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Brivaracetam Dosage

Medically reviewed on May 25, 2018.

Applies to the following strengths: 10 mg; 25 mg; 50 mg; 75 mg; 100 mg; 10 mg/mL

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Epilepsy

Initial dose: 50 mg orally 2 times a day
Maintenance dose: 25 mg to 100 mg orally twice a day based on clinical response and tolerability

IV Injection: 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:
-Gradual dose escalation is not required; 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

4 to less than 16 years:
-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 based on clinical response and tolerability

IV Injection: 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:
-Gradual dose escalation is not required; dose should be adjusted based on clinical response and tolerability.
-Tablets and oral solution can be used interchangeably.
-The use of IV injection in patients less than 16 years of age has not been studied and is not recommended.

Use: For the treatment of partial-onset seizures in patients 4 years of age 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

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 4 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule V

Dialysis

Not recommended

Other Comments

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:
-Measure dose with a calibrated measuring device; a household teaspoon or tablespoon is not an adequate measuring device
-Oral solution may be administered using a nasogastric tube or gastrostomy tube

IV Injection: When oral administration is not feasible in patients 16 years of older:
-Administer IV over 2 to 15 minutes; may administer IV bolus or by IV infusion (see compatible solutions below)

Storage Requirements:
-Injection or 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:
-This drug may be used as monotherapy or as adjunctive therapy in patients with partial-onset seizures.
-For patients 16 years of older, may be initiate therapy with IV or oral administration; clinical experience is limited to 4 consecutive days of IV treatment and there is not experience with IV use in patients under 16 years of age.

Monitor:
-Monitor for suicidal behavior/ideation and 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 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.
-Patients should be instructed to read the US FDA-approved patient labeling.

Further information

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

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