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Brivaracetam: Drug information

Brivaracetam: Drug information
(For additional information see "Brivaracetam: Patient drug information" and see "Brivaracetam: Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Briviact
Brand Names: Canada
  • Brivlera
Pharmacologic Category
  • Antiseizure Agent, Miscellaneous
Dosing: Adult
Partial onset seizures

Partial onset seizures (monotherapy or adjunctive therapy): Oral, IV: Initial: 50 mg twice daily; may decrease to 25 mg twice daily or increase up to 100 mg twice daily based on individual patient response and tolerability (maximum: 200 mg/day). Note: Use injection when oral administration is temporarily not feasible; clinical study experience with brivaracetam injection is limited to 4 consecutive days of treatment.

Discontinuation of therapy: Reduce gradually; it has been recommended to reduce the dose by 50 mg/day on a weekly basis with the final week of treatment at the dose of 20 mg/day (Brivlera Canadian product labeling).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

Mild to severe impairment: No dosage adjustment necessary.

End-stage renal disease requiring dialysis: Use is not recommended (has not been studied).

Dosing: Hepatic Impairment: Adult

Mild to severe impairment (Child Pugh classes A, B, and C): Initial: 25 mg twice daily, up to a maximum of 75 mg twice daily.

Dosing: Pediatric

(For additional information see "Brivaracetam: Pediatric drug information")

Partial-onset seizures; adjunct or monotherapy

Partial-onset seizures; adjunct or monotherapy:

Note: Avoid abrupt withdrawal; decrease dose gradually. Use injection when oral administration is temporarily not feasible; clinical study experience with brivaracetam injection is limited to 4 consecutive days of treatment.

Infants, Children, and Adolescents <16 years:

<11 kg: Oral, IV: Initial: 0.75 to 1.5 mg/kg/dose twice daily; adjust dose based on individual patient response and tolerability (gradual dose escalation not required); maximum daily dose: 6 mg/kg/day in 2 divided doses.

11 to <20 kg: Oral, IV: Initial: 0.5 to 1.25 mg/kg/dose twice daily; adjust dose based on individual patient response and tolerability (gradual dose escalation not required); maximum daily dose: 5 mg/kg/day in 2 divided doses.

20 kg to <50 kg: Oral, IV: Initial: 0.5 to 1 mg/kg/dose twice daily; adjust dose based on individual patient response and tolerability (gradual dose escalation not required); maximum daily dose: 4 mg/kg/day in 2 divided doses.

≥50 kg: Oral, IV: Initial: 25 to 50 mg twice daily; adjust dose based on individual patient response and tolerability (gradual dose escalation not required); maximum daily dose: 200 mg/day in 2 divided doses.

Adolescents ≥16 years: Oral, IV: Initial: 50 mg twice daily; may decrease to 25 mg twice daily or increase up to 100 mg twice daily based on individual patient response and tolerability (gradual dose escalation not required); maximum daily dose: 200 mg/day in 2 divided doses.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Infants, Children, and Adolescents: Oral, IV:

Mild to severe impairment: No dosage adjustment necessary.

End-stage renal disease requiring dialysis: Use is not recommended (has not been studied).

Dosing: Hepatic Impairment: Pediatric

Mild to severe impairment:

Infants, Children, and Adolescents <16 years: Oral, IV:

<11 kg: Initial: 0.75 mg/kg/dose twice daily; maximum daily dose 4.5 mg/kg/day in 2 divided doses.

11 to <20 kg: Initial: 0.5 mg/kg/dose twice daily; maximum daily dose: 4 mg/kg/day in 2 divided doses.

20 kg to <50 kg: Initial: 0.5 mg/kg/dose twice daily; maximum daily dose: 3 mg/kg/day in 2 divided doses.

≥50 kg: Initial: 25 mg twice daily; maximum daily dose: 150 mg/day in 2 divided doses.

Adolescents ≥16 years: Oral, IV: Initial: 25 mg twice daily; maximum daily dose: 150 mg/day in 2 divided doses.

