Products
Brivaracetam was approved in the EU, the United States, and many countries in 2016 in the form of film-coated tablets, oral solution, and solution for injection (Briviact).
Structure and properties
Brivaracetam (C11H20N2O2, Mr = 212.3 g/mol) is structurally and pharmacologically closely related to levetiracetam (Keppra, generics). Like levetiracetam, it is a pyrrolidinone derivative.
Effects
Brivaracetam (ATC N03AX23) has antiepileptic and anticonvulsant properties. The effects are due to binding to synaptic vesicle protein 2A (SV2A). SV2A is a membrane protein found in synaptic vesicles and plays an important role in the release of neurotransmitters from the vesicles into the synaptic space. Binding of brivaracetam to SV2A reduces neurotransmitter release. Brivaracetam binds to SV2A with a higher affinity than levetiracetam. It additionally interacts with voltage-gated sodium channels in the central nervous system. The half-life is approximately 9 hours.
Indications
As adjunctive therapy in the treatment of focal seizures with or without secondary generalization in adult patients with epilepsy.
Dosage
According to the SmPC. Tablets are taken twice daily (morning and evening), independent of meals.
Contraindications
- Hypersensitivity
For complete precautions, see the drug label.
Interactions
Brivaracetam should not be combined with alcohol because it potentiates its effects. Metabolism occurs primarily via hydrolysis. CYP2C19 is involved in the second step. Brivaracetam is a moderately potent inhibitor of epoxide hydrolase, which may lead to interaction with carbamazepine.
Adverse effects
The most common potential adverse effects include drowsiness, dizziness, and fatigue.
