Brivaracetam
Antiseizure medicines
Antiseizure medicines
A newer relative of levetiracetam that binds the synaptic vesicle protein SV2A more strongly. It treats focal seizures.
Quick facts
- Group
- Antiseizure medicines
- Target
- Synaptic vesicle glycoprotein 2A (SV2A)
- Used for
- Partial-onset
- Key effects
- Drowsiness · Extreme tiredness · Nausea
- Monitor
- Seizure diary · Mood · Liver disease
- ATC
- N03AX23
No doses: the clinician sets them by the current guideline.
Mechanism of action
The figure shows brivaracetam bound to human SV2A, a membrane protein of synaptic vesicles.
Brivaracetam is an analogue of levetiracetam and a high-affinity, selective ligand of SV2A, a protein of the synaptic vesicles that take part in neurotransmitter release. Binding SV2A is thought to modify vesicle function and reduce excessive release during a seizure. It also has some inhibitory effect on neuronal voltage-gated sodium channels.
- Brivaracetam binds SV2A with high affinity
- Synaptic vesicle release is modulated
- Excessive neuronal firing is damped
- Fewer focal seizures
Indications
- Partial-onset (focal) seizures Epilepsy and seizures →
Adverse effects
Common
- Drowsiness, sedation and dizziness
- Extreme tiredness
- Nausea, vomiting and constipation
- Blurred vision and poor balance
Contraindications
- Allergy to brivaracetam or any component of the product
Key interactions
- Alcohol
- Brivaracetam makes the effects of alcohol worse
- Other sedatives
- More drowsiness and poorer coordination
What is monitored
- Seizure diary
- Mood, behaviour and suicidal thoughts
- Liver disease (the dose may need adjusting)
Administration and safety
- Tablets swallowed whole with liquid; not split, chewed or crushed
- The liquid is measured with the device supplied, not a kitchen spoon
- It can be habit-forming: it is used only as prescribed
- It is tapered rather than stopped suddenly
Pregnancy and breastfeeding
Its safety in pregnancy is not well established; pregnancy is discussed with the treating team, who weighs the risk of uncontrolled seizures.
Nursing care
- Ask about depression, past substance use and liver disease before starting
- Assess drowsiness and fall risk
- Teach the family to report mood or behaviour changes
- Check the skin and mouth for rash or sores
Pharmacokinetics
- Absorption
- Rapidly absorbed by mouth; also available as a liquid and an injection
- Half-life
- Short; usually given twice a day
Test yourself
Think of the answer, then tap the question to see it.
What is the molecular target of brivaracetam?
The synaptic vesicle glycoprotein SV2A.
Which older antiseizure medicine is brivaracetam an analogue of?
Levetiracetam.
Which kind of seizures is brivaracetam approved for?
Partial-onset (focal) seizures.
Connections
← Back to the class: Antiseizure medicines
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Brivaracetam: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026); RCSB PDB - 8YF1: Cryo-EM structure of human SV2A in complex with Brivaracetam (RCSB Protein Data Bank, 2026).
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Representative model, for educational purposes only.