Brivaracetam is an analogue of
levetiracetam that is Food and Drug Administration-approved for adjunctive treatment of partial-onset
seizures in patients 16 years and older. In placebo-controlled trials adjunct
brivaracetam demonstrated efficacy in reducing the frequency of
seizures. The most commonly reported adverse effects are
somnolence,
dizziness, and
fatigue. Clinical trials have evaluated
brivaracetam for safety and efficacy in adjunctive treatment of partial-onset
seizures in patients 16 years and older for up to 16 weeks.
Brivaracetam's mechanism is similar to that of
levetiracetam but with greater receptor binding affinity on synaptic vesicle
protein 2A and inhibitory effects on
sodium channels. Clinically significant differences between these agents are undetermined.
Brivaracetam is available as oral
tablets, oral
solution, and intravenous
solution. The Food and Drug Administration-approved dose is 50 mg twice daily, and titration is not required.
Brivaracetam does not need dose adjustment for renal impairment and has minimal
drug-drug interactions. Current limitations of
brivaracetam include lack of head-to-head trials, limited long-term safety and efficacy data, and cost. Overall,
brivaracetam is a viable adjunct therapeutic option for refractory partial-onset
seizures in those who have failed conventional
therapies.