary generalized epilepsy
- Status epilepticus
It is FDA approved for treating focal epilepsy in children even at the early age of one month. Although multiple studies have shown its efficacy in primary generalized epilepsy as well, there is still a requirement to conduct more investigations into this matter. As Brivaracetam rapidly reaches the brain after its intravenous administration, it becomes an optimal option for very long and stubborn seizures in status epilepticus.
How does Brivaracetam Work?
Brivaracetam has a broad spectrum of antiseizure activity and works in a unique mechanism by inhibiting synaptic vesicle glycoprotein 2A (SV2A). Since it is ten times more specific and potent than Levetiracetam, the treatment dose becomes ten times lower than the other.
Besides, it interacts only with selected targets in the brain, unlike levetiracetam leading to fewer psychiatric side effects.
What are the Dose Forms Available?
Brivaracetam is available in multiple forms giving a broad space for its usage.
- tablets
- oral solutions
- IV forms
Hence, the treating doctor can choose the most appropriate form considering the nature of the seizure and the condition of the patient under different circumstances.
How is Brivaracetam Dosed?
The treatment dose in adults usually begins with 50mg twice a day. Then, the neurologist adjusts the dose based on the patient’s response. It can increase further, to the maximum dose of 100mg twice a day depending on the tolerability of the drug by the patient and the control of seizure. It can also decrease to 25mg twice daily in patients with low tolerability and in the elderly, who are more susceptible to medication. In clinical practice, we have given higher doses than 100 mg twice a day in certain cases.
In children, the dose varies depending on their body weight, and the initial treatment is 0.5 to 1mg/kg/day divided into two doses. The subsequent doses may either decrease or increase to the maximum of 4mg/kg/day.
In the case of patients under the treatment of Levetiracetam, you can switch directly from Levetiracetam to Brivaracetam without any problem and the switch can happen overnight. The conversion ratio is 10:1 or 15:1 from Levetiracetam to Brivaracetam.
Does the Dose Change in Patients with other Conditions?
- In Renal Impairment
Patients with mild to severe renal impairment can get the same treatment dose of Briviact despite partial damage to their kidneys. However, previous studies on Levetiracetam have proven that the drug gets filtered in case of complete renal failure and on renal dialysis, and it is necessary to add extra doses. But, there is a lack of information on what happens to Brivaracetam.
- In Liver Impairment
Patients with liver failure should decrease the initial dose to 25mg, whereas the maximum has to be 75 instead of 100mg. It is also essential to know that Brivaracetam is processed by the liver enzymes, unlike Levetiracetam which makes it susceptible to interactions with other medications that affect liver enzymes like Carbamazepine and Valproate.
For how long should I take Brivaracetam to gain results?
It is imperative to take a high enough dose without interruption for at least 3 to 6 months to see the effect of this medication.
However, if you are suffering with drug resistance epilepsy which is present in 25% of epilepsy cases, antiseizure drugs, including Brivaracetam, might not be beneficial, and you may need surgical treatment.
How to Stop Brivaracetam if it is Ineffective?
Just like other antiseizure drugs, Brivaracetam should be slowly tapered over a few weeks to prevent withdrawal seizures.
What are the Adverse Effects of Brivaracetam?
Though Brivaracetam is a well-tolerated drug, patients can initially experience common side effects such as,
- dizziness
- drowsiness
- fatigue
- irritability
These are self-limiting and usually disappear with time.
It can cause psychiatric side effects such as,
- depression
- anxiety
However, a study where the treatment switched from Levetiracetam to Brivaracetam revealed that 33 to 83% of the patients showed improvement in psychiatric side effects.
Yet like most antiseizure medications, Brivaracetam also has the potential for suicidal ideations, and simultaneous counseling is important.
Is Brivaracetam Safe During Pregnancy and Breastfeeding?
Since this is a recently invented drug, there are gaps in information on its usage in specific physiological conditions like pregnancy and breastfeeding. However, there are ongoing studies to understand the effects of Brivaracetam on embryos, fetuses, and babies.
In Summary
Brivaracetam is the drug of choice for new-onset seizures in patients who require quick seizure control, given the fast titration schedule and relative safety. We can introduce this drug to those under Levetiracetam treatment to get better responses more safely. This excellent medication will set another milestone in the successful treatment of epilepsy.