Brivaracetam

Actions

• Binds to the synaptic vesicle glycoprotein SV2A and inhibits presynaptic Ca++ channels reducing neurotransmitter release.

Metabolism

Hepatic

Enzymes involved

• CYP3A4
• CYP2B6
• CYP2C8
• CYP2C19

Elimination

Renal >95%

Half-life

7-8 hours

Binding to plasma proteins

<20%

Important side-effects

Suicidal behaviour and ideation.

Indications

Adjunctive therapy in the treatment of focal seizures.

Dosing recommendation

Start with 50 mg twice daily.

Increase after efficacy and tolerance up to 100 mg twice daily.

Target dose is 50-100 mg/day divided in 2 doses.

Renal impairment

No dose adjustment is necessary in patients with mild to moderate renal impairment. Insufficient data exist on the safety of brivaracetam in dialysis patients therefore its use is not recommended.

Hepatic impairment

Dose reduction is recommended in patients with hepatic impairment. The maximal dose in such patients should not exceed 150mg/day.