Brivaracetam ( UCB 34714; Briviact ) is an add-on treatment for adult patients with partial seizures. Similar to Levetiracetam ( Keppra ), Brivaracetam acts as a high-affinity ligand of the synaptic vesicle protein 2A, however, it has been shown to be 10- to 30-fold more potent than Levetiracetam.
Moreover, Brivaracetam does not share the Levetiracetam inhibitory activity on the high voltage Ca(2+) channels and AMPA receptors, and it has been reported to act as a partial antagonist on neuronal voltage-gated sodium channels.
The pharmacokinetic profile of Brivaracetam is favorable and linear, and it undergoes an extensive metabolism into inactive compounds, mainly through the hydrolysis of its acetamide group.
Furthermore, it does not significantly interact with other antiepileptic drugs and more than 95% is excreted through the urine, with an unchanged fraction of 8-11%.
Brivaracetam has a half-life of approximately 8-9 hours and it is usually given twice daily.
To date, a wide range of experimental studies have reported the effectiveness of Brivaracetam with regards to partial and generalized seizures. In humans, six randomized, placebo-controlled trials and two meta-analyses highlighted the efficacy, or good tolerability, of Brivaracetam as an add-on treatment for patients with uncontrolled partial seizures.
A wide dose range of Brivaracetam has been evaluated in those trials ( 5-200 mg ), but the most suitable for clinical use appears to be 50-100 mg/day.
The most common adverse reactions to Brivaracetam are mild to moderate, transient, often improve during the course of the treatment, and mainly consist of central nervous system symptoms, such as fatigue, dizziness, and somnolence. ( Xagena )
Ferlazzo E et al, Neuropsychiatr Dis Treat 2015;11: 2967-2973