Dosing: Older Adult

Refer to adult dosing. Consider starting at the low end of the dosage range.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous [preservative free]:

Briviact: 50 mg/5 mL (5 mL)

Solution, Oral:

Briviact: 10 mg/mL (300 mL) [contains methylparaben; raspberry flavor]

Tablet, Oral:

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

Generic Equivalent Available: US

No

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Brivlera: 50 mg/5 mL (5 mL)

Solution, Oral:

Brivlera: 10 mg/mL (300 mL) [contains methylparaben]

Tablet, Oral:

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

Controlled Substance

C-V

Medication Guide and/or Vaccine Information Statement (VIS)

An FDA-approved patient medication guide, which is available with the product information and as follows, must be dispensed with this medication:

Briviact: https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/205836s009,205837s007,205838s006lbl.pdf#page=18

Administration: Adult

IV: Administer IV over 2 to 15 minutes; may administer undiluted or diluted with NS, LR, or D5W.

Oral solution: Administer with or without food. Use a calibrated measuring device to measure (household teaspoon or tablespoon is not an adequate measuring device). May also be administered using a nasogastric tube or gastrostomy tube.

Tablets: Administer with or without food. Swallow tablets whole with liquid; do not chew or crush.

Administration: Pediatric

Oral: Administer with or without food.

Oral solution: Use a calibrated measuring device to measure (household teaspoon or tablespoon is not an adequate measuring device). May also be administered using a nasogastric tube or gastrostomy tube.

Tablets: Swallow tablets whole with liquid; do not chew or crush.

Parenteral: IV: Administer IV over 2 to 15 minutes; may administer undiluted or diluted with NS, LR, or D5W.

Use: Labeled Indications

Partial-onset seizures: Treatment of partial-onset seizures in patients ≥1 month of age with epilepsy as monotherapy or adjunctive therapy.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%: Nervous system: Dizziness (12%), drowsiness (≤16%), psychiatric disturbance (13%; includes psychotic and nonpsychotic), sedated state (≤16%)

1% to 10%:

Gastrointestinal: Constipation (2%), dysgeusia (≥3%), nausea (≤5%), vomiting (≤5%)

Hematologic & oncologic: Decreased white blood cell count (2%)

Local: Infusion site pain (≥3%)

Nervous system: Ataxia (≤3%), balance impairment (≤3%), euphoria (≥3%), fatigue (9%), intoxicated feeling (≥3%), irritability (3%)

Ophthalmic: Nystagmus disorder (≤3%)

<1%: Hematologic & oncologic: Decreased neutrophils

Frequency not defined:

Gastrointestinal: Decreased appetite

Nervous system: Abnormal gait, hypersomnia, lethargy, malaise, suicidal ideation, vertigo

Neuromuscular & skeletal: Asthenia

Postmarketing:

Hypersensitivity: Angioedema

Respiratory: Bronchospasm

Contraindications

Hypersensitivity to brivaracetam or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• CNS depression: May cause CNS depression (impaired coordination, ataxia, abnormal gait, dizziness and dose-related fatigue, and somnolence), which may impair physical or mental abilities. Risk is greatest early in treatment, but may occur at any time. Patients must be cautioned about performing tasks that require mental alertness (eg, operating machinery, driving).

• Hematologic effects: May cause hematologic abnormalities; significant decreased white blood cell count (<3.0 x 109/L) and decreased neutrophil count (<1.0 x 109/L) have been reported.

• Hypersensitivity: Bronchospasm and angioedema have been reported. Discontinue therapy if a hypersensitivity reaction develops. Multiorgan hypersensitivity syndrome (also known as Drug Rash Eosinophilia and Systemic Symptoms or DRESS), is a serious condition sometimes induced by antiseizure drugs. DRESS initially presents with fever and rash, then with other organ system involvement that may include eosinophilia, lymphadenopathy, hepatitis, nephritis, and/or myocarditis. If any of these hypersensitivity reactions are suspected and an alternative cause cannot be established, discontinue brivaracetam.

