What to Do When You Can't Fill Your Briviact Prescription

If you've been prescribed Briviact (Brivaracetam) for seizures and you can't find it at your pharmacy, you're probably feeling anxious — and understandably so. Missing doses of an antiepileptic medication can put you at risk for breakthrough seizures, so finding a solution quickly is important.

Before exploring alternatives, try using Medfinder to locate a pharmacy near you that has Briviact in stock. You may also want to read our tips on how to find Briviact in stock. But if you've exhausted those options, here's what you need to know about alternative medications.

What Is Briviact and How Does It Work?

Briviact is a brand-name antiepileptic drug (AED) that contains the active ingredient Brivaracetam. It was approved by the FDA in 2016 and is manufactured by UCB, Inc. Briviact is used to treat partial-onset (focal) seizures in patients as young as 1 month old.

Briviact works by binding to a protein called synaptic vesicle protein 2A (SV2A) in the brain. This protein plays a role in how nerve cells release chemical signals. By binding to SV2A with high affinity, Briviact helps reduce the abnormal electrical activity that triggers seizures. For a more detailed explanation, see our article on how Briviact works.

Briviact is a newer relative of Levetiracetam (Keppra) — it's actually a chemical analog designed to be more potent and potentially better tolerated. It binds to SV2A with about 20 times greater affinity than Levetiracetam.

Alternatives to Briviact

Important: Never switch seizure medications on your own. Always work with your neurologist or epileptologist to make any changes to your treatment. Switching AEDs requires careful planning, including gradual dose adjustments, to minimize the risk of breakthrough seizures.

That said, here are the most commonly considered alternatives to Briviact:

1. Levetiracetam (Keppra)

Levetiracetam is the most closely related alternative to Briviact. Both drugs belong to the racetam family and work by targeting SV2A. In fact, Briviact was developed as an improvement over Levetiracetam.

• How it works: Binds to SV2A, similar to Briviact but with lower affinity
• Available forms: Tablets, extended-release tablets, oral solution, and IV injection
• Key advantage: Widely available as a generic at a much lower cost — often under $30 per month
• Key consideration: Some patients experience behavioral side effects with Levetiracetam (irritability, mood changes, aggression) that they don't experience with Briviact. If you switched to Briviact because of Keppra's side effects, going back may not be ideal.
• Typical dose: 500 mg to 1,500 mg twice daily

2. Lacosamide (Vimpat)

Lacosamide is another newer antiepileptic drug approved for partial-onset seizures. It works through a different mechanism than Briviact.

• How it works: Enhances slow inactivation of voltage-gated sodium channels, reducing abnormal neuronal firing
• Available forms: Tablets, oral solution, and IV injection
• Key advantage: Well-tolerated by many patients and available in multiple formulations. Can be used as monotherapy or add-on therapy.
• Key consideration: Like Briviact, it is a Schedule V controlled substance. It can cause dizziness and cardiac rhythm changes (PR interval prolongation), so an ECG may be recommended before starting.
• Typical dose: 100 mg to 200 mg twice daily

3. Perampanel (Fycompa)

Perampanel works through a completely different mechanism and may be an option if SV2A-targeting drugs aren't working well for you.

• How it works: Blocks AMPA receptors, which are involved in excitatory signaling in the brain
• Available forms: Tablets and oral suspension
• Key advantage: Once-daily dosing (taken at bedtime). Effective for both partial-onset seizures and primary generalized tonic-clonic seizures.
• Key consideration: Schedule III controlled substance with a higher potential for behavioral side effects including irritability and aggression. Dizziness is very common.
• Typical dose: 4 mg to 12 mg once daily at bedtime

4. Cenobamate (Xcopri)

Cenobamate is one of the newest AEDs on the market and has shown strong efficacy in clinical trials for hard-to-treat focal seizures.

• How it works: Dual mechanism — enhances sodium channel inactivation and positively modulates GABA-A receptors
• Available forms: Tablets
• Key advantage: High efficacy rates in clinical trials, including some patients achieving seizure freedom. May be considered when other AEDs haven't fully controlled seizures.
• Key consideration: Requires a very slow dose titration (starting at 12.5 mg) over several weeks. Can cause drowsiness and dizziness. Schedule V controlled substance.
• Typical dose: 200 mg to 400 mg once daily

How to Talk to Your Doctor About Alternatives

If you need to discuss alternatives with your doctor, here are some helpful points to cover:

• Why you can't access Briviact (cost, availability, insurance)
• How well Briviact has been controlling your seizures
• Any side effects you've experienced on Briviact or other AEDs in the past
• Whether you've tried Levetiracetam before and why you switched
• Your concerns about transitioning to a new medication

Your neurologist can weigh these factors to recommend the best alternative for your situation. If you need help finding a specialist, see our guide on how to find a doctor who prescribes Briviact.

Final Thoughts

Switching seizure medications is never a decision to take lightly, and an alternative should only be considered when you truly cannot access Briviact. Before making any changes, try Medfinder to find Briviact in stock near you, check with independent pharmacies, and contact UCBCares at 833-948-2394 for help.

If an alternative is necessary, work closely with your neurologist to choose the right medication and create a safe transition plan. For more on managing costs during this process, read our article on how to save money on Briviact.