Briviact Drug Interactions You Need to Know About

If you take Briviact (Brivaracetam) for seizures, it's important to know which other medications, supplements, and substances can interact with it. Some interactions can make Briviact less effective, while others can increase your risk of side effects.

This guide covers the most important Briviact drug interactions based on FDA labeling, so you can have an informed conversation with your doctor.

How Drug Interactions Work

Drug interactions happen when one substance changes how another works in your body. There are a few common ways this can happen:

• One drug speeds up metabolism of another — This means your body breaks down the medication faster, so there's less of it in your system. The drug becomes less effective.
• One drug slows down metabolism of another — The medication builds up to higher levels than intended, increasing the risk of side effects.
• Additive effects — Two drugs with similar side effects (like drowsiness) can amplify each other.

Briviact is metabolized in the liver, primarily by the enzyme CYP2C19. It can also affect the levels of other drugs that are processed by the same enzyme pathways.

Medications That Interact With Briviact

Major Interactions

Rifampin

Rifampin is an antibiotic used to treat tuberculosis and certain other infections. It's a powerful enzyme inducer, meaning it speeds up how your body processes many medications — including Briviact. If you take Rifampin, your Briviact levels can drop significantly, potentially making it less effective at controlling seizures.

What to do: Your doctor may need to double your Briviact dose while you're taking Rifampin. Never adjust your dose on your own.

Carbamazepine (Tegretol)

Carbamazepine is another antiepileptic drug. When taken with Briviact, the levels of carbamazepine-epoxide (an active metabolite of Carbamazepine) can increase. This can lead to increased side effects from Carbamazepine, including dizziness, double vision, and coordination problems.

What to do: Your doctor may need to adjust your Carbamazepine dose if you start or stop Briviact.

Phenytoin (Dilantin)

Briviact can increase Phenytoin levels in your blood. Since Phenytoin has a narrow therapeutic window (meaning the difference between an effective dose and a toxic dose is small), even a modest increase can cause side effects like nystagmus (involuntary eye movements), ataxia (loss of coordination), and confusion.

What to do: Your doctor should monitor your Phenytoin levels and may need to reduce your Phenytoin dose.

Selinexor (Xpovio)

Selinexor is used to treat certain blood cancers. Combining it with Briviact increases the risk of neurological toxicities. This combination should generally be avoided.

CNS Depressants

Medications that depress the central nervous system can amplify Briviact's sedative effects. These include:

• Benzodiazepines — Diazepam (Valium), Lorazepam (Ativan), Clonazepam (Klonopin)
• Opioids — Oxycodone, Hydrocodone, Morphine, Fentanyl
• Sleep aids — Zolpidem (Ambien), Eszopiclone (Lunesta)
• Muscle relaxants — Cyclobenzaprine (Flexeril), Baclofen
• Certain antihistamines — Diphenhydramine (Benadryl)

What to do: If you take any of these medications, be especially cautious about drowsiness and sedation. Avoid driving or operating machinery until you know how the combination affects you.

Moderate Interactions

Other antiepileptic drugs metabolized by CYP2C19

Since Briviact interacts with the CYP2C19 enzyme pathway, it may affect levels of other AEDs that use the same pathway. Your doctor will monitor your response and may adjust doses accordingly.

Remifentanil

This potent opioid, used primarily in surgical settings, can cause increased sedation when combined with Briviact.

Supplements and OTC Medications to Watch

Over-the-counter products can interact with Briviact too. Here are the main ones to be aware of:

• Diphenhydramine (Benadryl) — An antihistamine with sedative properties. Can increase drowsiness when combined with Briviact.
• Doxylamine (Unisom) — Another sedating antihistamine found in many sleep aids.
• St. John's Wort — This herbal supplement is a known enzyme inducer and may reduce Briviact levels, similar to Rifampin. Avoid it while taking Briviact.
• Melatonin — Generally considered safe, but may add to Briviact's sedative effects. Use with caution and tell your doctor.
• CBD (Cannabidiol) — Increasingly popular, CBD is processed by liver enzymes and could potentially affect Briviact levels. Research is limited, so discuss with your doctor before using CBD products.

Food and Drink Interactions

Alcohol

This is the big one. Alcohol should be avoided while taking Briviact. Both alcohol and Briviact depress the central nervous system, and combining them can cause:

• Excessive drowsiness
• Impaired coordination
• Slowed reaction time
• Increased risk of falls and accidents

Even moderate drinking can amplify these effects. If you choose to drink, discuss it with your doctor first.

Food

There are no significant food interactions with Briviact. You can take it with or without food. Taking it with a high-fat meal may delay absorption slightly (peak levels shift from about 1 hour to about 3 hours), but it doesn't change the total amount of medication your body absorbs.

Grapefruit

Unlike many medications, Briviact does not have a known interaction with grapefruit or grapefruit juice.

What to Tell Your Doctor

Before starting Briviact — and at every follow-up visit — make sure your doctor knows about:

• All prescription medications you take, especially other AEDs, antibiotics, and opioids
• Over-the-counter medications, including allergy medicine, sleep aids, and pain relievers
• Supplements and herbal products, especially St. John's Wort and CBD
• Alcohol use — be honest about how much and how often
• Any new medications — if another doctor prescribes something new, make sure they know you take Briviact

A complete medication list is one of the most important things you can bring to any doctor's appointment. Consider keeping a running list on your phone or in your wallet.

Final Thoughts

Briviact has fewer drug interactions than many antiepileptic medications, but the ones it does have are important. Rifampin, Carbamazepine, Phenytoin, and CNS depressants are the biggest ones to watch. Avoiding alcohol is also essential.

The best way to stay safe is to keep your doctor informed about everything you take — prescription, OTC, and supplements. And if you're looking for Briviact at a pharmacy near you, Medfinder can help you find it in stock.