Brivaracetam

Brivaracetam is an anticonvulsant medication used as adjunctive therapy for partial-onset seizures in adults with epilepsy. It is a structural analogue of levetiracetam and binds selectively to synaptic vesicle protein 2A (SV2A) with high affinity, modulating neurotransmitter release in a way that helps reduce seizure activity. The exact mechanism is similar to that of levetiracetam but with greater SV2A affinity, which can translate to potent anticonvulsant effects with a distinct pharmacological profile.

Brivaracetam is marketed under the brand name Briviact by UCB and is approved in many regions for adjunctive treatment of partial-onset seizures. In addition to adults, some jurisdictions have granted approval for pediatric patients, with age ranges varying by country.

Pharmacokinetics and metabolism are characterized by rapid oral absorption and relatively high bioavailability. The drug is primarily excreted as metabolites after renal processing and has a simplified metabolic pathway with limited involvement of major hepatic enzymes, contributing to a low potential for drug–drug interactions. The elimination half-life is typically in the range of several hours, supporting twice-daily dosing in many regimens. Dose adjustments are often recommended for significant renal impairment; hepatic impairment generally does not require major dosing changes, though clinical monitoring is advised.

Dosing commonly involves tablets (for example, 50 mg and 100 mg strengths) and an oral solution. The typical titration starts at 50 mg twice daily, with potential increases to 100 mg twice daily as needed, up to a maximum of about 200 mg per day.

Common adverse effects include somnolence, dizziness, fatigue, and nausea, with mood changes such as irritability or agitation reported in some patients. Serious adverse events are rare but can include hypersensitivity reactions and behavioral changes; as with other antiepileptic drugs, monitoring for suicidality and mood disorders is advised.