Briviact: Uses, Dosage & Side Effects
A selective SV2A ligand antiepileptic used as adjunctive therapy for partial-onset (focal) seizures in adults, adolescents, and children from 2 years of age
Briviact (brivaracetam) is a prescription antiepileptic medicine belonging to the SV2A ligand class. It is used as add-on therapy for the treatment of partial-onset seizures, with or without secondary generalisation, in patients aged 2 years and older. Brivaracetam works by selectively binding to synaptic vesicle protein 2A (SV2A) in the brain, thereby reducing abnormal neuronal excitability. This comprehensive guide covers uses, dosage, side effects, drug interactions, and important safety information based on international medical guidelines.
Quick Facts
Key Takeaways
- Briviact is an adjunctive (add-on) antiepileptic specifically approved for partial-onset seizures in patients aged 2 years and older.
- It works by binding to SV2A with 15–30 times greater affinity than levetiracetam, its structural relative, potentially offering a faster onset and improved tolerability profile.
- The most common side effects are somnolence and dizziness; psychiatric effects such as depression and irritability should be monitored.
- Briviact should not be stopped abruptly — gradual dose reduction is essential to avoid increased seizure frequency.
- Dose adjustments are required for patients with hepatic impairment; no dose adjustment is needed for renal impairment.
What Is Briviact and What Is It Used For?
Quick Answer: Briviact (brivaracetam) is a prescription antiepileptic drug used as adjunctive therapy for the treatment of partial-onset (focal) seizures, with or without secondary generalisation, in adults, adolescents, and children from 2 years of age. It belongs to the SV2A ligand class and is designed to reduce the frequency of seizures when used alongside other antiepileptic medicines.
Briviact contains the active substance brivaracetam, which belongs to a group of medicines known as antiepileptics (also called anticonvulsants or anti-seizure medications). These medicines are used to treat epilepsy, a neurological condition characterised by recurrent seizures caused by abnormal electrical activity in the brain. Epilepsy affects approximately 50 million people worldwide according to the World Health Organization, making it one of the most common neurological conditions globally.
Specifically, Briviact is indicated for the treatment of partial-onset seizures, also known as focal seizures. These seizures originate in a specific area of one hemisphere of the brain. In some cases, the abnormal electrical activity can spread to involve larger areas on both sides of the brain, a phenomenon known as secondary generalisation or focal to bilateral tonic-clonic seizures. Briviact is effective in reducing the frequency of both types of seizure when used as an add-on treatment.
Briviact is approved for use in adults, adolescents, and children from 2 years of age. It is always prescribed in combination with at least one other antiepileptic drug, rather than as a standalone (monotherapy) treatment. The goal of adding Briviact to an existing treatment regimen is to achieve better seizure control and improve the patient's quality of life.
How Does Briviact Work?
Brivaracetam exerts its antiepileptic effect by selectively binding to synaptic vesicle protein 2A (SV2A) in the brain. SV2A is a transmembrane glycoprotein found on the surface of synaptic vesicles — the small structures within nerve cells that store and release neurotransmitters. By binding to SV2A with high affinity, brivaracetam modulates neurotransmitter release from presynaptic neurons, thereby reducing the neuronal hyperexcitability that underlies seizure activity.
Brivaracetam is structurally related to levetiracetam (marketed as Keppra), another widely used antiepileptic that also targets SV2A. However, brivaracetam binds to SV2A with approximately 15 to 30 times greater affinity than levetiracetam. This higher binding affinity is believed to contribute to its potent antiepileptic effect and may explain why some patients who do not respond adequately to levetiracetam may benefit from switching to or adding brivaracetam. Clinical studies have also suggested that brivaracetam has a faster brain penetration rate, which may contribute to a quicker onset of action.
After oral administration, brivaracetam is rapidly and almost completely absorbed, with a bioavailability close to 100%. Peak plasma concentrations are typically reached within approximately one hour. The drug is metabolised primarily by hydrolysis (via amidase) and secondarily by hydroxylation (via CYP2C19), and has an elimination half-life of approximately 9 hours, supporting twice-daily dosing.
