Can brinsupri be taken once daily if causing severe headaches?

Managing Brivaracetam (Brinsupri) When Causing Severe Headaches

For patients experiencing severe headaches from brivaracetam, once-daily dosing is not recommended as it may worsen side effects due to higher peak plasma concentrations compared to divided dosing.

Understanding Medication-Related Headaches

Headaches are a known side effect of many antiepileptic medications, including brivaracetam. When managing medication-related headaches, several important principles should be considered:

• Medication-related headaches can significantly impact quality of life and may lead to poor medication adherence if not properly addressed 1
• Headaches from antiepileptic medications like brivaracetam are often dose-related and may be exacerbated by higher peak plasma concentrations 2
• Divided dosing schedules generally provide more favorable pharmacokinetic profiles with lower peak concentrations and higher trough concentrations 3

Optimal Dosing Strategy for Brivaracetam

When severe headaches occur with brivaracetam:

• Maintain the divided dosing schedule (typically twice daily) rather than consolidating to once daily, as this helps minimize peak concentration-related side effects 3
• Consider that once-daily dosing of medications with similar pharmacokinetic profiles has been shown to increase adverse effects, particularly neurological symptoms like headaches 3
• Individualized dosing adjustments should be based on the frequency and severity of headaches while maintaining seizure control 2

Management Options for Medication-Related Headaches

If severe headaches persist despite divided dosing:

• NSAIDs are first-line treatment for medication-induced headaches of moderate severity 1
• Acetaminophen combined with caffeine may provide relief for milder headaches, though acetaminophen alone is generally ineffective 1
• Avoid using opioids or butalbital-containing medications for chronic medication-related headaches as they can lead to dependency and rebound headaches 1

Important Considerations and Pitfalls

• Medication overuse headache can develop if acute headache treatments are used more than twice per week - limit rescue medications accordingly 1
• Rebound headaches can occur with frequent use of analgesics, particularly those containing caffeine, butalbital, or opioids 1
• If headaches remain severe despite optimal dosing and appropriate analgesic use, consider consulting with the prescribing neurologist about alternative antiepileptic options 1

Special Warning

• Never abruptly discontinue brivaracetam as this may precipitate seizures 2
• Any dosing changes should be made under medical supervision to ensure continued seizure control while managing side effects 2