brivaracetam: clinical use

Prescribing considerations

• Confirm that use matches the licensed adjunctive indication and age range.
• Review mood, behaviour and suicidal ideation before and during treatment.
• Counsel about sleepiness, dizziness, alcohol and safe driving or machinery use.
• Review treatment if pregnancy is planned or confirmed.
• End-stage renal disease requiring dialysis lacks adequate evidence.
• Consider excipient suitability, swallowing ability and enteral access when choosing a formulation.

Contraindications and cautions

• Hypersensitivity to brivaracetam, another pyrrolidone derivative or a formulation excipient.
• The sorbitol-containing oral solution should not be used in hereditary fructose intolerance.

Monitoring

• Seizure control and adherence
• Somnolence, dizziness and functional impairment
• Depression, aggression, agitation, psychotic symptoms or suicidal ideation
• New rash, mucosal lesions or hypersensitivity symptoms
• Tolerability and clinical response after interacting medicines are started or stopped
• Infant wellbeing if breastfeeding continues

Clinical pharmacology

Brivaracetam is a high-affinity, selective SV2A ligand. Oral absorption is rapid and essentially complete, protein binding is low, and elimination follows extensive metabolism with inactive metabolites; CYP2C19 contributes to a secondary metabolic pathway.

Formulation and product differences

• Film-coated tablets are swallowed whole and may be taken with or without food.
• Oral solution is measured with the supplied syringe, may be diluted in water or juice, and can be administered through nasogastric or gastrostomy tubes. It contains sorbitol, methyl parahydroxybenzoate and propylene glycol.
• Intravenous solution provides a temporary alternative when oral administration is not feasible and may be given as a bolus or compatible infusion by healthcare professionals.
• Oral and intravenous formulations provide similar overall systemic exposure, although peak concentration is slightly higher intravenously.

Oral solution

Route: Oral

Strengths: 10 mg/mL

Tablet

Route: Oral

Strengths: 10 mg, 25 mg, 50 mg, 75 mg, 100 mg