Brivaracetam Dosage

Medically reviewed by Drugs.com. Last updated on May 15, 2023.

Usual Adult Dose for Epilepsy

Initial dose: 50 mg orally 2 times a day

• Based on individual patient tolerability and response, dose should be adjusted up or down

Maintenance dose: 25 mg to 100 mg orally twice a day based on clinical response and tolerability
Maximum dose: 200 mg/day

IV Administration:

• May be used when oral administration is temporarily not feasible
• Administer at the same dose and same frequency as oral formulations
• Experience with IV injection is limited to 4 consecutive days of treatment

Comments:

• When initiating therapy, gradual dose escalation is not required; following initiation, dose should be adjusted based on clinical response and tolerability.
• Tablets, oral solution and injection can be used interchangeably.

Use: For the treatment of partial-onset seizures

Usual Pediatric Dose for Epilepsy

1 month to 16 years:

• Weight: Less than 11 kg: Initial dose: 0.75 to 1.5 mg/kg orally twice a day; Maintenance dose: 0.75 to 3 mg/kg orally twice a day
• Weight: 11 kg to less than 20 kg: Initial dose: 0.5 to 1.25 mg/kg orally twice a day; Maintenance dose: 0.5 to 2.5 mg/kg orally twice a day
• Weight: 20 kg to less than 50 kg: Initial dose: 0.5 to 1 mg/kg orally twice a day; Maintenance dose: 0.5 to 2 mg/kg orally twice a day
• Weight: 50 kg or greater: Initial dose: 25 to 50 mg orally twice a day; Maintenance dose: 25 to 100 mg orally twice a day

16 years of age and older:
Initial dose: 50 mg orally 2 times a day
Maintenance dose: 25 mg to 100 mg orally twice a day

IV Administration: May be used in patients 16 years or older when oral administration is temporarily not feasible

• Administer at the same dose and same frequency as oral formulations
• Experience with the IV injection is limited to 4 consecutive days of treatment

Comments:

• When initiating therapy, gradual dose escalation is not required; following initiation, dose should be adjusted based on clinical response and tolerability.
• Tablets, oral solution and injection can be used interchangeably.

Use: For the treatment of partial-onset seizures in patients 1 month or older

Renal Dose Adjustments

Mild, moderate, or severe renal dysfunction: No adjustment recommended
ESRD undergoing dialysis: Not recommended

Liver Dose Adjustments

Adults and Pediatric Patients: Weight: 50 kg or greater:

• Initial dose: 25 mg twice a day
• Maximum dose: 75 mg twice a day

Pediatric Patients: Weight: 20 kg to less than 50 kg:

• Initial dose: 0.5 mg/kg twice a day
• Maximum dose: 1.5 mg/kg twice a day

Pediatric Patients: Weight: 11 kg to less than 20 kg:

• Initial dose: 0.5 mg/kg twice a day
• Maximum dose: 2 mg/kg twice a day

Pediatric Patients: Weight: Less than 11 kg:

• Initial dose: 0.75 mg/kg twice a day
• Maximum dose: 2.25 mg/kg twice a day

Dose Adjustments

Elderly: Dose selection should be judicious, generally starting at the low end of dosing range

Concomitant Administration with Rifampin:

• Dose of brivaracetam should be increased up to 100% (i.e., double the dose)

Discontinuation:

• Avoid abrupt withdrawal of therapy in order to minimize the risk of increased seizure frequency and status epilepticus.

Precautions

CONTRAINDICATIONS:

• Hypersensitivity to the active component or any of the ingredients

Safety and efficacy have not been established in patients younger than 1 month.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule V

Dialysis

Not recommended

Other Comments

Administration Advice:
Oral Tablets and Oral Solution:

• Take orally twice a day with or without food
• Oral tablets: Swallow whole with liquid; do not chew or crush
• Oral solution: A calibrated measuring device should be used to measure and deliver prescribed dose accurately; a household teaspoon or tablespoon is not an adequate measuring device
• Oral solution may be administered using a nasogastric tube or gastrostomy tube

IV Administration:

• May be used when oral administration is temporarily not feasible
• Administer IV over 2 to 15 minutes

Storage Requirements:

• Store at controlled room temperature
• Injection and oral solution: Do not freeze
• Oral Solution: Discard unused oral solution 5 months after date of first opening

IV Preparation Techniques:

• May be administered without further dilution or mixed with 0.9% sodium chloride, Lactated Ringer's, or 5% Dextrose injection
• Single-dose vials; discard unused portion of vial
• Diluted IV solution: May store for up to 4 hours at room temperature in polyvinyl chloride bags

General:

• May be used as monotherapy or as adjunctive therapy in patients with partial-onset seizures.
• May initiate therapy with IV or oral administration; clinical experience is limited to 4 consecutive days of IV treatment

Monitor:

• Monitor for suicidal behavior/ideation, changes in mood and behavior
• Monitor for neurological adverse reactions including somnolence and fatigue
• Monitor phenytoin levels if this drug is added or discontinued from ongoing phenytoin therapy

Patient advice:

• Patients should be instructed to read the US FDA-approved patient labeling (Medication Guide).
• Patients should be instructed on proper administration and advised not to discontinue therapy without consulting with their healthcare provider.
• Patients should be advised that this drug, like other antiepileptic drugs, may increase the risk of suicidal thoughts and behaviors; patients or caregivers should report emergence or worsening of depression, unusual changes in mood or behavior, suicidal thoughts or behavior or thoughts of self-harm to their healthcare provider promptly.
• Patients should be instructed not to drive or perform hazardous tasks until they have sufficient experience with this drug to gauge how it affects them; their performance may be affected by somnolence, dizziness, fatigue, and gait disturbances.
• Women of childbearing potential should be advised to speak with their healthcare provider if they become pregnant or intend to become pregnant during therapy.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Medical Disclaimer