• Psychiatric symptoms: Psychosis, paranoia, hallucinations, and behavioral symptoms (including abnormal behavior, adjustment disorder, affect liability, aggression, agitation, altered mood, anger, anxiety, apathy, belligerence, depression, irritability, mood swings, nervousness, psychomotor hyperactivity, restlessness, and tearfulness) may occur; clinical trials reported events in 13% of adult patients receiving brivaracetam compared with 8% receiving placebo (adverse events in pediatric patients were similar to those observed in adult patients).

• Suicidal ideation: Pooled analysis of trials involving various antiseizure medications (regardless of indication) showed an increased risk of suicidal thoughts/behavior (incidence rate: 0.43% treated patients compared with 0.24% of patients receiving placebo); risk observed as early as 1 week after initiation and continued through duration of trials (most trials ≤24 weeks). Monitor all patients for notable changes in behavior that might indicate suicidal thoughts or depression; notify the health care provider immediately if symptoms occur.

Disease-related concerns:

• Hepatic impairment: Use caution in patients with hepatic impairment; dosage adjustment recommended.

• Renal impairment: Not recommended in patients with end-stage renal disease (ESRD) undergoing dialysis.

Special populations:

• CYP2C19 poor metabolizers: Poor metabolizers of CYP2C19 may require dose reduction.

Other warnings/precautions:

• Withdrawal: Antiseizure medications should not be discontinued abruptly because of the possibility of increasing seizure frequency; therapy should be withdrawn gradually to minimize the potential of increased seizure frequency, unless safety concerns require a more rapid withdrawal.

Metabolism/Transport Effects

Substrate of CYP2C19 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Alcohol (Ethyl): May enhance the CNS depressant effect of Brivaracetam. Risk C: Monitor therapy

Alizapride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Azelastine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Blonanserin: CNS Depressants may enhance the CNS depressant effect of Blonanserin. Management: Use caution if coadministering blonanserin and CNS depressants; dose reduction of the other CNS depressant may be required. Strong CNS depressants should not be coadministered with blonanserin. Risk D: Consider therapy modification

Brexanolone: CNS Depressants may enhance the CNS depressant effect of Brexanolone. Risk C: Monitor therapy

Brimonidine (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Bromopride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Bromperidol: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Buprenorphine: CNS Depressants may enhance the CNS depressant effect of Buprenorphine. Management: Consider reduced doses of other CNS depressants, and avoiding such drugs in patients at high risk of buprenorphine overuse/self-injection. Initiate buprenorphine at lower doses in patients already receiving CNS depressants. Risk D: Consider therapy modification

Cannabinoid-Containing Products: CNS Depressants may enhance the CNS depressant effect of Cannabinoid-Containing Products. Risk C: Monitor therapy

CarBAMazepine: Brivaracetam may increase serum concentrations of the active metabolite(s) of CarBAMazepine. CarBAMazepine may decrease the serum concentration of Brivaracetam. Risk C: Monitor therapy

Chlormethiazole: May enhance the CNS depressant effect of CNS Depressants. Management: Monitor closely for evidence of excessive CNS depression. The chlormethiazole labeling states that an appropriately reduced dose should be used if such a combination must be used. Risk D: Consider therapy modification

Chlorphenesin Carbamate: May enhance the adverse/toxic effect of CNS Depressants. Risk C: Monitor therapy

CNS Depressants: May enhance the adverse/toxic effect of other CNS Depressants. Risk C: Monitor therapy

CYP2C19 Inducers (Moderate): May decrease the serum concentration of Brivaracetam. Risk C: Monitor therapy

CYP2C19 Inducers (Strong): May decrease the serum concentration of Brivaracetam. Management: Increase the brivaracetam dose by up to 100% (ie, double the dose) if used with rifampin and consider the same dose adjustment if used with other strong CYP2C19 inducers. Monitor for reduced brivaracetam efficacy. Risk D: Consider therapy modification

