What to Know About Briviact (Brivaracetam)

Briviact (brivaracetam) is a prescription anti-epilepsy drug (AED) used to prevent seizures in certain types of epilepsy. This medication can be taken by mouth in both tablet and liquid forms and intravenously (IV, in a vein).

Seizures are abnormal, uncontrolled electrical activity in the brain that comes on suddenly and may occur only once, while epilepsy is a continued recurrence of seizures.

Briviact has a strong tendency to bind to the synaptic vesicle glycoprotein 2A (SV2A) in the brain, a membrane protein that regulates nerve and neurotransmitter activity to prevent the excess electrical activity that contributes to seizures. 

Uses

This medication is approved by the Food and Drug Administration (FDA) as an adjunctive therapy for preventing partial-onset seizures. In this case, adjunctive seizure therapy is AED medication that is meant to be used with one or more other AEDs to prevent seizures, rather than on its own.

Children ages 4 years old and up should take Briviact by mouth, while people 16 years and older can get the medication through an IV.

Partial-onset seizures are seizures that affect the nerve cells in one part of the brain:

• Partial-onset seizures can be focal seizures, with a variety of symptoms. These include unusual sensations and jerking or shaking movements, sometimes with impaired consciousness.
• Partial-onset seizures may become secondarily generalized seizures. These seizures occur in both sides of the brain. They can cause symptoms that affect both sides of the body as well, and they typically include unresponsiveness.

Briviact can be effective when used to prevent partial-onset seizures with or without secondary generalization.

Off-Label Uses

Off-label use is when a drug is used for conditions or in ways that are not in the FDA list of indications for the drug. Briviact is sometimes used off-label in these ways:

• The oral and IV forms have been used in children under age 16 who are older than 4 years old. 
• This medication has also been prescribed for seizure prevention in children and adults who have Lennox-Gastaut syndrome, a developmental disorder that causes many types of recurrent and severe seizures, as well as cognitive and behavioral problems.
• The IV formulation has also been used in the treatment of status epilepticus, a type of prolonged and dangerous seizure that does not resolve until it is treated with fast-acting anti-seizure medication.

Before Taking

You should not take Briviact if you have had an adverse reaction to this medication in the past. Also, before you start taking Briviact, let your doctor know if you have had a severe reaction to other anti-epilepsy drugs.

Precautions and Contraindications

This medication might not be right for everyone, including:

• People with a history of suicidal thoughts, suicidal behavior, or psychosis: Talk with your doctor about these risks, which can increase while taking Briviact.
• People who are pregnant, plan to become pregnant, or are breastfeeding: Risks to the baby are not well known. You and your doctor would need to discuss the risks and benefits before you start taking this medication under these conditions.

Other AEDS

There are several other AEDs used to prevent seizures. Keppra (levetiracetam) is considered the most similar to Briviact. These drugs generally are not used together because the side effects can be more severe when taken together. Also, the benefits of using them this way have not been established.

Dosage

Briviact comes in tablets of 10 milligrams (mg), 25 mg, 50 mg, 75 mg, and 100 mg. The oral solution comes in a concentration of 10 mg/milliliter (mL). The injection comes in single dose vials at a concentration of 50 mg/5 mL.

This medication is meant to be taken twice per day every day to prevent seizures. When the tablet or oral solution is prescribed, the recommended starting dose is 100 mg per day, taken as 50 mg twice per day. Your doctor might adjust your dose in a range of 50 mg per day to 200 mg per day.

Briviact injection is administered through an IV by a healthcare professional over a period of 2–15 minutes.

When it is used off-label, the dosing of Briviact may be different from the standard recommended doses, such as when it is used for children younger than age 16.

Modifications

For people who have liver disease, Briviact is modified to a lower dose, starting at 25 mg twice a day, or approximately one-third to one-half of the regular dose. The maximum daily dose of 150 mg in two divided doses of 75 mg each for patients with decreased liver function.

How to Take and Store

Briviact can be taken with or without food or drink. The tablet should be swallowed whole, not cut or crushed. 

You should take your tablet or liquid Briviact at the same time each day and in a consistent manner (for example, always with food or always without food) so you won’t have drastic fluctuations in the way it works. 

The IV form has to be administered by a healthcare professional and is reserved for people who have difficulty swallowing medication, such as during a severe illness. 

This medication should be stored in its original container and kept away from children and pets. Briviact should be stored at a temperature of 77 degrees Fahrenheit (F), which is equivalent to 25 degrees Celsius (C). You can take it out for brief trips at temperatures between 59 F and 86 F (15 C–30 C). The Briviact injectable solution and the oral solution should not be frozen.

Plan to discard any unused Briviact oral solution five months after first opening the bottle.

Side Effects

Briviact can cause side effects, even when used at recommended dosages. Generally, the most common side effects are mild and tolerable. Severe side effects can be dangerous.

Common

Common side effects may improve after you take Briviact for a while, but they can persist at times.

The most common side effects of this medication are:

• Headaches
• Tiredness/sleepiness
• Dizziness
• Nausea and vomiting

Talk to your doctor about your side effects. You may either be offered additional medications for these symptoms or a dose adjustment of your Briviact.

Severe 

Briviact can cause severe side effects, including:

• Thoughts of suicide or suicidal behavior
• Severe fatigue
• Anxiety
• Irritability
• Depression
• Aggression
• Psychotic symptoms
• Bronchospasm (sudden narrowing of the airways), with shortness of breath or inability to breathe
• Angioedema, with a rash, swelling of the body, and trouble breathing

It's important that you are aware of these potential symptoms and that you get medical attention if you start to experience these issues. Bronchospasm and angioedema can be life-threatening.

Warnings and Interactions

As an adjunctive epilepsy treatment, Briviact is used with other medications. Briviact can interact with several other drugs, and you may require a dose adjustment of one or more of the medications you take.

Common interactions include:

• Rifampin: May decrease Briviact concentrations in the body 
• Carbamazepine: May require reducing your Briviact dose 
• Phenytoin: May result in higher concentrations of phenytoin
• Primidone, phenobarbital, phenytoin: May lower Briviact concentrations

To avoid these adverse events, be sure to tell your doctor and pharmacist about all medications, herbs, supplements, and other therapies that you are using. For example, Briviact can interact with Saint-John's-wort. Also, if you are diagnosed with another medical condition while you are taking Briviact, inform your doctor and your pharmacist of this.

Summary

Briviact is an anti-epilepsy drug that is used along with other anti-epilepsy medications. It can prevent partial-onset seizures in people ages 4 and older. It is available in tablet, oral, and intravenous forms.