BRIVERA TABLET 50MG

Indications

• Focal seizures with or without secondary generalization
• Refractory epilepsy

Dosage

Children: For children aged 4-17 years with body weight 50 kg and above: initially 25-50 mg twice daily, adjusted according to response; usual maintenance 50 mg twice daily (max. per dose 100 mg twice daily). For children under 50 kg: initially 0.5-1 mg/kg twice daily, adjusted according to response; usual maintenance 1 mg/kg twice daily (max. per dose 2 mg/kg twice daily).

Adults: Initially, 50 mg twice daily, adjusted according to response; usual maintenance 100 mg twice daily (max. per dose 200 mg twice daily).

Mechanism of action

Brivaracetam binds to the synaptic vesicle protein 2A (SV2A), which is thought to modulate neurotransmitter release and inhibit excessive neuronal firing, thereby reducing seizure activity.

Pharmacodynamics

Brivaracetam exhibits anticonvulsant properties through its action on SV2A, leading to a decrease in the frequency of seizures. Its efficacy has been established in clinical trials for patients with focal seizures.

Pharmacokinetics

Brivaracetam is rapidly absorbed, with peak plasma concentrations typically occurring within 1 to 2 hours after oral administration. It has a high bioavailability, and its elimination half-life is approximately 8 to 9 hours. The drug is primarily metabolized by hydrolysis and does not significantly interact with cytochrome P450 enzymes.

Adverse effects

• Anxiety
• Decreased appetite
• Constipation
• Cough
• Depression
• Dizziness
• Drowsiness
• Irritability

Interactions

• Rifampicin: Moderate (decreases exposure)
• Enzalutamide: Unknown (decreases exposure)
• St. John's Wort: Unknown (decreases exposure)

Precautions

• Caution in hepatic impairment (risk of increased exposure)
• Avoid abrupt withdrawal-reduce daily dose gradually

Pregnancy

Manufacturer advises to avoid unless potential benefit outweighs risk-limited information available.

Breast-feeding

Manufacturer advises to avoid-present in milk in animal studies.

Storage

Store at room temperature. Protect from light.

Formulations

• Brivaracetam 10 mg per 1 ml oral solution
• Brivaracetam 25 mg tablets
• Brivaracetam 50 mg tablets
• Brivaracetam 75 mg tablets

Mechanism of action

The precise mechanism of brivaracetam's anti-epileptogenic activity is unknown.

Pharmacodynamics

Brivaracetam binds SV2A with high affinity. SV2A is known to play a role in epileptogenesis through modulation of synaptic GABA release. It is thought that brivaracetam exerts its anti-epileptogenic effects through its binding to SV2A. Brivaracetam is also known to inhibit Na+ channels which may also contribute to its anti-epileptogenic action.