What Should You Know Before Taking Briviact?
Quick Answer: Before starting Briviact, inform your doctor if you have liver problems, a history of depression or suicidal thoughts, or if you are pregnant or breastfeeding. Briviact is contraindicated in patients with known hypersensitivity to brivaracetam or related compounds. Close monitoring is required during the initial treatment period.
Contraindications
Briviact must not be taken by patients who are allergic (hypersensitive) to brivaracetam, to other chemically related substances such as levetiracetam or piracetam, or to any of the other ingredients in the formulation. If you are uncertain about any allergy, consult your doctor or pharmacist before starting treatment.
Additionally, Briviact must not be taken by patients who have previously experienced a severe skin reaction, including skin peeling, blistering, or mouth sores, after taking brivaracetam. Serious cutaneous adverse reactions, including Stevens-Johnson syndrome (SJS), have been reported in association with Briviact treatment. Stevens-Johnson syndrome is a rare but potentially life-threatening skin condition that requires immediate medical attention. If you notice any widespread rash with blistering, especially around the mouth, nose, eyes, or genitals, stop taking Briviact and seek emergency medical care immediately.
Severe skin reactions including Stevens-Johnson syndrome have been reported with Briviact. Stop treatment and seek immediate medical attention if you develop a widespread rash with blistering or peeling, particularly around the mouth, nose, eyes, or genital area.
Warnings and Precautions
Before starting and during treatment with Briviact, certain precautions should be observed. Discuss the following with your doctor:
Suicidal ideation and behaviour: A small number of patients treated with antiepileptic drugs, including Briviact, have experienced thoughts of self-harm or suicide. The International League Against Epilepsy (ILAE) and regulatory agencies including the FDA and EMA recommend that all patients starting antiepileptic therapy should be monitored for signs of depression, suicidal thoughts, or unusual changes in mood or behaviour. If you experience any such symptoms, contact your healthcare provider immediately. According to FDA meta-analyses, the increased risk of suicidal thoughts among patients on antiepileptic drugs is approximately twice the background rate, emerging as early as one week after starting treatment.
Hepatic impairment: Patients with liver problems may need dose adjustments, as brivaracetam is metabolised in the liver. Your doctor will assess liver function and may prescribe a lower maximum dose. For patients with any degree of hepatic impairment, the maximum recommended dose is 75 mg twice daily (150 mg/day) for adults and adolescents weighing 50 kg or more.
Driving and operating machinery: Briviact may cause drowsiness, dizziness, or fatigue, particularly at the beginning of treatment or after a dose increase. These effects can impair your ability to drive, cycle, or operate heavy machinery. Do not engage in these activities until you know how the medicine affects you. The European Medicines Agency recommends that patients exercise caution with activities requiring full alertness, especially during the first weeks of treatment.
Pregnancy and Breastfeeding
Women of childbearing potential should discuss contraceptive options with their doctor before starting Briviact. The effects of brivaracetam on pregnancy and the unborn child have not been fully established in humans. Animal studies have shown some adverse effects at high doses, though the clinical relevance is uncertain. As a precautionary measure, Briviact is generally not recommended during pregnancy unless the treating physician considers it clearly necessary for seizure control.
Brivaracetam is excreted in breast milk, and breastfeeding is therefore not recommended during treatment. However, the decision to discontinue breastfeeding or to discontinue therapy should be made in consultation with the prescribing physician, weighing the benefits of breastfeeding against the therapeutic benefit of the drug to the mother. Importantly, patients should never stop antiepileptic treatment abruptly without medical supervision, as this may lead to an increase in seizures, which could be harmful to both the mother and the child.
Use in Children
Briviact is approved for use as adjunctive therapy in children aged 2 years and older for the treatment of partial-onset seizures. It is not recommended for use in children under 2 years of age, as safety and efficacy have not been established in this age group. Dosing in paediatric patients is weight-based and determined by the treating physician.
