Drug reference
Adjunctive therapy of focal seizures with or without secondary generalisation ▶BY MOUTH, OR BY INTRAVENOUS INJECTION, OR BY INTRAVENOUS INFUSION ▶Adult: Initially 25–50 mg twice daily, adjusted according to response; usual maintenance 25–100 mg twice daily (max. per dose 100 mg twice daily)
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Manufacturer advises if switching between oral therapy and intravenous therapy (for those temporarily unable to take oral medication), the total daily dose and the frequency of administration should be maintained.
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Scottish Medicines Consortium (SMC) decisions SMC No. 1160/16 The Scottish Medicines Consortium has advised (July 2016) that brivaracetam (Briviact ®) is accepted for restricted use within NHS Scotland as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in patients from 16 years of age with refractory epilepsy. Treatment should be initiated by physicians who have appropriate experience in the treatment of epilepsy. All Wales Medicines Strategy Group (AWMSG) decisions AWMSG No. 3387 The All Wales Medicines Strategy Group has advised Nervous system (December 2018) that brivaracetam (Briviact ®) is recommended as an option for restricted use within NHS Wales. Brivaracetam (Briviact ®) should be restricted for use in the treatment of patients with refractory epilepsy, who remain uncontrolled with, or are intolerant to, other adjunctive anti-epileptic medicines, within its licensed indication as adjunctive therapy in the treatment of partial-onset seizures with or without secondary generalisation in patients from 4 years of age with epilepsy. Brivaracetam (Briviact ®) is not recommended for use within NHS Wales outside of this subpopulation.
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→Appendix 1: antiepileptics
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▶Common or very common Anxiety. appetite decreased. constipation. cough. depression. dizziness. drowsiness. fatigue. increased risk of infection. insomnia. irritability. nausea. vertigo. vomiting ▶Uncommon Aggression. psychotic disorder
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Manufacturer advises avoid unless potential benefit outweighs risk—limited information available. See also Pregnancy in Epilepsy p. 321.
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Manufacturer advises avoid—present in milk in animal studies.
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Manufacturer advises caution (risk of increased exposure). Dose adjustments Manufacturer advises consider initial dose of 25 mg twice daily; max. maintenance dose of 75 mg twice daily (limited information available).
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▶With intravenous use For intermittent intravenous infusion, manufacturer advises dilute in Glucose 5% or Sodium Chloride 0.9% or Lactated Ringer’s solution; give over 15 minutes. ▶With oral use Manufacturer advises oral solution can be diluted in water or juice shortly before swallowing.
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There can be variation in the licensing of different medicines containing the same drug. Solution for injection CAUTIONARY AND ADVISORY LABELS 2 ELECTROLYTES: May contain Sodium ▶Briviact (UCB Pharma Ltd) A Brivaracetam 10 mg per 1 ml Briviact 50mg/5ml solution for injection vials | 10 vial P £222.75 Oral solution CAUTIONARY AND ADVISORY LABELS 2, 8 EXCIPIENTS: May contain Sorbitol ELECTROLYTES: May contain Sodium ▶Briviact (UCB Pharma Ltd) A Brivaracetam 10 mg per 1 ml Briviact 10mg/ml oral solution sugar- free | 300 ml P £115.83 DT = £115.83 Tablet CAUTIONARY AND ADVISORY LABELS 2, 8, 25 ▶Briviact (UCB Pharma Ltd) A Brivaracetam 10 mg Briviact 10mg tablets | 14 tablet P £34.64 DT = £34.64 Brivaracetam 25 mg Briviact 25mg tablets | 56 tablet P £129.64 DT = £129.64 Brivaracetam 50 mg Briviact 50mg tablets | 56 tablet P £129.64 DT = £129.64 Brivaracetam 75 mg Briviact 75mg tablets | 56 tablet P £129.64 DT = £129.64 Brivaracetam 100 mg Briviact 100mg tablets | 56 tablet P £129.64 DT = £129.64
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Manufacturer advises avoid abrupt withdrawal—reduce daily dose in steps of 50 mg at weekly intervals, then reduce to 20 mg daily for a final week.
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Missed doses Manufacturer advises if one or more doses are missed, a single dose should be taken as soon as possible and the next dose should be taken at the usual time. Driving and skilled tasks Manufacturer advises patients and carers should be cautioned on the effects on driving and performance of skilled tasks—increased risk of dizziness.
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Initially 25–50 mg twice daily, adjusted
First-line fragment. Read the complete Indications and Dose section above.
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