Partial onset seizures with or without secondary generalisation

Active Ingredient: Brivaracetam

Indication for Brivaracetam

Population group: only children (1 year - 12 years old) , adolescents (12 years - 18 years old) , adults (18 - 65 years old)
Therapeutic intent: Curative procedure

Brivaracetam is indicated as adjunctive therapy in the treatment of partial onset seizures with or without secondary generalisation in adults, adolescents and children from 2 years of age with epilepsy.

For this indication, competent medicine agencies globally authorize below treatments:

50 or 100 mg/day and thereafter 100 mg/day

For:

Dosage regimens

Oral, between 50 milligrams brivaracetam and 100 milligrams brivaracetam, divided 2 times daily. Afterwards, oral, between 50 milligrams brivaracetam and 200 milligrams brivaracetam, divided 2 times daily. The maximum allowed total dose is 200 milligrams brivaracetam daily.

Detailed description

The physician should prescribe the most appropriate formulation and strength according to weight and dose.

The dose should be administered in two equally divided doses, approximately 12 hours apart.

The recommended starting dose is either 50 mg/day or 100 mg/day based on physician's assessment of required seizure reduction versus potential side effects. Based on individual patient response and tolerability, the dose may be adjusted in the effective dose range of 50 mg/day to 200 mg/day.

Missed doses

If patients missed one dose or more, it is recommended that they take a single dose as soon as they remember and take the following dose at the usual morning or evening time. This may avoid the brivaracetam plasma concentration falling below the efficacy level and prevent breakthrough seizures from occurring.

Discontinuation

For patients from 16 years of age, if brivaracetam has to be discontinued, it is recommended that the dose is reduced gradually by 50 mg/day on a weekly basis.

After 1 week of treatment at 50 mg/day, a final week of treatment at the dose of 20 mg/day is recommended.

50-200 mg/day for patients weighing ≥50 kg, 1-4 mg/kg/day for patients weighing 20-50 kg, 1-5 mg/kg/day for patients weighing <20 kg

For:

Dosage regimens

Regimen A, in case that patient weight is ≥ 50 kg

Oral, 50 milligrams brivaracetam, divided 2 times daily. Afterwards, oral, 100 milligrams brivaracetam, divided 2 times daily. The maximum allowed total dose is 200 milligrams brivaracetam daily.

Regimen B, in case that patient weight is ≥ 20 kg and patient weight is ≤ 50 kg and patient age in years is ≥ 2

Oral, between 1 milligrams brivaracetam per kilogram of body weight and 2 milligrams brivaracetam per kilogram of body weight, divided 2 times daily. Afterwards, oral, 2 milligrams brivaracetam per kilogram of body weight, divided 2 times daily. The maximum allowed total dose is 4 milligrams brivaracetam per kilogram of body weight daily.

Regimen C, in case that patient weight is ≥ 10 kg and patient weight is ≤ 20 kg and patient age in years is ≥ 2

Oral, between 1 milligrams brivaracetam per kilogram of body weight and 2.5 milligrams brivaracetam per kilogram of body weight, divided 2 times daily. Afterwards, oral, 2.5 milligrams brivaracetam per kilogram of body weight, divided 2 times daily. The maximum allowed total dose is 5 milligrams brivaracetam per kilogram of body weight daily.

Detailed description

The dose should be administered in two equally divided doses, approximately 12 hours apart.

Adolescents and children weighing 50 kg or more

The recommended starting dose is 50 mg/day. Brivaracetam may also be initiated at 100 mg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 100 mg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 50 mg/day to 200 mg/day.

Adolescents and children weighing from 20 kg to less than 50 kg

The recommended starting dose is 1 mg/kg/day. Brivaracetam may also be initiated at doses up to 2 mg/kg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 2 mg/kg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 1 mg/kg/day to 4 mg/kg/day.

Children weighing from 10 kg to less than 20 kg

The recommended starting dose is 1 mg/kg/day. Brivaracetam may also be initiated at doses up to 2.5 mg/kg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 2.5 mg/kg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 1 mg/kg/day to 5 mg/kg/day.

Missed doses

If patients missed one dose or more, it is recommended that they take a single dose as soon as they remember and take the following dose at the usual morning or evening time. This may avoid the brivaracetam plasma concentration falling below the efficacy level and prevent breakthrough seizures from occurring.

Discontinuation

For patients from 16 years of age, if brivaracetam has to be discontinued, it is recommended that the dose is reduced gradually by 50 mg/day on a weekly basis. For patients below the age of 16 years, if brivaracetam has to be discontinued, it is recommended that the dose is reduced by a maximum of half the dose every week until a dose of 1 mg/kg/day (for patients with a body weight less than 50 kg) or 50 mg/day (for patients with body weight of 50 kg or more) is reached.

After 1 week of treatment at 50 mg/day, a final week of treatment at the dose of 20 mg/day is recommended.

50 or 100 mg/day as starting dose followed by 50-200 mg/day for up to 4 days

For:

Dosage regimens

Intravenous, between 50 milligrams brivaracetam and 100 milligrams brivaracetam, divided 2 times daily, over the duration of 1 day. Afterwards, intravenous, between 50 milligrams brivaracetam and 200 milligrams brivaracetam, divided 2 times daily, over the duration of 1 to 3 days. The maximum allowed total dose is 200 milligrams brivaracetam daily.

