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Antiepileptic — SV2A Ligand (Focal Seizures) Pregnancy: Avoid — teratogenic risk in animals; use effective contraception; register with UK Epilepsy and Pregnancy Register

Brivaracetam

Brand names: Briviact

Adult dose

Dose: 50 mg twice daily initially; may adjust to 25–100 mg twice daily
Route: Oral (tablet, oral solution) or IV (when oral not possible)
Frequency: Twice daily
Max: 200 mg/day
IV dose same as oral — 1:1 conversion. Can be initiated at 100 mg twice daily if rapid seizure control needed. May be taken with or without food. IV infusion over 2–15 minutes.

Paediatric dose

Dose: 1–2 mg/kg mg/kg
Route: Oral or IV
Frequency: Twice daily
Max: 4 mg/kg/day (max 200 mg/day)
Licensed from 4 years of age. Oral solution available (10 mg/mL) — useful for children.

Dose adjustments

Renal

No dose adjustment required (not renally cleared as active drug)

Hepatic

Reduce maximum dose to 150 mg/day in hepatic impairment (all degrees)

Paediatric weight-based calculator

Licensed from 4 years of age. Oral solution available (10 mg/mL) — useful for children.

Clinical pearls

  • Brivaracetam has 15–30× higher affinity for SV2A than levetiracetam — may work where levetiracetam has failed
  • Fewer psychiatric adverse effects than levetiracetam — better option in patients with pre-existing mood/behavioural issues
  • 1:1 oral-to-IV conversion allows seamless transition in perioperative or critically ill patients
  • No dose titration required — can start at therapeutic dose immediately
  • Licensed as monotherapy and adjunctive therapy for focal-onset seizures in adults and children ≥4 years

Contraindications

  • Hypersensitivity to brivaracetam or levetiracetam (cross-reactivity possible)

Side effects

  • Somnolence
  • Dizziness
  • Fatigue
  • Nausea
  • Behavioural symptoms (irritability, aggression — less than levetiracetam)
  • Depression
  • Suicidal ideation

Interactions

  • Carbamazepine — increases brivaracetam clearance (consider dose adjustment)
  • Rifampicin — reduces brivaracetam levels
  • Phenytoin — may increase phenytoin levels
  • Alcohol — additive CNS depression
  • No significant interaction with oral contraceptives

Monitoring

  • Seizure diary
  • Mood and behaviour assessment
  • LFTs at baseline (hepatic impairment dosing)
  • Drug levels not routinely monitored

Reference: BNFc; BNF 90; NICE TA564 (Brivaracetam as Adjunctive Therapy); EMA SmPC Briviact; BRIVARACETAM Phase III Trials. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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