CYP2C19 Inhibitors (Moderate): May increase the serum concentration of Brivaracetam. Risk C: Monitor therapy

CYP2C19 Inhibitors (Strong): May increase the serum concentration of Brivaracetam. Risk C: Monitor therapy

Daridorexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dose reduction of daridorexant and/or any other CNS depressant may be necessary. Use of daridorexant with alcohol is not recommended, and the use of daridorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

Desmopressin: Hyponatremia-Associated Agents may enhance the hyponatremic effect of Desmopressin. Risk C: Monitor therapy

DexmedeTOMIDine: CNS Depressants may enhance the CNS depressant effect of DexmedeTOMIDine. Management: Monitor for increased CNS depression during coadministration of dexmedetomidine and CNS depressants, and consider dose reductions of either agent to avoid excessive CNS depression. Risk D: Consider therapy modification

Difelikefalin: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Dimethindene (Topical): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Doxylamine: May enhance the CNS depressant effect of CNS Depressants. Management: The manufacturer of Diclegis (doxylamine/pyridoxine), intended for use in pregnancy, specifically states that use with other CNS depressants is not recommended. Risk C: Monitor therapy

Droperidol: May enhance the CNS depressant effect of CNS Depressants. Management: Consider dose reductions of droperidol or of other CNS agents (eg, opioids, barbiturates) with concomitant use. Risk D: Consider therapy modification

Esketamine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Flunarizine: CNS Depressants may enhance the CNS depressant effect of Flunarizine. Risk X: Avoid combination

Flunitrazepam: CNS Depressants may enhance the CNS depressant effect of Flunitrazepam. Management: Reduce the dose of CNS depressants when combined with flunitrazepam and monitor patients for evidence of CNS depression (eg, sedation, respiratory depression). Use non-CNS depressant alternatives when available. Risk D: Consider therapy modification

Fosphenytoin-Phenytoin: Brivaracetam may increase the serum concentration of Fosphenytoin-Phenytoin. Fosphenytoin-Phenytoin may decrease the serum concentration of Brivaracetam. Risk C: Monitor therapy

HydrOXYzine: May enhance the CNS depressant effect of CNS Depressants. Management: Consider a decrease in the CNS depressant dose, as appropriate, when used together with hydroxyzine. Increase monitoring of signs/symptoms of CNS depression in any patient receiving hydroxyzine together with another CNS depressant. Risk D: Consider therapy modification

Kava Kava: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Kratom: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Lemborexant: May enhance the CNS depressant effect of CNS Depressants. Management: Dosage adjustments of lemborexant and of concomitant CNS depressants may be necessary when administered together because of potentially additive CNS depressant effects. Close monitoring for CNS depressant effects is necessary. Risk D: Consider therapy modification

LevETIRAcetam: May diminish the therapeutic effect of Brivaracetam. Specifically, the therapeutic effect of brivaracetam may be diminished and/or negligible when given to patients already receiving levetiracetam. Management: Consider alternatives to the combined use of levetiracetam and brivaracetam due to an apparent lack of brivaracetam effectiveness in patients receiving levetiracetam. Risk D: Consider therapy modification

Lisuride: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Lofexidine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Lumacaftor and Ivacaftor: May decrease the serum concentration of CYP2C19 Substrates (High risk with Inducers). Risk C: Monitor therapy

Magnesium Sulfate: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Mefloquine: May diminish the therapeutic effect of Antiseizure Agents. Mefloquine may decrease the serum concentration of Antiseizure Agents. Management: Mefloquine is contraindicated for malaria prophylaxis in persons with a history of seizures. If antiseizure drugs are being used for another indication, monitor antiseizure drug concentrations and treatment response closely with concurrent use. Risk D: Consider therapy modification

