. 2019 Sep 9;15:2587–2600. doi: 10.2147/NDT.S143548

Table 4.

Comparisons of pharmacological properties of brivaracetam and levetiracetam

	Brivaracetam	Levetiracetam
Discovery	Target-based rational drug discovery program	Screening in audiogenic seizure susceptible mice
Available formulations	Oral and intravenous	Oral and intravenous
Approval status (FDA) Focal-onset seizures Generalized onset seizures	First time approval in 2016 Yes (for age >4 years old) No	First time approval in 1999 Yes (for age >1 month old) Yes Primary generalized GTCs (age >6 years old) Myoclonic seizures (>12 years old)
Mechanism of action	Selective binding to SV2A	Binding to SV2A Inhibition of AMPA receptors Inhibition of high-voltage-gated calcium currents
Binding affinity to SVA2	15–30 times higher than LEV	-
Drug entry to the brain	Fast speed of entry (within minutes)	Longer than BRV (1 hr)
Clinically relevant drug interactions	With rifampin and combined oral contraceptives	None
Involvement of CYP450 enzymes	Yes	No
Dosing adjustments in liver failure	Required in severe cases	Not required
Dosing adjustments in renal failure	Not required	Required
Behavioral and psychiatric adverse events	3%	10–15%
Effect on cognition	Suspected to be similar to LEV	Neutral⁸⁶ or positive⁸⁷^,⁸⁸ effect on cognition First-line therapy for dementia-related epilepsy
Switching from LEV to BRV	10:1–15:1 without titration	–

Abbreviations: AMPA, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor; BRV, brivaracetam; CYP450, Cytochrome P450; FDA, Food and Drug Administration; GTCs, generalized tonic-clonic seizures; LEV, levetiracetam; SV2A, synaptic vesicle glycoprotein 2A.