Lactose and Sodium Content
Briviact film-coated tablets contain lactose. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption should not take these tablets. The tablets also contain less than 1 mmol (23 mg) of sodium per tablet, meaning they are essentially sodium-free.
How Does Briviact Interact with Other Drugs?
Quick Answer: Briviact has relatively few clinically significant drug interactions. Rifampicin and St John's Wort can reduce brivaracetam levels by inducing its metabolism. Brivaracetam may increase plasma levels of certain drugs metabolised by CYP2C19, such as phenytoin. Always inform your doctor about all medicines, supplements, and herbal products you are taking.
Drug interactions are an important consideration when prescribing any antiepileptic medication, particularly since many patients with epilepsy take multiple drugs simultaneously (polytherapy). Brivaracetam is metabolised primarily by hydrolysis and to a lesser extent by CYP2C19. It has a relatively low potential for pharmacokinetic interactions compared to many older antiepileptic drugs such as carbamazepine, phenytoin, or phenobarbital, which are potent enzyme inducers.
Nevertheless, certain drug combinations require attention. Inform your healthcare provider about all medications you are currently taking, have recently taken, or plan to take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.
Significant Drug Interactions
| Drug | Effect | Clinical Significance | Recommendation |
|---|---|---|---|
| Rifampicin | Decreases brivaracetam plasma levels by approximately 45% | Major | Dose adjustment of Briviact may be needed; consult prescriber |
| St John's Wort (Hypericum perforatum) | May decrease brivaracetam levels through enzyme induction | Major | Avoid combination or adjust Briviact dose |
| Carbamazepine | Reduces brivaracetam levels by approximately 26%; brivaracetam slightly increases carbamazepine-epoxide | Moderate | Dose adjustment generally not required; monitor for toxicity |
| Phenytoin | Brivaracetam may increase phenytoin levels by up to 20% via CYP2C19 inhibition | Moderate | Monitor phenytoin levels; dose adjustment may be needed |
| Phenobarbital | May reduce brivaracetam levels through enzyme induction | Moderate | Monitor seizure control; dose adjustment may be considered |
| Oral Contraceptives | No clinically relevant interaction at therapeutic doses | Low | No dose adjustment required |
Alcohol Interaction
Combining Briviact with alcohol is not recommended. Both brivaracetam and alcohol act on the central nervous system, and their combined use can enhance side effects such as drowsiness, dizziness, and impaired coordination. Moreover, alcohol can lower the seizure threshold in patients with epilepsy, potentially reducing the effectiveness of antiepileptic treatment. Patients should discuss alcohol consumption with their healthcare provider and exercise caution.
Food Interactions
Briviact can be taken with or without food. Food does not significantly affect the rate or extent of absorption of brivaracetam, though it may slightly delay the time to peak plasma concentration. This delay is not considered clinically significant, and patients can take the medication at mealtimes for convenience or on an empty stomach as preferred.
What Is the Correct Dosage of Briviact?
Quick Answer: For adults and adolescents weighing 50 kg or more, the recommended starting dose is 25 mg to 50 mg twice daily, with a maximum of 100 mg twice daily (200 mg/day). Dosing in children is based on body weight, starting at 0.5 mg/kg twice daily. Briviact should always be taken as directed by the prescribing physician.
Briviact should always be taken exactly as directed by the prescribing doctor. The daily dose is divided into two equal doses, taken approximately 12 hours apart, to maintain consistent drug levels in the blood. Tablets should be swallowed whole with a glass of liquid and can be taken with or without food. Other formulations, such as the oral solution, may be more appropriate for certain patients (e.g., young children or those who cannot swallow tablets); these should be discussed with the prescribing physician.
Adults and Adolescents (50 kg and Above)
Standard Dosing
The recommended starting dose is 25 mg to 50 mg twice daily. Based on individual response and tolerability, the doctor may subsequently adjust the dose. The effective dose range is 25 mg to 100 mg twice daily. The maximum recommended dose is 100 mg twice daily (200 mg total per day).
