BRIVARACETAM:
Brivaracetam is an Antiepileptic medication primarily used to treat epilepsy.
What is Brivaracetam used for?
- Partial onset seizures.
- Status epilepticus, refractory.
What is Brivaracetam available as?
- Tablet.
- Syrup.
- Injection.
BRIVARACETAM VS LEVETIRACETAM
Brivaracetam and levetiracetam are both anticonvulsant medications used to treat epilepsy, and they are quite similar in their mechanisms of action. However, they have differences in terms of effectiveness, side effects, and individual response. Whether one is “better” than the other depends on individual needs, tolerability, and specific circumstances.
Ultimately, the choice between brivaracetam and levetiracetam should be made with the guidance of doctor, who will consider factors like seizure type, previous medication response, side effects, and convenience.
Why is brivaracetam a controlled substance?
Brivaracetam is a controlled substance in America, due to its potential for abuse or dependence and is available only with a prescription. Keep it secure to prevent misuse.
How does Brivaracetam act (mechanism of action)?
Brivaracetam works by stabilizing electrical activity in the brain to reduce the frequency and severity of seizures. (It acts on synaptic vesicle protein 2A (SV2A) in the brain.)
How much time does Brivaracetam take to act?
Brivaracetam begins to take effect quickly when taken orally, peak plasma time 1 hour without food, slower absorption with a high fat meal.
For intravenous (IV) administration, Brivaracetam acts more rapidly, often showing effects within minutes to an hour, as the drug directly enters the bloodstream.
However, it may take several days or weeks to notice improvements in seizure control, depending on dosage, frequency, and individual response.
Why is Brivaracetam important for you/your child’s treatment?
It is important that you/your child (4-18years) takes Brivaracetam regularly to decrease the number of seizures or have no Seizures at all.
Do not stop taking brivaracetam suddenly, as it may lead to increase in number of seizures.
What is the ideal time to take Brivaracetam?
Twice a day; morning and evening. Ideally, 10-12 hours apart.
For example, anytime between 7 to 8 am and right after 12 hours between 7 to 8 pm. You can adjust the time slot according to your schedule.
However, there are some exceptions when your doctor may advise to give it thrice a day. Please follow your doctor’s instructions in such case.
It should ideally be given at the same time every day to establish a routine as it minimizes the chances of missing a dose.
What if I miss the dose?
If you remember to give it within a lapse of 6 hours, the child can be given the missed dose. If you fail to give the missed dose within 6 hours, then might as well leave it. It is advisable to wait until the time of next routine dose.
NEVER GIVE A DOUBLE DOSE OF BRIVARACETAM.
If your child vomits the contents of medicine within 30 minutes of taking a dose, then you can give the dose again; but if your child vomits after 30 minutes of taking the dose, then leave him be and do not give it again.
How should I give Brivaracetam?
Tablets: A whole tablet must be swallowed with a glass of water, juice or milk. You may give it by crushing and mixing it in water.
Liquid or syrup: Use an oral syringe or a medicine spoon to measure the accurate quantity. You can easily get these from any pharmacy nearby.
Do not use a kitchen teaspoon as it will not give the accurate amount of the drug.
When Should I take Brivaracetam?
Brivaracetam can be taken either before or after food, as food does not significantly affect its absorption. However, it is important to follow the specific instructions provided by your healthcare provider
Could this medication have any side effects?
Every medication has both positive and potential negative effects. Fortunately, adverse effects are not common for everyone, but it’s essential to be aware of them. Understanding possible side effects allows us to act quickly and effectively if they occur, ensuring that we can address any concerns promptly while continuing to benefit from the intended effects of medications.
Even though it may be rare, few people sometimes may have serious side effects when taking a drug. Consult your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect.
Side effects of Brivaracetam
Common (More than 10%):
- Feeling dizzy, sleepy, or tired.
- Headaches and low energy.
- Feeling very drowsy or sedated.
- Uncontrolled eye movements.
Less Common (1% to 10%):
- Stomach issues like diarrhoea, vomiting, constipation, or less appetite.
- abnormal behaviour or irritability
- Pain or irritation where the injection is given.
Rare (Less than 1%):
- Swelling in specific areas (like lips or face).
- Difficulty breathing (tight airways).
- Reduced white blood cells (neutrophils).
- Trouble walking properly.
- Overactive immune responses (allergic reactions).
- Thoughts of self-harm.
When to seek immediate help:
If you or your child:
- Gets worse or feels sick frequently.
- Has stomach pain.
- Shows pale yellow skin or eyes (could indicate liver issues).
- Feels extremely sleepy or weak.
Has more seizures than usual.
