RESTRICTED:

Continuation of patient’s oral home medication:

• Patients < 4 years of age: Brivaracetam is non-formulary. Patients may use home med.
• Patients > 4 years of age: Brivaracetam use is not restricted.

 New inpatient therapy initiation: Brivaracetam use is restricted to Epilepsy service line and the following criteria for use:

• If injection, patient must be > 16 years of age; if oral, patient must be > 4 years of age

AND

• Diagnosis of partial-onset seizures

AND

• Documentation of inadequate response, intolerance, or contraindication to 2 first-line AEDs PLUS levetiracetam 

• Inadequate response to levetiracetam shall be defined by:

• Patient has received a loading dose of at least 2,000 mg and continues to have ongoing ictal activity suggestive of status epilepticus on EEG

AND/OR

• Patient has ongoing recurrent seizures despite a reasonable dose of levetiracetam (2,000-6,000 mg/day) for a minimum of 4 doses.

AND

• Maximum treatment duration of 4 consecutive days for IV brivaracetam
  

AND

• Concurrent use of brivaracetam and levetiracetam will not be permitted as current data suggests that there is no additional benefit of concomitant therapy.

• UpToDate
• Lexicomp
• DailyMed Package Inserts
• Johns Hopkins Guides