Can't find Briviact? Learn about alternatives like Keppra, Vimpat, and Fycompa — how they compare, what to discuss with your neurologist, and what to consider.
Briviact (brivaracetam) is an effective anti-seizure medication, but it's not always easy to find at your local pharmacy. Whether you're dealing with availability issues, insurance coverage problems, or cost concerns, you may be wondering: are there alternatives that could work for me?
The short answer is yes — but with an important caveat. Never switch seizure medications on your own. Changing anti-epileptic drugs (AEDs) requires careful medical supervision because abrupt changes can trigger breakthrough seizures or even status epilepticus, a life-threatening condition. Always work with your neurologist before making any changes.
That said, it's helpful to understand what alternatives exist so you can have an informed conversation with your doctor.
Briviact is the brand name for brivaracetam, an anticonvulsant approved by the FDA in 2016 for the adjunctive treatment of partial-onset (focal) seizures. It's manufactured by UCB and is available as tablets, oral solution, and intravenous injection.
Briviact works by selectively binding to synaptic vesicle glycoprotein 2A (SV2A) in the brain. This protein plays a key role in how nerve cells package and release neurotransmitters. By modulating SV2A activity, Briviact helps reduce the abnormal electrical activity that causes seizures.
Briviact is chemically related to Levetiracetam (Keppra) but has a higher affinity for SV2A — roughly 15 to 30 times stronger binding. This is part of why many neurologists prescribe Briviact for patients who respond well to the SV2A mechanism but can't tolerate Keppra's behavioral side effects.
How it works: Like Briviact, Levetiracetam binds to SV2A, though with lower affinity. It's the most closely related alternative.
Availability: Widely available as a generic. You can find it at virtually any pharmacy in the country.
Cost: Generic Levetiracetam is very affordable — typically $15 to $50 per month without insurance, compared to $1,500+ for brand Briviact.
Key differences: The main reason many patients switch from Keppra to Briviact is behavioral side effects. Levetiracetam is known for causing irritability, mood changes, aggression, and depression in some patients — sometimes called "Keppra rage." Briviact tends to have a better behavioral side effect profile. If you originally switched to Briviact because of these issues, going back to Keppra may not be ideal.
Forms: Tablets, extended-release tablets, oral solution, injection.
How it works: Lacosamide has a different mechanism than Briviact. It enhances the slow inactivation of voltage-gated sodium channels, which stabilizes overexcited nerve cells.
Availability: Available as both brand (Vimpat) and generic. More widely stocked than Briviact at chain pharmacies, though it's also a Schedule V controlled substance.
Cost: Generic Lacosamide runs approximately $80 to $200 per month. Brand Vimpat is approximately $700 to $1,000 per month.
Key differences: Because it uses a completely different mechanism, Lacosamide may be a good add-on option or substitute for patients with different seizure patterns. Common side effects include dizziness, headache, nausea, and double vision. It requires an EKG before starting (can cause PR interval prolongation).
Forms: Tablets, oral solution, injection.
How it works: Perampanel is an AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid) receptor antagonist. It works by blocking glutamate activity at AMPA receptors, reducing excitatory neurotransmission.
Availability: Brand-only (Fycompa). Available at specialty pharmacies and some larger chain pharmacies. It's a Schedule III controlled substance.
Cost: Approximately $1,200 to $1,500 per month without insurance. Manufacturer savings programs are available through Eisai.
Key differences: Perampanel is approved for both focal seizures and primary generalized tonic-clonic seizures. It's taken once daily (at bedtime), which some patients prefer. Side effects can include dizziness, drowsiness, and — notably — psychiatric side effects including aggression and hostility, particularly at higher doses. The FDA requires a boxed warning about serious psychiatric and behavioral reactions.
Forms: Tablets, oral suspension.
How it works: Cenobamate has a dual mechanism — it blocks voltage-gated sodium channels and positively modulates GABA-A ion channels. This makes it effective through two complementary pathways.
Availability: Brand-only (Xcopri). Available through specialty pharmacies and the Xcopri REMS program.
Cost: Approximately $800 to $1,200 per month without insurance. SK Life Science offers patient savings programs.
Key differences: Cenobamate is one of the newer AEDs and has shown impressive efficacy in clinical trials for focal seizures. It requires very slow dose titration (weeks to months to reach target dose) to minimize side effects. It's approved for adults only. Common side effects include somnolence, dizziness, and fatigue.
Forms: Tablets.
If you're considering alternatives to Briviact, come prepared to discuss:
If Briviact is working well for you, switching should be a last resort. Before you explore alternatives, try these steps to find your current medication:
Briviact is a valuable medication for many people with epilepsy, and the fact that it can be hard to find doesn't mean there aren't solutions. But if you genuinely need an alternative, medications like Levetiracetam, Lacosamide, Perampanel, and Cenobamate each offer different mechanisms and profiles that your neurologist can evaluate for your specific situation.
The most important thing: don't make changes on your own. Work with your medical team, and use tools like Medfinder to keep your treatment on track.
You focus on staying healthy. We'll handle the rest.
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