Adults

Initial recommended dose is 50 mg twice daily. Depending on individual patient response and tolerability, the dose may be adjusted from 25 mg twice daily to 100 mg twice daily. Doses should be titrated gradually.

Elderly

No specific dosage adjustment is required based on age alone. However, caution is advised due to potential for decreased renal or hepatic function.

Renal_impairment

No dose adjustment is required for mild to moderate renal impairment. For severe renal impairment, consider a maximum initial dose of 50 mg twice daily, with careful monitoring.

Onset

Within hours, but full therapeutic effect may take several days of consistent dosing.

Excretion

Approximately 95% of the dose is excreted in urine within 72 hours, with about 88% as metabolites and 8% as unchanged drug.

Half life

Approximately 9 hours.

Absorption

Rapid and complete absorption after oral administration, with peak plasma concentrations typically reached within 2 hours. Bioavailability is approximately 100%.

Metabolism

Primarily metabolized by hydrolysis of the amide moiety, mainly by hepatic CYP450 enzymes (CYP2C19) and non-CYP pathways. The main metabolite is inactive.

Rifampicin

May decrease brivaracetam plasma concentrations. Dose adjustment of brivaracetam may be necessary.

Oral Contraceptives

Brivaracetam at doses of 100 mg twice daily has been shown to reduce the plasma concentrations of ethinylestradiol and levonorgestrel. Patients should be advised to use additional or alternative non-hormonal contraception if necessary.

Phenytoin, Carbamazepine, Phenobarbital

May decrease brivaracetam levels; co-administration may require brivaracetam dose adjustment. Conversely, brivaracetam may slightly increase phenytoin levels.