Brivaracetam
BRIVIACT
Pronunciation: briv-a-RA-se-tam
“Brave act (in a) Brave race”
What it isSV2A ligand with higher affinity than levetiracetam; focal seizures.
Why this oneLess irritability and mood disturbance than levetiracetam, which is the usual reason to switch.
What limits itSedation and dizziness. CYP2C19 variation affects exposure; Schedule V.
FDA-approved for
- partial-onset seizures (2016)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Partial-onset seizures (monotherapy or adjunctive) | Adults & peds ≥16 yr | 50 mg BID | 25–100 mg BID | 100 mg BID (200 mg/day) |
| Partial-onset seizures | Peds 1 mo–<16 yr, weight-based | Weight-based BID (e.g. 0.5–1.5 mg/kg BID) | 0.5–3 mg/kg BID by weight | Up to 3 mg/kg BID (<11 kg) |
Renal No adjustment needed; not recommended in ESRD/dialysis
Hepatic Reduce dose for all stages (adults: start 25 mg BID, max 75 mg BID)
Instructions
- Swallow tablets whole with liquid; do not chew or crush
- May take with or without food
- Avoid abrupt withdrawal — taper to reduce seizure/status epilepticus risk
- IV injection over 2–15 min when oral temporarily not feasible; same dose and frequency
- Double the dose with concomitant rifampin
Available strengths
- tab 10, 25, 50, 75, 100 mg
- sol 10 mg/mL
- inj 50 mg/5 mL
Cautions
- Suicidal behavior and ideation
- Somnolence, fatigue, dizziness, and coordination disturbance
- Psychiatric reactions (psychosis, irritability, aggression, depression, anxiety)
- Hypersensitivity: bronchospasm and angioedema
- Serious dermatologic reactions (SJS, TEN)
Adverse reactions
- Somnolence/sedation
- Dizziness
- Fatigue
- Nausea/vomiting
Pregnancy Insufficient human data; developmental toxicity in animals. Pregnancy registry available (1-888-233-2334)
Lactation Present in human milk; insufficient data on effects
Cost
| Strength | #/mo | generic $ | brand $ | CostPlus | |
|---|---|---|---|---|---|
| 10 mg | tab | 60 BID | — | $1,439.19/mo | not offered |
| 25 mg | tab | 60 BID | $13.34/mo | — | not offered |
| 50 mg | tab | 60 BID | $11.33/mo | — | not offered |
| 75 mg | tab | 60 BID | $15.96/mo | — | not offered |
| 100 mg | tab | 60 BID | $15.52/mo | — | not offered |
| 10 mg/mL | sol | per unit | $0.27/mL | — | not offered |
| 50 mg/5 mL | inj | per unit | — | not offered |
Generic entry2025
NO BOXED WARNINGS
Principal riskSedation and dizziness
Classes and tags
Clinical profile
Legacy pregnancy categoryNot assigned — PLLR-era drug
Defining liabilitySomnolence and behavioral adverse effects; misuse potential is lower than many sedatives but not absent.
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