Children and Adolescents (20 kg to Less Than 50 kg)
Weight-Based Dosing
The recommended starting dose is 0.5 mg per kilogram of body weight twice daily. The doctor may adjust the dose up to a maximum of 2 mg per kilogram twice daily, based on individual response and tolerability.
Children (10 kg to Less Than 20 kg)
Weight-Based Dosing
The recommended starting dose is 0.5 mg per kilogram of body weight twice daily. The doctor may adjust the dose up to a maximum of 2.5 mg per kilogram twice daily, based on individual response and tolerability.
Dosage Adjustments for Special Populations
| Patient Group | Adjustment | Maximum Dose |
|---|---|---|
| Hepatic impairment (adults ≥50 kg) | Lower maximum dose recommended | 75 mg twice daily (150 mg/day) |
| Hepatic impairment (children 20–50 kg) | Lower maximum weight-based dose | 1.5 mg/kg twice daily |
| Hepatic impairment (children 10–20 kg) | Lower maximum weight-based dose | 2 mg/kg twice daily |
| Renal impairment | No dose adjustment required | Standard dosing applies |
| Elderly patients | No specific dose adjustment; use caution | Standard dosing applies |
Missed Dose
If you miss a dose of Briviact, take it as soon as you remember. Then take the next dose at the regularly scheduled time. Do not take a double dose to compensate for a missed one. Consistent dosing is important for maintaining stable drug levels and optimal seizure control. If you are unsure about how to manage a missed dose, contact your doctor or pharmacist for advice.
Overdose
If you have taken more Briviact than prescribed, seek medical advice immediately. Symptoms of overdose may include dizziness, drowsiness, nausea, vertigo (a spinning sensation), problems with balance, anxiety, excessive tiredness, irritability, aggressive behaviour, difficulty sleeping, depression, and in severe cases, thoughts of self-harm. There is no specific antidote for brivaracetam overdose; treatment is supportive. Haemodialysis is not expected to be effective due to the drug's relatively low plasma protein binding but moderate volume of distribution.
Never stop taking Briviact without consulting your doctor. Abrupt discontinuation of antiepileptic drugs can cause a rebound increase in seizure frequency and may lead to status epilepticus, a medical emergency. If treatment needs to be stopped, your doctor will gradually reduce the dose over a period of time.
What Are the Side Effects of Briviact?
Quick Answer: The most common side effects are somnolence (drowsiness) and dizziness, affecting more than 1 in 10 patients. Other common side effects include fatigue, nausea, depression, and upper respiratory tract infections. Serious but rare side effects include suicidal ideation, neutropenia, and Stevens-Johnson syndrome.
Like all medicines, Briviact can cause side effects, although not everyone experiences them. Side effects are most likely to occur at the start of treatment or following a dose increase and often diminish as the body adjusts to the medication. The frequency categories below follow standardised medical reporting conventions used by the EMA and WHO.
Very Common
May affect more than 1 in 10 patients
- Somnolence (drowsiness, sleepiness)
- Dizziness
Common
May affect up to 1 in 10 patients
- Fatigue (feeling very tired)
- Nausea and vomiting
- Constipation
- Depression
- Anxiety
- Insomnia (difficulty sleeping)
- Irritability
- Upper respiratory tract infections (common cold), cough
- Influenza (flu)
- Vertigo (spinning sensation)
- Convulsions
- Decreased appetite
Uncommon
May affect up to 1 in 100 patients
- Allergic reactions (hypersensitivity)
- Psychotic disorder (abnormal thoughts, loss of contact with reality)
- Aggressive behaviour, agitation
- Suicidal ideation or suicide attempt — seek immediate medical help
- Neutropenia (decreased white blood cell count, detected in blood tests)
Not Known
Frequency cannot be estimated from available data
- Stevens-Johnson syndrome — widespread rash with blistering and skin peeling, particularly around the mouth, nose, eyes, and genitals
Additional Side Effects in Children
In clinical trials involving paediatric patients, the following additional side effect was observed:
- Common (up to 1 in 10 children): Psychomotor hyperactivity (restlessness and overactivity)
Contact your doctor or seek emergency medical care immediately if you experience: thoughts of self-harm or suicide, a widespread skin rash with blistering (possible Stevens-Johnson syndrome), signs of a severe allergic reaction (swelling of the face, lips, tongue, or throat, difficulty breathing), or signs of infection with persistent fever (possible neutropenia).
