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Keppra vs Briviact
Introduction
For patients with epilepsy, certain drugs that regulate the irregular electrical activity in the brain can help in controlling seizures and managing symptoms. Keppra and Briviact are two such antiepileptic drugs (AEDs) that are prescribed for this neurological disorder. They each impact different aspects of synaptic transmission in the brain, but both have seizure-controlling effects in patients with epilepsy. Keppra is a pyrrolidone derivative which binds to synaptic vesicle protein 2A (SV2A), influencing neurotransmitter release from synaptic vesicles. On the other hand, Briviact is an analog of levetiracetam (Keppra's active ingredient), also binding SV2A but at a much higher affinity than its predecessor, potentially resulting in better control over epileptic seizures.
Keppra vs Briviact Side By Side
| Attribute | Keppra | Briviact |
|---|---|---|
| Brand Name | Keppra | Briviact |
| Contraindications | May increase the risk of suicidal thoughts or behavior. Should not be taken with certain drugs like rifampin without a proper washout period. | May increase the risk of suicidal thoughts or behavior. Should not be taken with certain drugs like rifampin without a proper washout period. |
| Cost | For brand name, around $840 for 60 tablets of 500 mg. Generic versions significantly lower, between $0.20 and $2 per day. | For brand name, approximately $1,100 for 30 tablets of 50 mg. No generic version available yet. |
| Generic Name | Levetiracetam | Brivaracetam |
| Most Serious Side Effect | Mood or behavioral changes, including thoughts about suicide or self-harm. | Signs of an allergic reaction, changes in mood or behavior, severe dizziness and tiredness, unusual changes in muscle movement. |
| Severe Drug Interactions | Negative interactions with drugs like rifampin. | Negative interactions with drugs like rifampin. |
| Typical Dose | For adults and adolescents over 12 years old, starts at 1000 mg/day, divided into two doses. Maximum dosage should not exceed 3000 mg/day. | Starts at 50 mg/day, can be increased to 100 mg/day, divided into two doses. Maximum dose may be increased to 200 mg/day. |
What is Keppra?
Levetiracetam (the generic name for Keppra) is an antiepileptic drug that was first approved by the FDA in 1999. It belongs to a newer class of antiseizure medications and is used to treat different forms of epilepsy. Levetiracetam works by affecting the transmission of nerve signals in the brain, thus reducing seizure activity.
Brivaracetam (the brand name Briviact), like Keppra, also falls within this new generation of antiepileptic drugs and contains a derivative structure similar to levetiracetam. Approved by the FDA in 2016, it's considered more selective than Keppra and exhibits up to 15 times higher affinity towards synaptic vesicle protein 2A (SV2A) in the brain - which is thought to play a role in controlling seizures.
While both drugs are well-tolerated with few side effects, Briviact has shown lower incidences of behavioral side effects compared to Keppra such as aggression or agitation. However, these medications' effectiveness can vary significantly based on individual patient characteristics.
What conditions is Keppra approved to treat?
Keppra and Briviact are both approved for the treatment of different types of epilepsy:
- Keppra (levetiracetam) is used as monotherapy or adjunctive therapy in treating partial-onset seizures, myoclonic seizures, and primary generalized tonic-clonic seizures in adults and children.
- Briviact (brivaracetam), on the other hand, is used as an add-on medication to treat partial onset seizures in patients who are at least 16 years old.
How does Keppra help with these illnesses?
Keppra helps to manage epileptic seizures by reducing excessive electrical activity in the brain. It does this by binding to synaptic vesicle protein 2A (SV2A), present in neurons, which is believed to contribute to the modulation of neurotransmitter release and thus reduce neuron excitability. Epilepsy is a neurological disorder characterized by abnormal brain activity causing seizures or periods of unusual behavior, sensations, and sometimes loss of awareness. It's thought that individuals with epilepsy have an imbalance between excitatory signals that increase electrical activity and inhibitory signals that decrease it. Therefore, by modulating SV2A-mediated neurotransmission, Keppra can limit the negative effects of excessive neuronal firing and help patients manage their condition.