Detailed description

Brivaracetam solution for injection/infusion is an alternative route of administration for patients when oral administration is temporarily not feasible. There is no experience with twice daily intravenous administration of brivaracetam for a period longer than 4 days.

The dose should be administered in two equally divided doses, approximately 12 hours apart.

Brivaracetam may be initiated with either intravenous or oral administration. When converting from oral to intravenous administration or vice versa, the total daily dose and frequency of administration should be maintained.

The recommended starting dose is either 50 mg/day or 100 mg/day based on physician's assessment of required seizure reduction versus potential side effects. Based on individual patient response and tolerability, the dose may be adjusted in the effective dose range of 50 mg/day to 200 mg/day.

Missed doses

If patients missed one dose or more, it is recommended that they take a single dose as soon as they remember and take the following dose at the usual morning or evening time. This may avoid the brivaracetam plasma concentration falling below the efficacy level and prevent breakthrough seizures from occurring.

Discontinuation

For patients from 16 years of age, if brivaracetam has to be discontinued, it is recommended that the dose is reduced gradually by 50 mg/day on a weekly basis.

After 1 week of treatment at 50 mg/day, a final week of treatment at the dose of 20 mg/day is recommended.

50-200 mg/day for patients weighing ≥50 kg, 1-4 mg/kg/day for patients weighing 20-50 kg, 1-5 mg/kg/day for patients weighing <20 kg

For:

Dosage regimens

Regimen A, in case that patient weight is ≥ 50 kg

Intravenous, 50 milligrams brivaracetam, divided 2 times daily, over the duration of 1 day. Afterwards, intravenous, 100 milligrams brivaracetam, divided 2 times daily, over the duration of 1 to 3 days.

Regimen B, in case that patient weight is ≥ 20 kg and patient weight is ≤ 50 kg and patient age in years is ≥ 2

Intravenous, between 1 milligrams brivaracetam per kilogram of body weight and 2 milligrams brivaracetam per kilogram of body weight, divided 2 times daily, over the duration of 1 day. Afterwards, intravenous, 2 milligrams brivaracetam per kilogram of body weight, divided 2 times daily, over the duration of 1 to 3 days. The maximum allowed total dose is 4 milligrams brivaracetam per kilogram of body weight daily.

Regimen C, in case that patient weight is ≥ 10 kg and patient weight is ≤ 20 kg and patient age in years is ≥ 2

Intravenous, between 1 milligrams brivaracetam per kilogram of body weight and 2.5 milligrams brivaracetam per kilogram of body weight, divided 2 times daily, over the duration of 1 day. Afterwards, intravenous, 2.5 milligrams brivaracetam per kilogram of body weight, divided 2 times daily, over the duration of 1 to 3 days. The maximum allowed total dose is 5 milligrams brivaracetam per kilogram of body weight daily.

Detailed description

Brivaracetam solution for injection/infusion is an alternative route of administration for patients when oral administration is temporarily not feasible. There is no experience with twice daily intravenous administration of brivaracetam for a period longer than 4 days.

The dose should be administered in two equally divided doses, approximately 12 hours apart.

Adolescents and children weighing 50 kg or more

The recommended starting dose is 50 mg/day. Brivaracetam may also be initiated at 100 mg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 100 mg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 50 mg/day to 200 mg/day.

Adolescents and children weighing from 20 kg to less than 50 kg

The recommended starting dose is 1 mg/kg/day. Brivaracetam may also be initiated at doses up to 2 mg/kg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 2 mg/kg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 1 mg/kg/day to 4 mg/kg/day.

Children weighing from 10 kg to less than 20 kg

The recommended starting dose is 1 mg/kg/day. Brivaracetam may also be initiated at doses up to 2.5 mg/kg/day based on physician's assessment of need for seizure control. The recommended maintenance dose is 2.5 mg/kg/day. Based on individual patient response, the dose may be adjusted in the effective dose range of 1 mg/kg/day to 5 mg/kg/day.

Missed doses

If patients missed one dose or more, it is recommended that they take a single dose as soon as they remember and take the following dose at the usual morning or evening time. This may avoid the brivaracetam plasma concentration falling below the efficacy level and prevent breakthrough seizures from occurring.

Discontinuation

For patients from 16 years of age, if brivaracetam has to be discontinued, it is recommended that the dose is reduced gradually by 50 mg/day on a weekly basis.

For patients below the age of 16 years, if brivaracetam has to be discontinued, it is recommended that the dose is reduced by a maximum of half the dose every week until a dose of 1 mg/kg/day (for patients with a body weight less than 50 kg) or 50 mg/day (for patients with body weight of 50 kg or more) is reached.

After 1 week of treatment at 50 mg/day, a final week of treatment at the dose of 20 mg/day is recommended.

Active ingredient

Brivaracetam

Brivaracetam displays a high and selective affinity for synaptic vesicle protein 2A (SV2A), a transmembrane glycoprotein found at presynaptic level in neurons and in endocrine cells. Although the exact role of this protein remains to be elucidated it has been shown to modulate exocytosis of neurotransmitters.

Read more about Brivaracetam

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