|Oral (tablets, oral solution), IV|
|ATC code||N03AX23 (WHO)|
|Metabolism||Hydrolysis by amidase, CYP2C19-mediated hydroxylation|
|Metabolites||3 inactive metabolites|
|Biological half-life||~9 hours|
|CAS Number||357336-20-0 [chemspider]|
|Chemical and physical data|
|Molar mass||212.15 g/mol|
|3D model (Jmol)||Interactive image|
|Specific rotation||[α]D −60°|
|Melting point||72 to 77 °C (162 to 171 °F)|
Brivaracetam is used to treat partial-onset seizures with or without secondary generalisation, in combination with other antiepileptic drugs. No data are available for its effectiveness and safety in patients younger than 16 years.
Coadministration of brivaracetam with carbamazepine may increase exposure to carbamazepine-epoxide, the active metabolite of carbamazepine, and could theoretically lead to reduced tolerability. Coadministration of brivaracetam with phenytoin may increase phenytoin levels. Coadministration of other antiseizure drugs are unlikely to affect brivaracetam exposure. Brivaracetam provides no added therapeutic benefit when administered in conjunction with levetiracetam that acts on the same protein.
Mechanism of action
Brivaracetam is believed to act by binding to the ubiquitous synaptic vesicle glycoprotein 2A (SV2A), like levetiracetam. but with 20-fold greater affinity. There is some evidence that racetams including levetiracetam and brivaracetam access the luminal side of recycling synaptic vesicles during vesicular endocytosis. They may reduce excitatory neurotransmitter release and enhance synaptic depression during trains of high-frequency activity, such as is believed to occur during epileptic activity.
Brivaracetam exhibits linear pharmacokinetics over a wide dose range, is rapidly and completely absorbed after oral administration, has an elimination half-life of 7 to 8 hours, and has plasma protein binding of less than 20%. It is extensively metabolized (>90%), primarily via hydrolysis of the acetamide group, and secondarily through hydroxylation mediated by the liver enzyme CYP2C19. The three major metabolites (hydroxy, acid, and hydroxyacid) are pharmacologically inactive. Brivaracetam is eliminated as urinary metabolites, with over 95% of a radioactive test dose recovered in the urine within 72 hours, including only 8.6% as unchanged brivaracetam.
Chemical and physical properties
Brivaracetam is the 4R-propyl analogue of the anticonvulsant levetiracetam.
Positive preliminary results from stage III trials were recorded in 2008, along with evidence that it is around 10 times more potent for the prevention of certain types of seizure in mouse models than its analogue levetiracetam.
On 14 January 2016, the European Commission, and on 18 February 2016, the Food and Drug Administration approved brivaracetam under the trade name Briviact. The Drug Enforcement Administration (DEA) has issued an interim final rule placing brivaracetam into schedule V of the Controlled Substances Act (CSA) effective 12 May 2016. As of May 2016, brivaracetam is not approved in other countries, including Australia, Canada and Switzerland.
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