Similarly, Briviact also reduces seizure frequency but it has a higher affinity for SV2A compared to Keppra which makes it more potent at lower doses. This means fewer medication doses per day are required for effective seizure control with Briviact as compared to Keppra.
What is Briviact?
Briviact is a brand name for brivaracetam, which is an anticonvulsant medication. Similar to Keppra (levetiracetam), it works by binding to synaptic vesicle protein 2A in the brain, thereby reducing the hypersynchronization of neuronal firing, which can lead to seizures. However, Briviact has a higher affinity for this protein and hence may be more effective in controlling seizures compared to Keppra. The FDA first approved Brivaracetam in 2016 after clinical trials showed its efficacy as adjunctive therapy in treating partial-onset seizures.
Unlike many other seizure medications, Briviact does not interact with liver enzymes that metabolize drugs; therefore it has fewer drug-drug interactions than some older anti-seizure medicines. Its side effect profile also differs from these traditional agents: while drowsiness and fatigue are common with most antiepileptics like Keppra, Briviact seems less likely to cause irritability or depression but could potentially increase the risk of neuropsychiatric adverse events such as suicidal thoughts or behavior.
What conditions is Briviact approved to treat?
Briviact has been approved by the FDA for the treatment of:
- Partial-onset seizures in patients aged 4 years and older with epilepsy, a common neurological disorder characterized by recurrent seizures.
- Briviact can be used as monotherapy or adjunctive therapy, meaning it can be used alone or together with other medication to control seizures.
How does Briviact help with these illnesses?
Briviact, like Keppra, is a medication used in the treatment of seizures. It operates by binding to synaptic vesicle protein 2A (SV2A) in the brain, which plays a significant role in regulating the release of neurotransmitters and thus decreasing excessive electrical activity that can lead to seizures. Briviact has been shown to be effective at reducing seizure frequency and is often prescribed when first-line treatments such as Keppra are not sufficient or cause undesirable side effects. Though it works similarly to Keppra, Briviact binds more selectively to SV2A which may contribute to its potentially lower risk for side effects and improved tolerability amongst some patients. As an antiepileptic drug (AED), Briviact does not significantly affect serotonin levels but rather targets specific processes involved in seizure occurrence making it ideal for those who do not respond well or experience adverse reactions with other AEDs.
How effective are both Keppra and Briviact?
Levetiracetam (Keppra) and brivaracetam (Briviact) are both antiepileptic drugs used to manage seizures in patients with epilepsy. They were approved by the FDA several years apart, with Keppra gaining approval in 1999 and Briviact in 2016. Both medications work by binding to synaptic vesicle protein SV2A, thereby reducing nerve conduction across synapses and decreasing neuronal hyperactivity that leads to seizures.
The effectiveness of levetiracetam and brivaracetam has been directly compared in a number of clinical trials; these studies have shown similar efficacy between the two drugs for seizure control. However, there may be differences when it comes to side effects: some data suggests that Briviact might have a better tolerability profile than Keppra.
In terms of overall use, Levetiracetam is one of the most commonly prescribed antiepileptic drugs worldwide due its wide range of indications and generally good safety profile. The usual starting dose for adults is 500 mg twice daily which can be increased based on individual patient response up to a maximum dosage of 3000 mg per day.
Brivaracetam however, due its more recent introduction into the market does not yet share as broad usage as Levetiracetam but has been noted for its strong binding affinity - being up-to 15 times stronger than Levetiraceratm - potentially providing greater seizure control at lower doses. Like Keppra though, Briviact also carries risk factors including mood changes or feelings of depression so careful monitoring during treatment initiation is crucial.
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At what dose is Keppra typically prescribed?
Oral dosages of Keppra for adults and adolescents over 12 years old typically start at 1000 mg/day, divided into two doses. However, this may be adjusted based on individual response and tolerance. The maximum dosage should not exceed 3000 mg/day. For children aged between 1 month to less than 6 months, the initial recommended dose is usually around 14mg/kg twice daily. A similar approach is taken with Briviact; starting doses for adults are often set at approximately 50mg twice per day but can range up to a maximum of 200mg per day depending on patient response. Always consult your healthcare provider before changing any medication dosages.
