Names and pronunciation
(briv-a-ra′se-tam) Briviact
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Drug reference
(briv-a-ra′se-tam) Briviact
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Func. class.: Anticonvulsant Controlled Substance V
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ACTION: The exact mechanism is not known, may occur in modulation of syn- aptic vesicle proteins; additional anticon- vulsant activity may be related to the modulation of voltage-dependent sodium channels
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USES: For the adjunctive treatment of partial seizures
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CONTRAINDICATIONS: Hyper- B sensitivity Precautions: Abrupt discontinuation, breastfeeding, depression, driving or oper- ating machinery, geriatric patients, hepatic disease, pregnancy, suicidal ideation
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SIDE EFFECTS CNS: Dizziness, drowsiness, ataxia, euphoria, fatigue, irritability, depression, emotional lability, hallucinations, psy- chosis, suicidal ideation GI: Constipation, nausea, vomiting HEMA: Leukopenia INTEG: Angioedema, infusion site pain RESP: Bronchospasm
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INTERACTIONS Increase: sedation—TCAs, antihistamines, benzodiazepines, other CNS depressants Increase: possible toxicity—car BAMazepine Decrease: brivaracetam absorption— sevelamer Drug/Lab Test: Increase: LFTs Decrease: Hct/HB, WBC, RBC
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DOSAGE AND ROUTES • Adult/adolescent ≥16: PO/IV 50 mg bid. Adjust dose to 25 mg bid or 100 mg bid based on clinical response; max 100 mg bid. Use IV when PO is temporarily not feasible • Child/adolescent 4-15 yr and ≥50 kg: PO 25-50 mg bid. Child maintenance dos- ing for 20-49 kg is 0.5–2 mg/kg/dose twice daily. Initial dosing as listed is correct. Child maintenance dosing for 11–19 kg is 0.5–2.5 mg/kg/dose twice daily. Initial dos- ing should be 0.5–1.25 mg/kg/dose twice daily. • Child/adolescent 4-15 yr and 20-49 kg: PO 0.5-1 mg/kg/dose bid; mainte- nance 0.5–2mg/kg/dose twice daily • Child/adolescent 4-12 yr and 11-19 kg: PO 0.5-1.25 mg/kg/dose bid; maintenance 0.5–2.5mg/kg/dose twice daily; max 5 mg/kg/day With rifampin use: Adult/child: In- crease brivaractan by up to double dose
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Available forms: • Tablets 10, 25, 50, 75, 100; oral solu- tion 10 mg/mL; solution for injection 50 mg/5 mL (10 mg/mL), single-dose vial
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Administer: • May be administered without regard to meals • To discontinue, gradually reduce the dose to minimize the risk for increased seizure frequency and status epilepticus Tablets: • Swallow tablets whole; do not crush or chew Oral solution: • No dilution is necessary • Measure and administer oral solution using a calibrated measuring device • A nasogastric tube or gastrostomy tube may be used for administration • Storage: discard any unused solution 5 mo after first opening the bottle IV screens • Visually inspect, do not use if discolor- ation or particulate matter is present; injection is a clear, colorless solution • May be given IV without further dilu- tion or may be mixed with a diluent, in- cluding 0.9% NaCl injection, LR injec- tion, or D5 injection • Infuse over 2 to 15 min • Storage: after dilution, the solution may be stored ≤4 hr at room temperature and may be stored in polyvinyl chloride (PVC) bags; discard any unused injection vial contents; for single dose only
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Assess: • Seizures: type, location, duration, character; provide seizure precautions • Renal studies: urinalysis, BUN, urine creatinine q3mo • Blood studies: CBC, LFTs • Mental status: mood, sensorium, affect, behavioral changes, suicidal thoughts/behaviors; if mental status changes, notify prescriber • Assistance with ambulation during early part of treatment; dizziness, drowsi- ness occurs, sedation • Hypersensitivity: Angioedema, product should be discontinued immediately, treat • DRESS: Rash, hepatitis, fever, eosino- philia, discontinue immediately, treat • Pregnancy/breastfeeding: use only if benefits outweigh fetal risk; pregnant pa- tients should be registered at the North American Antiepileptic Drug Pregnancy Reg- istry (888-233-2334); discontinue breast- feeding or product; excretion is unknown
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Evaluate: • Therapeutic response: decreased sei- zure activity
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To carry emergency ID stating patient’s name, medications taken, condition, pre- scriber’s name and phone number • How to use oral solution, use cali- brated device to measure • To notify prescriber if pregnancy is planned or suspected • To avoid driving, other activities requiring alertness until response is known; drowsi- ness occurs when beginning therapy • To obtain medical care immediately for angioedema, bronchospasm • Not to discontinue quickly after long-term use; withdrawal seizure may occur; date bottle, throw away oral solution after 5 mo • Not to breastfeed; to notify prescriber immediately if pregnancy is planned or suspected • To report immediately suicidal thoughts/ behaviors, psychotic symptoms (halluci- nation, delusions, or unusual behaviors)
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PHARMACOKINETICS Protein binding 20%, primarily metab- olized by hydrolysis to form a hydroxy metabolite, metabolized by CYP2C19, excreted in urine, feces <1%, half-life 9 hr, all forms may be used inter- changeably, peak 1 hr without food, high-fat meal slows absorption
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• Adult/adolescent ≥16: PO/IV 50 mg bid. Adjust dose to 25 mg bid or 100 mg bid based on clinical response; max 100 mg bid. Use IV when PO is temporarily not feasible
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