Nurses Compass
Drug Guide
Brivaracetam
Classification
Therapeutic: Anticonvulsant/Antiepileptic
Pharmacological: Selective SV2A protein ligand
FDA Approved Indications
- Partial-onset seizures in patients 16 years of age and older
Mechanism of Action
Brivaracetam binds selectively to synaptic vesicle protein 2A (SV2A), modulating neurotransmitter release and reducing neuronal excitability, thus preventing seizures.
Dosage and Administration
Adult: Start with 50 mg twice daily; titrate gradually to a target dose of 100 mg twice daily based on response and tolerability.
Pediatric: Not approved for pediatric use; consult latest guidelines for off-label considerations.
Geriatric: Adjust dose based on renal function; start at lower end of dosing range.
Renal Impairment: Reduce dose or extend dosing interval in patients with moderate to severe impairment.
Hepatic Impairment: Use with caution; no specific adjustment recommended in mild hepatic impairment.
Pharmacokinetics
Absorption: Rapid, complete absorption after oral administration.
Distribution: Widely distributed; approximately 20% protein bound.
Metabolism: Primarily metabolized via hydrolysis and minor oxidative metabolism; extensive phase I and phase II metabolism.
Excretion: Excreted mainly in urine as metabolites; minimal unchanged drug.
Half Life: Approximately 9 hours.
Contraindications
- Hypersensitivity to brivaracetam or any component of the formulation.
Precautions
- Use cautiously in patients with psychiatric history; potential for mood changes and behavioral abnormalities.
Adverse Reactions - Common
- Dizziness (>10%)
- Somnolence (>10%)
- Fatigue (>10%)
Adverse Reactions - Serious
- Suicidal thoughts or behavior (Less common)
- Allergic reactions including rash, angioedema (Rare)
Drug-Drug Interactions
- Other CNS depressants (additive sedation)
- Medicines that alter hepatic enzyme activity (may affect brivaracetam levels)
Drug-Food Interactions
N/ADrug-Herb Interactions
N/ANursing Implications
Assessment: Monitor for seizure control, behavioral changes, and adverse reactions.
Diagnoses:
- Risk for injury due to dizziness or somnolence
- Risk for mood disturbance or behavioral changes
Implementation: Administer consistently, monitor renal function, and assess for side effects.
Evaluation: Evaluate seizure frequency and severity, behavioral status, and tolerability.
Patient/Family Teaching
- Do not stop medication abruptly.
- Report mood changes or suicidal thoughts.
- Avoid alcohol and CNS depressants unless approved by healthcare provider.
Special Considerations
Black Box Warnings:
- None specified for brivaracetam.
Genetic Factors: None specifically noted.
Lab Test Interference: None known.
Overdose Management
Signs/Symptoms: Dizziness, somnolence, sedation, agitation, ataxia, nystagmus.
Treatment: Supportive care, stabilization of airway, breathing, and circulation; activated charcoal if within appropriate time window; hemodialysis in severe cases.
Storage and Handling
Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).
Stability: Stable up to the expiration date when stored properly.