At what dose is Briviact typically prescribed?
Briviact treatment generally commences at a dosage of 50 mg/day. The dose can then be increased to 100 mg/day, divided into two doses, spaced approximately 12 hours apart. If needed and tolerated, the maximum dose may be increased to 200 mg/day split into two doses of 100 mg each and taken about every twelve hours. Your healthcare provider might consider this higher dosage if there is no significant response to treatment at the standard daily dose after an adequate period.
What are the most common side effects for Keppra?
Common side effects of Keppra (levetiracetam) and Briviact (brivaracetam), two medications used to manage seizures, can include:
- Somnolence (sleepiness/drowsiness)
- Asthenia (general weakness and fatigue)
- Dizziness
- Anxiety
- Nervousness
- Insomnia
- Irritability or mood changes
- Tremor
- Nausea or vomiting
- Diarrhea
- Constipation
- Changes in weight or appetite
-Dry mouth
-Rash or itching skin
-Unusual tiredness -Infections such as flu syndrome, sinusitis, pharyngitis
Always remember that the presence of these symptoms does not mean they will occur in all individuals. Always seek medical advice when starting a new medication.
Are there any potential serious side effects for Keppra?
While both Keppra and Briviact are effective medications for controlling seizures, they can have serious side effects in rare cases. For Briviact:
- Watch out for signs of mood or behavioral changes, including thoughts about suicide or self-harm.
- Be aware of allergic reactions: hives, difficulty breathing, swelling in your face or throat.
- Monitor any changes in vision such as blurred vision or seeing halos around lights.
- Pay attention to heart-related issues like fast or pounding heartbeats, fluttering in your chest, shortness of breath and sudden dizziness (feeling like you might pass out).
- Low sodium levels can occur - symptoms include headache, confusion, slurred speech, severe weakness, vomiting and loss of coordination.
- Severe nervous system reaction is another potential risk – watch out for very stiff muscles (rigidity), high fever sweating confusion fast uneven heartbeats tremors feeling like you might pass out
- Symptoms such as agitation hallucinations fever sweating shivering fast heartbeat muscle stiffness twitching loss coordination nausea vomiting diarrhea could indicate a rare but serious condition known as serotonin syndrome.
Immediate medical attention should be sought if any of these side effects are experienced while taking Briviact.
What are the most common side effects for Briviact?
Briviact, like Keppra, is an antiepileptic drug but it may have different side effects:
- Drowsiness or fatigue
- Dizziness or imbalance
- Nausea and vomiting
- Irritability and mood swings
- Headache
- Difficulty sleeping (insomnia)
- Cough, upper respiratory tract infections
- Changes in behavior such as aggression or agitation. Remember that everyone reacts differently to medication. While these are potential side effects, not everyone who takes Briviact will experience them. It's important to talk with your healthcare provider about what you can expect when starting a new medication.
Are there any potential serious side effects for Briviact?
While Briviact is generally well-tolerated, it can occasionally lead to serious side effects. If you notice any of the following symptoms after starting Briviact, contact your doctor immediately:
- Signs of an allergic reaction: difficulty breathing; swelling in your face, lips, tongue or throat; hives or skin rash
- Changes in mood or behavior: agitation, aggression, depression, suicidal thoughts or actions
- Severe dizziness and tiredness
- Unusual changes in muscle movement such as unsteady walking (ataxia)
- Trouble sleeping (insomnia)
- Rapid heart rate In rare cases, a severe skin reaction may occur that requires immediate medical attention. This includes fever with swollen glands and abdominal pain leading to a red or purple skin rash that spreads especially in the face or upper body causing blistering and peeling.
Contraindications for Keppra and Briviact?