Patients and caregivers should be aware that psychiatric side effects, while uncommon, can occur with any antiepileptic medication. The FDA issued a class-wide warning for all antiepileptic drugs regarding the potential risk of suicidal thoughts and behaviour. Regular follow-up appointments with your prescribing neurologist are important, especially during the first months of treatment, to monitor for both therapeutic response and any adverse effects.
If you notice any side effect not listed here, or if any side effect becomes severe, report it to your doctor or pharmacist. Post-marketing surveillance and pharmacovigilance play a crucial role in identifying rare adverse reactions and ensuring the ongoing safety of medicines.
How Should You Store Briviact?
Quick Answer: Store Briviact at room temperature, away from children. No special storage conditions are required for the film-coated tablets. Do not use the medicine after the expiry date printed on the packaging.
Proper storage of medications ensures their effectiveness and safety throughout their shelf life. Briviact film-coated tablets do not require any special storage conditions — they can be kept at room temperature. However, the following general guidelines should always be observed:
- Keep out of sight and reach of children. Store medicines in a secure location that children cannot access.
- Check the expiry date. Do not use Briviact after the expiry date (EXP) printed on the carton and blister pack. The expiry date refers to the last day of the stated month.
- Proper disposal. Do not dispose of unused medicines via household waste or the sewage system. Return unused or expired medicines to your pharmacy for safe disposal. This helps protect the environment.
If you are prescribed the oral solution formulation of Briviact, specific storage instructions may apply, including a limited shelf life after opening. Always refer to the product labelling and your pharmacist's instructions for formulation-specific storage requirements.
What Does Briviact Contain?
Quick Answer: The active ingredient is brivaracetam, available in film-coated tablets of 10 mg, 25 mg, 50 mg, 75 mg, and 100 mg. Each tablet strength is colour-coded for easy identification. Inactive ingredients include lactose monohydrate, croscarmellose sodium, and magnesium stearate.
Active Ingredient
Each film-coated tablet contains brivaracetam in the following strengths: 10 mg, 25 mg, 50 mg, 75 mg, or 100 mg.
Inactive Ingredients
The tablet core contains: croscarmellose sodium, lactose monohydrate, betadex (beta-cyclodextrin), anhydrous lactose, and magnesium stearate. The film coating varies by tablet strength and includes poly(vinyl alcohol), titanium dioxide (E171), macrogol (3350), talc, and various iron oxides (E172) depending on the colour.
Tablet Identification
| Strength | Colour | Shape | Imprint |
|---|---|---|---|
| 10 mg | White to off-white | Round, 6.5 mm diameter | u 10 |
| 25 mg | Grey | Oval, 8.9 mm × 5.0 mm | u 25 |
| 50 mg | Yellow | Oval, 11.7 mm × 6.6 mm | u 50 |
| 75 mg | Purple | Oval, 13.0 mm × 7.3 mm | u 75 |
| 100 mg | Grey-green | Oval, 14.5 mm × 8.1 mm | u 100 |
Briviact tablets are packaged in PVC/PCTFE-aluminium blisters and supplied in cartons containing 14, 56, or 100 film-coated tablets, as well as multipack cartons containing 168 tablets (3 packs of 56). Not all pack sizes may be marketed in all countries. The marketing authorisation holder is UCB Pharma S.A., based in Brussels, Belgium.
Frequently Asked Questions About Briviact
Briviact (brivaracetam) is an antiepileptic drug used as adjunctive therapy for the treatment of partial-onset (focal) seizures, with or without secondary generalisation, in adults, adolescents, and children from 2 years of age. It is taken alongside other antiepileptic medicines to reduce the frequency of seizures. Briviact belongs to the SV2A ligand class and is structurally related to levetiracetam.
