Brivaracetam's primary indication
Brivaracetam, marketed under the brand name Briviact, is an antiepileptic drug (AED) specifically approved for the treatment of partial-onset seizures. These seizures originate in one area of the brain but can sometimes spread to other areas. It is indicated for use in adults and children one month of age and older.
Adjunctive and monotherapy uses
Initially approved for adjunctive therapy (use with other AEDs), brivaracetam received expanded FDA approval for monotherapy (use alone) in adults and older children with partial-onset seizures. This makes it a flexible treatment option for epilepsy management, either as the sole medication or as a supplement to a patient’s existing regimen to achieve better seizure control.
How brivaracetam works
The precise mechanism of action for brivaracetam is not fully understood, but it is known to exert its effects primarily by binding with high affinity to the synaptic vesicle protein 2A (SV2A) in the brain. SV2A is a protein involved in the release of neurotransmitters, the chemical messengers that allow nerve cells to communicate. By binding to this protein, brivaracetam modulates the abnormal, excessive electrical activity in the brain that causes seizures. This targeted action helps to stabilize electrical signaling and reduce the likelihood of a seizure occurring. The drug's affinity for SV2A is significantly higher than that of its related precursor, levetiracetam.
Drug interactions and metabolism
Brivaracetam is metabolized mainly by hydrolysis and, to a lesser extent, by the liver enzyme CYP2C19. This metabolic pathway is important because co-administration with other drugs can influence brivaracetam's effectiveness. For instance, strong liver enzyme inducers like rifampin can significantly decrease brivaracetam levels, requiring a potential dosage adjustment. Conversely, patients with reduced CYP2C19 function, known as "poor metabolizers," may experience increased brivaracetam exposure and potentially a greater risk of adverse effects. Healthcare providers carefully monitor these interactions to adjust dosages as needed.
Dosage and administration
Brivaracetam is typically taken with or without food. It is available in multiple forms to accommodate different patient needs:
- Tablets: For oral administration. They should be swallowed whole and not crushed or chewed.
- Oral Solution: A liquid formulation for patients who cannot swallow tablets. A calibrated measuring device should be used for accurate dosing.
- Intravenous (IV) Injection: Used when oral administration is not possible for a short period. This is typically limited to four consecutive days of treatment.
The appropriate dosage is determined by a healthcare provider based on factors such as age, weight, and individual response. Unlike some other AEDs, brivaracetam generally does not require a long dose-escalation period, allowing for a faster transition to a therapeutic approach.
Potential side effects and warnings
Like all medications, brivaracetam carries a risk of side effects. Common adverse effects include:
- Drowsiness or sedation
- Dizziness
- Fatigue
- Nausea and vomiting
More serious side effects can also occur, and patients should be monitored carefully for:
- Neurological issues: Problems with balance and coordination.
- Psychiatric symptoms: Mood and behavior changes, including anxiety, depression, agitation, and aggression. There is also a risk of suicidal thoughts or actions, a warning common to many AEDs.
- Hypersensitivity reactions: Allergic reactions like bronchospasm (wheezing, difficulty breathing) or angioedema (swelling of the face, tongue, or throat) can occur.
Brivaracetam is also a Schedule V controlled substance in the United States due to a low but present potential for abuse and dependence, especially at higher doses.
Brivaracetam vs. Levetiracetam
Brivaracetam is structurally related to levetiracetam (Keppra), another widely used AED that also targets the SV2A protein. However, there are key differences that can influence a doctor's prescribing decision.
| Feature | Brivaracetam (Briviact) | Levetiracetam (Keppra) |
|---|---|---|
| SV2A Binding | Higher affinity and selectivity for SV2A. | Lower affinity for SV2A. |
| Neuropsychiatric Side Effects | Appears to have a more favorable profile, with less common behavioral adverse events like irritability and agitation. | Higher incidence of neuropsychiatric side effects, which is a common reason for switching to brivaracetam. |
| Controlled Substance | Yes, Schedule V controlled substance. | No. |
| Generic Availability | No, currently only available as the brand name Briviact. | Yes, available in generic form. |
| Administration Frequency | Typically twice daily for most formulations. | Typically twice daily for immediate-release, once daily for extended-release. |
For patients who experience intolerable behavioral side effects with levetiracetam, switching to brivaracetam can provide an effective alternative with a better-tolerated psychiatric profile.
Conclusion
In summary, brivaracetam is a modern anti-epileptic drug primarily used for treating partial-onset seizures in adults and children aged one month and older. It can be used alone or in conjunction with other medications to help control seizure frequency. Its mechanism of action, involving high-affinity binding to the SV2A protein, allows it to effectively regulate abnormal brain activity. While generally well-tolerated, it is associated with common side effects such as drowsiness and dizziness, and more serious risks like psychiatric and hypersensitivity reactions. As a Schedule V controlled substance, its use requires careful medical oversight. For many patients, particularly those who experience neuropsychiatric side effects with related drugs like levetiracetam, brivaracetam represents a valuable and effective treatment option for improving seizure control and quality of life.
Disclaimer: This information is for general knowledge and should not be taken as medical advice. Consult with a healthcare professional before starting any new supplement regimen or medication.