Take your child to doctor or emergency immediately in such cases.
Can other common medicines be taken during Brivaracetam (Contraindications of Brivaracetam)?
Yes, other common medicines can generally be taken during the course of Brivaracetam, but caution is needed due to potential drug interactions. When combined with other medications, it could affect how the drugs work or increase the risk of side effects.
Concomitant use of Opioid analgesics should be avoided as it enhances CNS depressant effect of brivaracetam. If combined, the dosages and duration of each drug must be reduced.
Some other epilepsy medications may interfere and can cause side effects. Always consult your healthcare provider before administering any additional medicines to your child, including herbal or complementary treatments.
If you/your child experience an increase in seizures or any other adverse reactions after taking other medications, contact your doctor immediately.
What foods should I avoid while taking Brivaracetam?
There is no specific food restrictions associated with Brivaracetam. However, it’s always a good idea to follow general guidelines to ensure the medication works effectively and minimize any potential side effects. Here are a few considerations:
- Alcohol: Drinking alcohol while taking brivaracetam may increase the risk of dizziness and drowsiness. This combination may also impair your ability to perform tasks that require alertness, such as driving.
- Foods that contain stimulants, like caffeine in coffee, tea, energy drinks, soft drinks, or chocolate, can interfere with epilepsy medications and potentially trigger seizures.
- Carbohydrates: Increased sugar levels in the blood can increase the risk of seizure
- A high-salt diet: This can raise sodium levels in the body, causing an electrolyte imbalance that may disrupt the brain’s electrical signals and potentially trigger a seizure.
General Advice:
- Stay hydrated and maintain a balanced diet.
- If you experience any side effects or unusual symptoms after eating, inform your healthcare provider to assess any potential food-drug interactions.
It’s always a good idea to consult your healthcare provider for personalized advice regarding food and medication interactions while you’re on Brivaracetam.
PREGNANCY AND LACTATION:
Brivaracetam should only be used in pregnancy if absolutely necessary, and only under the guidance and supervision of a healthcare provider. The potential benefits must outweigh the risks, and alternative treatments should be considered whenever possible. The potential effect on the baby has to be discussed with the treating doctor.
If you are breastfeeding, discuss with your doctor whether the benefits of taking brivaracetam outweigh the potential risks to your baby. Your doctor may suggest an alternative treatment or advise monitoring the baby for any
Is there any risk if I conceive while taking Brivaracetam?
Conceiving while taking brivaracetam may carry certain risks. It may have potential risks, but the benefits may outweigh the risks in some cases. Your doctor may recommend adjusting your medication or monitoring you more closely during pregnancy to ensure the best outcome for both you and your child.
Where should I store Brivaracetam?
- Keep the medicine in a cupboard, secured away from heat and direct sunlight. It is not a must to keep the medicine in the refrigerator though.
- Make sure the medicine is out of your child’s reach.
- Store the medication in the same box it was packed in.
For complete information please see the manufacturer’s information leaflet.
Monitoring parameters for Brivaracetam
- It is mandatory to monitor liver and renal function.
- Complete blood count.
How to cope up with side effects of Brivaracetam?
- Dizziness: use a wall or furniture for support which can help you avoid falls. Avoid machinery works and driving.
- Fatigue: Engaging in physical activity, even a brief walk, can help increase your energy levels. Additionally, short naps during the day can be effective in combating fatigue.
- Skin rash or allergic reaction: Notify Your Doctor immediately if you notice a skin rash, swelling, or any signs of an allergic reaction.
- Vomiting, nausea: Taking Brivaracetam after food may help reduce nausea or upset stomach.
- Weight changes: Maintain a Healthy Diet; Eating a balanced diet and exercising regularly can help manage weight changes.
- Suicidal thoughts: If you experience any changes in your mood or thoughts while on brivaracetam, contact your healthcare provider.
However, if any symptoms are preventing you from participating in regular activities or you’re also feeling depressed, it’s important to consult with your healthcare provider.
Brivaracetam is a helpful medicine for managing epilepsy, especially for reducing seizures. Taking it regularly and following your doctor’s advice is essential. Be aware of possible side effects and consult your doctor if you notice anything unusual. This medicine can make a big difference in the quality of life for people with epilepsy when used correctly.
Author:
1. Dr Praveen Kumar, B.Pharm, Pharm D(PB), Head Clinical Pharmacologist, Aster Hospitals, Bengaluru
2. Dr. Ramya. R, Pharm D, Clinical pharmacologist, Aster Hospitals, Bengaluru
3. Dr C P Ravi Kumar, Consultant Paediatric Neurologist, Aster CMI Hospital