Indications

Bricet is indicated for the treatment of partial-onset seizures in patients 1 month of age and older.

Pharmacology

Brivaracetam,the active ingredient in Bricet,is an anticonvulsant.While its precise mechanism of action is not fully known,it is thought to work by displaying a high and selective affinity for synaptic vesicle protein 2A (SV2A) in the brain,which may contribute to its anticonvulsant effect.

Dosage

The recommended dose is taken orally,with or without food,and is based on the patient's age and body weight.Gradual dose escalation is not required.

• Adults (16 years and older):
  • Initial dose: 50 mg twice daily (100 mg per day).
  • Maintenance dose: 25 mg to 100 mg twice daily (50 mg to 200 mg per day).
• Pediatric patients weighing 50 kg or more:
  • Initial dose: 25 mg to 50 mg twice daily (50 mg to 100 mg per day).
  • Maintenance dose: 25 mg to 100 mg twice daily (50 mg to 200 mg per day).
• Pediatric patients weighing less than 50 kg:
  • The dosage is weight-dependent,ranging from an initial dose of 0.5 mg/kg to 1.5 mg/kg twice daily and a maintenance dose of 0.5 mg/kg to 3 mg/kg twice daily.
• Geriatric Use: Dose selection should be judicious,starting at the low end of the dosing range.
• Renal Impairment: No dose adjustments are required,but use is not recommended in patients with end-stage renal disease undergoing dialysis.
• Children and Adolescents: Safety and effectiveness have not been established for patients younger than 1 month.

Administration

Brivaracetam tablets or oral solution are for oral use.An intravenous (IV) injection is also available for adults when oral administration is not feasible.The injection can be administered undiluted or mixed with common diluents and given over 2 to 15 minutes.

Interaction

• Rifampin: Co-administration with rifampin may decrease Bricet plasma concentrations,requiring a dose increase of up to 100% (doubling the dose) while on rifampin.
• Carbamazepine: Co-administration may increase the active metabolite of carbamazepine,and a dose reduction of carbamazepine should be considered if tolerability issues arise.
• Phenytoin: Bricet can increase phenytoin levels,so monitoring is required when starting or stopping Bricet.
• Levetiracetam: Bricet provides no additional therapeutic benefit when co-administered with levetiracetam.

Contraindications

Brivaracetam is contraindicated in patients with known hypersensitivity to brivaracetam or any other components of this product.

Side Effects

The most common side effects include nausea/vomiting,constipation,sleepiness,sedation,dizziness,fatigue,balance issues,and irritability.

Pregnancy & Lactation

Brivaracetam should be used during pregnancy only if the clinical benefits outweigh the potential risks to the fetus.There are no data on the presence of brivaracetam in human milk,so the benefits of breastfeeding must be weighed against the potential risks to the infant.

Precautions & Warnings

• Suicidal Thoughts: Antiepileptic drugs,including Bricet,increase the risk of suicidal thoughts or behavior.Patients should be monitored for new or worsening depression and unusual changes in mood or behavior.
• CNS Depression: Bricet can cause sleepiness,fatigue,dizziness,and coordination problems.Patients should be advised not to drive or operate machinery.
• Psychiatric Symptoms: The medication can cause a range of psychiatric side effects,including irritability,anxiety,aggression,and psychotic symptoms like hallucinations and paranoia.
• Withdrawal: The drug should be withdrawn gradually to avoid increased seizure frequency and status epilepticus.

Overdose Effects

Adverse reactions with an overdose include vertigo,balance disorders,fatigue,nausea,double vision,anxiety,and a slow heart rate (bradycardia).There is no specific antidote.Standard medical practice for overdose management should be followed,including ensuring a clear airway and monitoring vital signs.

Therapeutic Class

Bricet is an adjunct anti-epileptic drug.

Storage Conditions

Store in a cool (below 30°C) and dry place,protected from light.Keep away from the reach of children.