Adults

Initial recommended dose is 50 mg twice daily (100 mg/day). Depending on individual patient response and tolerability, the dose may be adjusted from 25 mg twice daily (50 mg/day) to a maximum of 100 mg twice daily (200 mg/day). Doses should be titrated gradually.

Elderly

No specific dose adjustment is required based on age alone, but caution should be exercised due to potential age-related decrease in renal or hepatic function.

Renal_impairment

No dose adjustment is required for mild to moderate renal impairment. For severe renal impairment (creatinine clearance < 30 mL/min) or end-stage renal disease requiring dialysis, a maximum daily dose of 150 mg/day (75 mg twice daily) is recommended.

Onset

Rapid onset of action, typically within hours of initial dose.

Excretion

Mainly eliminated by renal excretion. Approximately 95% of the dose is excreted in urine, with about 88% as metabolites and 7-10% as unchanged drug. Fecal excretion accounts for less than 1%.

Half life

Mean plasma half-life is approximately 9 hours.

Absorption

Rapid and almost complete oral absorption (approx. 100% bioavailability). Peak plasma concentrations reached within 0.5 to 2 hours.

Metabolism

Primarily metabolized by hydrolysis of the amide moiety (approximately 60%) and N-dealkylation (approximately 30%). CYP2C19 is involved in N-dealkylation but is not the sole pathway. No significant active metabolites.

Phenytoin

Brivaracetam may cause a modest increase in phenytoin plasma concentrations. Close monitoring of phenytoin levels is recommended.

Rifampicin

Rifampicin is a strong enzyme inducer that can decrease brivaracetam plasma concentrations. Concomitant use should be approached with caution.

Carbamazepine

No significant interaction, but carbamazepine can slightly decrease brivaracetam plasma levels.