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HelpTest Code BRIVA Brivaracetam, Plasma
Specimen Required
Supplies: Sarstedt Aliquot Tube 5 mL (T914)
Collection Container/Tube:
Preferred: Lavender top (K2 EDTA)
Acceptable: Lavender top (K3 EDTA), green top (sodium or lithium heparin), light-blue top (sodium citrate)
Submission Container/Tube: Plastic vial
Specimen Volume: 1 mL
Collection Instructions:
1. Draw blood immediately before next scheduled dose.
2. For sustained-release formulations only, draw blood a minimum of 12 hours after last dose.
3. Within 2 hours of collection, centrifuge and aliquot plasma into a plastic vial.
Secondary ID
620767Useful For
Assessing compliance and toxicity for brivaracetam
Method Name
Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)
Reporting Name
Brivaracetam, PSpecimen Type
Plasma EDTASpecimen Minimum Volume
0.5 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Plasma EDTA | Refrigerated (preferred) | 28 days | |
| Ambient | 28 days | ||
| Frozen | 28 days |
Reject Due To
| Gross hemolysis | OK |
| Gross lipemia | OK |
| Gross icterus | OK |
Clinical Information
Brivaracetam is a newer antiepileptic drug, an analogue of levetiracetam, that is used as therapy for partial onset seizures in patients one month or older. It is available in both an oral and intravenous solution and oral tablet. When taken orally, it is rapidly and completely absorbed. It is primarily excreted through the renal system and has an elimination half-life of approximately nine hours. While the exact mechanism for brivaracetam's anticonvulsive effects is unknown, it has a high and selective binding affinity for synaptic vesicle protein 2A in the brain. The drug has a narrow therapeutic range and a wide interindividual variability in rate of elimination.
Adults and children 16 years and older typically take 25 mg twice daily up to 100 mg twice daily. Trough therapeutic reference ranges in plasma have been reported between 0.5 to 0.9 mcg/mL (mg/L) with toxicity more common above 1.8 mcg/mL. The most common adverse effects include somnolence/sedation, dizziness, fatigue, and nausea/vomiting. Vertigo, balance disorder, fatigue, nausea, diplopia, anxiety, and bradycardia have also been reported following brivaracetam overdose.
Reference Values
0.2-2.0 mcg/mL
Interpretation
The report is intended for use by a physician to determine if the patient is receiving a dose sufficient to achieve a therapeutic effect or to assess whether the patient is compliant with prescribed dose. The reference range represents the concentrations observed to be associated with greatest drug efficacy without side effects or toxicity.
Most individuals display optimal response to brivaracetam with plasma levels 0.2 to 2.0 mcg/mL. Some individuals may respond well outside of this range or may display toxicity within the therapeutic range; thus, interpretation should include clinical evaluation. Toxic levels have not been well established. Therapeutic ranges are based on specimens collected at trough (ie, immediately before the next dose).
Cautions
This test cannot be performed on whole blood.
Clinical Reference
1. Patsalos PN, Spencer EP, Berry DJ. Therapeutic drug monitoring of antiepileptic drugs in epilepsy: A 2018 Update. Ther Drug Monit. 2018;40(5):526-548
2. Aalapati KK., Amit S, Patnaik, RS. Method development and validation of a novel UHPLC coupled with MS/MS system for the estimation of brivaracetam in human (K2EDTA) plasma samples and its application to pharmacokinetic study. Curr Pharm Anal. 2022;18.5:504-512
3. Hiemke C, Bergemann N, Clement HW, et al. Consensus guidelines for therapeutic drug monitoring in neuropsychopharmacology: Update 2017 [published correction appears in Pharmacopsychiatry. 2018 Jan;51(1-02):e1]. Pharmacopsychiatry. 2018;51(1-02):9-62
4. Khaleghi F, Nemec EC 2nd. Brivaracetam (Briviact): A novel adjunctive therapy for partial-onset seizures. P T. 2017;42(2):92-96
5. Mohamed S, Riva R, Contin M. Development and validation of an UHPLC-MS/MS assay for the therapeutic monitoring of brivaracetam plasma concentrations in patients with epilepsy. Ther Drug Monit. 2020;42(3):445-451
Method Description
The plasma sample is diluted in an acetonitrile internal standard. The protein precipitate is centrifuged, and a portion of the supernatant is diluted with mobile phase 1 for analysis using liquid chromatography tandem mass spectrometry.(Unpublished Mayo method)
Day(s) Performed
Monday through Friday
Report Available
Same day/1 to 2 daysSpecimen Retention Time
14 daysPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test was developed and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. It has not been cleared or approved by the US Food and Drug Administration.CPT Code Information
80299
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| BRIVA | Brivaracetam, P | 88894-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 620767 | Brivaracetam, P | 88894-1 |