Methotrimeprazine: CNS Depressants may enhance the CNS depressant effect of Methotrimeprazine. Methotrimeprazine may enhance the CNS depressant effect of CNS Depressants. Management: Reduce the usual dose of CNS depressants by 50% if starting methotrimeprazine until the dose of methotrimeprazine is stable. Monitor patient closely for evidence of CNS depression. Risk D: Consider therapy modification

Metoclopramide: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

MetyraPONE: Antiseizure Agents may diminish the diagnostic effect of MetyraPONE. Management: Consider alternatives to the use of the metyrapone test in patients taking antiseizure agents. Risk D: Consider therapy modification

MetyroSINE: CNS Depressants may enhance the sedative effect of MetyroSINE. Risk C: Monitor therapy

Mianserin: May diminish the therapeutic effect of Antiseizure Agents. Risk C: Monitor therapy

Minocycline (Systemic): May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Olopatadine (Nasal): May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Opioid Agonists: CNS Depressants may enhance the CNS depressant effect of Opioid Agonists. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Orlistat: May decrease the serum concentration of Antiseizure Agents. Risk C: Monitor therapy

Orphenadrine: CNS Depressants may enhance the CNS depressant effect of Orphenadrine. Risk X: Avoid combination

Oxomemazine: May enhance the CNS depressant effect of CNS Depressants. Risk X: Avoid combination

Oxybate Salt Products: CNS Depressants may enhance the CNS depressant effect of Oxybate Salt Products. Management: Consider alternatives to this combination when possible. If combined, dose reduction or discontinuation of one or more CNS depressants (including the oxybate salt product) should be considered. Interrupt oxybate salt treatment during short-term opioid use Risk D: Consider therapy modification

OxyCODONE: CNS Depressants may enhance the CNS depressant effect of OxyCODONE. Management: Avoid concomitant use of oxycodone and benzodiazepines or other CNS depressants when possible. These agents should only be combined if alternative treatment options are inadequate. If combined, limit the dosages and duration of each drug. Risk D: Consider therapy modification

Paraldehyde: CNS Depressants may enhance the CNS depressant effect of Paraldehyde. Risk X: Avoid combination

Perampanel: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

PHENobarbital: May decrease the serum concentration of Brivaracetam. Risk C: Monitor therapy

Piribedil: CNS Depressants may enhance the CNS depressant effect of Piribedil. Risk C: Monitor therapy

Pramipexole: CNS Depressants may enhance the sedative effect of Pramipexole. Risk C: Monitor therapy

Primidone: May decrease the serum concentration of Brivaracetam. Risk C: Monitor therapy

Procarbazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Ropeginterferon Alfa-2b: CNS Depressants may enhance the adverse/toxic effect of Ropeginterferon Alfa-2b. Specifically, the risk of neuropsychiatric adverse effects may be increased. Management: Avoid coadministration of ropeginterferon alfa-2b and other CNS depressants. If this combination cannot be avoided, monitor patients for neuropsychiatric adverse effects (eg, depression, suicidal ideation, aggression, mania). Risk D: Consider therapy modification

ROPINIRole: CNS Depressants may enhance the sedative effect of ROPINIRole. Risk C: Monitor therapy

Rotigotine: CNS Depressants may enhance the sedative effect of Rotigotine. Risk C: Monitor therapy

Rufinamide: May enhance the adverse/toxic effect of CNS Depressants. Specifically, sleepiness and dizziness may be enhanced. Risk C: Monitor therapy

Suvorexant: CNS Depressants may enhance the CNS depressant effect of Suvorexant. Management: Dose reduction of suvorexant and/or any other CNS depressant may be necessary. Use of suvorexant with alcohol is not recommended, and the use of suvorexant with any other drug to treat insomnia is not recommended. Risk D: Consider therapy modification

Thalidomide: CNS Depressants may enhance the CNS depressant effect of Thalidomide. Risk X: Avoid combination

Trimeprazine: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Valerian: May enhance the CNS depressant effect of CNS Depressants. Risk C: Monitor therapy

Zolpidem: CNS Depressants may enhance the CNS depressant effect of Zolpidem. Management: Reduce the Intermezzo brand sublingual zolpidem adult dose to 1.75 mg for men who are also receiving other CNS depressants. No such dose change is recommended for women. Avoid use with other CNS depressants at bedtime; avoid use with alcohol. Risk D: Consider therapy modification

Food Interactions

Food may delay but does not affect the extent of absorption. Management: Administer without regard to meals.