Both Keppra and Briviact, along with most other seizure medications, may increase the risk of suicidal thoughts or behavior in some people. If you notice worsening depression symptoms, an increase in suicidal ideation, thoughts or behaviors while taking these drugs, please seek immediate medical attention.
Neither Keppra nor Briviact should be taken if you are also using certain drugs that interact negatively with them such as rifampin. Always inform your physician about all medications you're currently taking; if a drug like rifampin has been used recently it would require a period of around 2 weeks to clear from your system to prevent harmful interactions with Keppra and Briviact.
Furthermore, remember to gradually reduce your dosage under the supervision of a healthcare professional when stopping treatment. Abrupt discontinuation can lead to increased seizures.
How much do Keppra and Briviact cost?
For the brand name versions of these drugs:
- The cost for a supply of 60 tablets of Keppra (500 mg) averages around $840, which works out to about $14-$28/day depending on your dose.
- The price for 30 tablets of Briviact (50 mg) is approximately $1,100. This works out to nearly $37/day.
Thus, if you are in the higher dosage range for Keppra (i.e., 3000 mg/day or higher), then the brand-name Briviact might be less expensive on a per-day treatment basis. However, please remember that cost should not be your primary consideration when determining which drug is right for you.
For generic versions of Keppra and Briviact (levetiracetam and brivaracetam respectively), costs are significantly lower:
- Levetiracetam can come in packs ranging from 30 up to hundreds with approximate costs between $0.20 and $2 per day depending on dosages typically between 250mg/day to as high as 3000mg/day.
- Currently, there's no generic version available yet for Brivaracetam but once it becomes available it could likely reduce costs drastically similar to how generic levetiracetam does compared to its branded counterpart.
Popularity of Keppra and Briviact
Levetiracetam, in generic form as well as brand names such as Keppra, was estimated to have been prescribed to about 3.6 million people in the US in 2020. Levetiracetam accounted for just over 15% of antiepileptic drug prescriptions in the US. It is a broad-spectrum anticonvulsant used to treat various seizure disorders and has seen a steady increase in prevalence since its launch.
Brivaracetam, also available under the brand name Briviact, was prescribed to approximately 120 thousand people within the same year. In the US, brivaracetam makes up around 1% of overall antiepileptic prescriptions and it's relatively new compared to levetiracetam having only been approved by FDA for use in adults with epilepsy since late-2015/early-2016. The prevalence of brivaracetam while currently lower than levetiracetam is expected to rise due its reported higher potency and fewer side effects.
Conclusion
Both Keppra (levetiracetam) and Briviact (brivaracetam) have proven to be effective in the management of epilepsy, with numerous clinical studies and meta-analyses showing that they are more efficacious than placebo treatments. They can sometimes be combined, but this is subject to careful consideration by a physician as they may interact with one another. Due to their different mechanisms of action — both being synaptic vesicle protein 2A ligands but Briviact having a higher binding affinity — they tend to be prescribed under different circumstances.
Keppra is often considered as a first-line treatment option for epileptic patients, whereas Briviact tends to serve as an adjuvant therapy or in patients who did not respond well to first-line antiepileptics like Keppra.
As for cost-effectiveness, both drugs are available in generic form which represents significant savings especially for patients who must pay out of pocket. Both medications may also require an adjustment period before effects become noticeable.
The side effect profile between the two drugs is similar; however, compared with Keppra, Briviact has been shown to induce fewer behavioral side effects such as irritability and aggression. For both drugs, it's crucial that patients closely monitor their seizure occurrences and immediately seek medical help if seizures worsen or new types appear.
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Refrences
- Hirsch, M., Hintz, M., Specht, A., & Schulze-Bonhage, A. (2018, October). Tolerability, efficacy and retention rate of Brivaracetam in patients previously treated with Levetiracetam: A monocenter retrospective outcome analysis. Seizure. Elsevier BV.http://doi.org/10.1016/j.seizure.2018.07.017
- von Rosenstiel, P. (2007, January). Brivaracetam (UCB 34714). Neurotherapeutics. Elsevier BV.http://doi.org/10.1016/j.nurt.2006.11.004