BRIVIACT® (brivaracetam) CV is indicated for the treatment of partial-onset seizures in patients 4 years of age and older.

As the safety of BRIVIACT injection in pediatric patients has not been established, BRIVIACT injection is indicated for the treatment of partial-onset seizures only in adult patients (16 years of age and older).

Approved For Pediatric Patients (4 Years of Age and Older)

BRIVIACT® (brivaracetam) CV is indicated for the treatment of partial-onset seizures in patients 4 years of age and older.

As the safety of BRIVIACT injection in pediatric patients has not been established, BRIVIACT injection is indicated for the treatment of partial-onset seizures only in adult patients (16 years of age and older).

Approved For Pediatric Patients (4 Years of Age and Older)

Dosing

Dosing

BRIVIACT® offers a therapeutic dose on DAY ONE

The recommended starting dose for monotherapy and adjunctive therapy is 50 mg twice daily (100 mg/day) and is initiated without titration1

BRIVIACT® (brivaracetam) CV Dosing Graphic

Gradual dose escalation is not required with BRIVIACT

  • Based on individual patient response, the dose may be adjusted between 25 mg twice daily (50 mg/day) and 100 mg twice daily (200 mg/day)
  • Avoid abrupt withdrawal from BRIVIACT in order to minimize the risk of increased seizure frequency and status epilepticus

Dosing in specific populations

  • For all stages of hepatic impairment, the recommended starting dosage is 25 mg twice daily (50 mg/day) and the recommended maximum dosage is 75 mg twice daily (150 mg/day)
  • Dose adjustments are not required for patients with impaired renal function; there are no data in patients with end-stage renal disease undergoing dialysis, and use of BRIVIACT is not recommended in this patient population

BRIVIACT® is available in multiple formulations, allowing for dosing flexibility

Considerations for tablets and oral solution1

  • BRIVIACT can be given with or without food
  • Tablets should be swallowed whole with liquid; they should not be chewed or crushed; tablets are not scored

Considerations for intravenous (IV) use*1

BRIVIACT injection may be used when oral administration is temporarily not feasible.

Preparation

  • BRIVIACT injection can be administered intravenously without further dilution or may be mixed with diluents listed below:
    • 0.9% sodium chloride injection, USP
    • Lactated Ringer's injection
    • 5% dextrose injection, USP

Administration

  • BRIVIACT injection should be administered intravenously over 2 to 15 minutes

Adverse reactions with BRIVIACT injection are generally similar to those observed with BRIVIACT tablets and also include dysgeusia, euphoric mood, feeling drunk, and infusion site pain.

BRIVIACT® (brivaracetam) CV Multiple Formulations

10-mg tablets are available for down titration.


Blood levels1

  • No blood-level monitoring required

Pharmacokinetic profile1

  • Approximately 100% oral bioavailability
  • Linear pharmacokinetics
  • The half-life (t1/2) is approximately 9 hours, steady-state reached after 2 days
  • BRIVIACT is weakly bound (≤20%) to plasma proteins
  • No pharmacologically active metabolites
  • *Clinical study experience limited to 4 consecutive days of treatment.
Dosing