Both Briviact (brivaracetam) and levetiracetam (Keppra) target the same synaptic vesicle protein 2A (SV2A), but brivaracetam binds with approximately 15–30 times greater affinity. Clinical studies suggest brivaracetam may have a faster onset of action and may be better tolerated by some patients, particularly regarding behavioural side effects such as irritability and aggression. However, individual responses vary, and the choice between these medications should be made by the treating neurologist based on the patient's specific clinical situation.
Yes, Briviact is approved for use in children aged 2 years and older as adjunctive therapy for partial-onset seizures. Dosing is weight-based: children weighing 10–20 kg start at 0.5 mg/kg twice daily (max 2.5 mg/kg twice daily), and those weighing 20–50 kg start at 0.5 mg/kg twice daily (max 2 mg/kg twice daily). For children weighing 50 kg or more, adult dosing applies. Briviact is not recommended for children under 2 years of age.
Combining Briviact with alcohol is not recommended. Both brivaracetam and alcohol affect the central nervous system, and together they can intensify side effects such as drowsiness, dizziness, and impaired coordination. Alcohol may also lower the seizure threshold in people with epilepsy, potentially reducing the medication's therapeutic benefit. Discuss alcohol consumption with your healthcare provider.
If you miss a dose, take it as soon as you remember. Then take your next dose at the usual time. Do not take a double dose to compensate for a missed one. Maintaining consistent dosing is important for stable seizure control. If you are unsure about what to do, contact your doctor or pharmacist for guidance.
The effects of Briviact during pregnancy have not been fully established. As a precaution, it is generally not recommended during pregnancy unless clearly necessary. Women of childbearing potential should discuss effective contraception with their doctor. Importantly, never stop antiepileptic treatment abruptly without medical supervision, as this can lead to increased seizures that may be harmful to both the mother and baby. Breastfeeding is not recommended during Briviact treatment as the drug passes into breast milk.
References
- European Medicines Agency (EMA). Briviact (brivaracetam) – Summary of Product Characteristics. Last updated 2025. Available at: https://www.ema.europa.eu/en/medicines/human/EPAR/briviact
- U.S. Food and Drug Administration (FDA). Briviact (brivaracetam) Prescribing Information. UCB, Inc. Revised 2024.
- Klein P, Schiemann J, Sperling MR, et al. A randomized, double-blind, placebo-controlled, multicenter, parallel-group study of adjunctive brivaracetam in patients with uncontrolled partial-onset seizures. Epilepsia. 2015;56(12):1890–1898. doi:10.1111/epi.13212
- Kwan P, Trinka E, Van Paesschen W, et al. Adjunctive brivaracetam for uncontrolled focal and generalized epilepsies: Results of a phase III, double-blind, randomized, placebo-controlled, flexible-dose trial. Epilepsia. 2014;55(1):38–46. doi:10.1111/epi.12391
- National Institute for Health and Care Excellence (NICE). Epilepsies in children, young people and adults. NICE guideline [NG217]. Updated 2024. Available at: https://www.nice.org.uk/guidance/ng217
- Lattanzi S, Cagnetti C, Foschi N, et al. Brivaracetam add-on for refractory focal epilepsy: A systematic review and meta-analysis. Neurology. 2016;86(14):1344–1352. doi:10.1212/WNL.0000000000002545
- World Health Organization (WHO). Epilepsy: A Public Health Imperative. Geneva: WHO; 2019.
- International League Against Epilepsy (ILAE). Updated ILAE evidence review of antiseizure medication efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. Epilepsia. 2023;64(5):1186–1197.
- Brigo F, Lattanzi S, Nardone R, et al. Brivaracetam in the treatment of patients with epilepsy – profile, evidence, and clinical potential. Neuropsychiatric Disease and Treatment. 2019;15:2599–2611.
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