Pregnancy Considerations

Adverse events have been observed in animal reproduction studies.

Females exposed to brivaracetam during pregnancy are encouraged to enroll themselves into the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233-2334. Additional information is available at http://www.aedpregnancyregistry.org.

Breastfeeding Considerations

It is not known if brivaracetam is present in breast milk. According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Monitoring Parameters

CBC with differential, liver and renal function, and symptoms of depression and suicidality (baseline and as clinically indicated)

Mechanism of Action

The precise mechanism by which brivaracetam exerts its antiseizure activity is unknown. Brivaracetam displays a high and selective affinity for synaptic vesicle protein 2A (SV2A) in the brain, which may contribute to the antiseizure effect.

Pharmacokinetics

Absorption: Oral: Rapidly and almost completely absorbed; delayed by 3 hours with a high-fat meal

Distribution: 0.5 L/kg

Protein binding: ≤20% to plasma proteins

Metabolism: Hepatic and extrahepatic amidase mediated hydrolysis of the amide moiety to form carboxylic acid metabolite (primary route) and hydroxylation primarily by CYP2C19 to form the hydroxy metabolite (secondary route). Metabolites are inactive, including an additional hydroxy acid metabolite.

Half-life elimination: ~9 hours

Time to peak: Oral: 1 hour (fasting, range: 0.25 to 3 hours)

Excretion: Urine (>95%; <10% unchanged); feces (<1%)

Pharmacokinetics: Additional Considerations

Altered kidney function: In adult patients with creatinine clearance <30 mL/minute/1.73 m2 not requiring dialysis, plasma AUC of brivaracetam was moderately increased (21%), while the AUCs of the acid, hydroxy, and hydroxyacid metabolites were increased 3-fold, 4-fold, and 21-fold, respectively. Renal clearance of these inactive metabolites was decreased 10-fold.

Hepatic function impairment: In adult patients with hepatic cirrhosis, Child-Pugh classes A, B, and C, showed 50%, 57%, and 59% increases in brivaracetam exposure, respectively; the effect of hepatic impairment is expected to be comparable in pediatric patients.

Older adult: Plasma half-life was 7.9 hours and 9.3 hours in the 65 to 75 and >75 years of age groups, respectively. Steady-state plasma clearance was slightly lower than in younger patients.

CYP2C19 poor metabolizers: In patients possessing genetic variations in CYP2C19, production of the hydroxy metabolite is decreased 2-fold or 10-fold, and the blood level of brivaracetam itself is increased by 22% or 42%, respectively, in individuals with one or both mutated alleles.

Pricing: US

Solution (Briviact Intravenous)

50 mg/5 mL (per mL): $13.36

Solution (Briviact Oral)

10 mg/mL (per mL): $5.19

Tablets (Briviact Oral)

10 mg (per each): $25.97

25 mg (per each): $25.97

50 mg (per each): $25.97

75 mg (per each): $25.97

100 mg (per each): $25.97

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Briviact (AT, AU, BE, CH, CZ, DE, DK, EE, ES, FI, FR, GB, GR, HK, HR, IE, IL, LT, NL, NO, PL, PT, RO, SE, SK, TW)


For country code abbreviations (show table)
  1. Briviact (brivaracetam) oral and intravenous [prescribing information]. Smyrna, GA: UCB Inc; March 2022.
  2. Brivlera (brivaracetam) [product monograph]. Oakville, Ontario, Canada: UCB Canada Inc; June 2021.
Topic 106990 Version 175.0