Important Safety Information

WARNINGS AND PRECAUTIONS

  • Suicidal Behavior and Ideation: Antiepileptic drugs, including BRIVIACT, increase the risk of suicidal behavior and ideation. Monitor patients taking BRIVIACT for the emergence or worsening of depression; unusual changes in mood or behavior; or suicidal thoughts, behavior, or self-harm. Advise patients, their caregivers, and/or families to be alert for these behavioral changes and report them immediately to a healthcare provider.
  • Neurological Adverse Reactions: BRIVIACT causes somnolence, fatigue, dizziness, and disturbance in coordination. Somnolence and fatigue-related adverse reactions were reported in 25% of adult patients taking at least 50 mg per day of BRIVIACT compared to 14% of adult patients taking placebo. Dizziness and disturbance in gait and coordination were reported in 16% of adult patients taking at least 50 mg per day of BRIVIACT compared to 10% of adult patients taking placebo. The risk is greatest early in treatment but can occur at any time. Monitor patients for these signs and symptoms and advise them not to drive or operate machinery until they have gained sufficient experience on BRIVIACT.
  • Psychiatric Adverse Reactions: BRIVIACT causes psychiatric adverse reactions, including non-psychotic and psychotic symptoms. These events were reported in approximately 13% of adult patients taking at least 50 mg per day of BRIVIACT compared to 8% of adult patients taking placebo. A total of 1.7% of adult patients taking BRIVIACT discontinued treatment due to psychiatric reactions compared to 1.3% of patients taking placebo. Psychiatric adverse reactions were also observed in open-label pediatric trials and were generally similar to those observed in adults. Advise patients to report these symptoms immediately to a healthcare provider.
  • Hypersensitivity: BRIVIACT can cause hypersensitivity reactions. Bronchospasm and angioedema have been reported. Discontinue BRIVIACT if a patient develops a hypersensitivity reaction after treatment. BRIVIACT is contraindicated in patients with a prior hypersensitivity reaction to brivaracetam or any of the inactive ingredients.
  • Withdrawal of Antiepileptic Drugs: As with all antiepileptic drugs, BRIVIACT should generally be withdrawn gradually because of the risk of increased seizure frequency and status epilepticus.

DOSING CONSIDERATIONS

  • Dose adjustments are recommended for patients with all stages of hepatic impairment.
  • When BRIVIACT is co-administered with rifampin, an increase in the BRIVIACT dose is recommended.

ADVERSE REACTIONS

In adult adjunctive therapy placebo-controlled clinical trials, the most common adverse reactions (at least 5% for BRIVIACT and at least 2% more frequently than placebo) were somnolence and sedation, dizziness, fatigue, and nausea and vomiting symptoms. Adverse reactions reported in clinical studies of pediatric patients 4 years to less than 16 years of age were generally similar to those in adult patients.

BRIVIACT is a Schedule V controlled substance.

Please see full Prescribing Information.

To report suspected adverse reactions, contact UCB, Inc. at UCBCares® (1-844-599-2273) or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

References

  1. BRIVIACT (brivaracetam): US prescribing information. Smyrna (GA): UCB, Inc., May 2018.
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  3. Data on file. UCB, Inc.
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  5. Klitgaard H, Matagne A, Nicolas JM, et al. Brivaracetam: Rationale for discovery and preclinical profile of selective SV2A ligand for epilepsy treatment. Epilepsia. 2016;57(4):538-548.
  6. Noyer M, Gillard M, Matagne A, Hénichart J-P, Wülfert E. The novel antiepileptic drug levetiracetam (ucb L059) appears to act via a specific binding site in CNS membranes. Eur J Pharmacol. 1995;286;137-146.
  7. Yan HD, Ishihara K, Seki T, et al. Inhibitory effects of levetiracetam on the high-voltage-activated L-type Ca2+ channels in hippocampal CA3 neurons of spontaneously epileptic rat (SER). Brain Res Bull. 2013;90:142-148.
  8. Niespodziany I, Klitgaard H, Margineanu DG. Levetiracetam inhibits the high-voltage-activated Ca(2+) current in pyramidal neurons of rat hippocampal slices. Neurosci Lett. 2001;306(1-2):5-8.
  9. Lukyanetz EA, Shkryl VM, Kostyuk PG. Selective blockade of N-type calcium channels by levetiracetam. Epilepsia. 2002;43(1):9-18.
  10. Carunchio I, Pieri M, Ciotti MT, Albo F, Zona C. Modulation of AMPA receptors in cultured cortical neurons induced by the antiepileptic drug levetiracetam. Epilepsia. 2007;48(4):654-662.
  11. Rigo JM, Nguyen L, Hans G, et al. UCB 34714: effect on inhibitory and excitatory neurotransmission. Epilepsia. 2004;45(3):56.
  12. PARx Solutions, Inc., November 2017.
  13. CoverMyMeds, LLC, December 2017.
  14. CoverMyMeds. CoverMyMeds website: https://www.covermymeds.com/main/. Accessed October 9, 2017.