A daily capsule to prevent hereditary angioedema attacks
Berotralstat
A daily oral capsule used to prevent attacks of hereditary angioedema.
What is Berotralstat?
Berotralstat is a specialist medicine used to prevent attacks of hereditary angioedema, a rare condition that causes sudden, severe swelling. It is taken as a daily capsule by mouth to reduce how often attacks happen, rather than to treat an attack once it has started. Stomach upset is common early on and usually settles. It can affect the heart's rhythm (the QT interval) and interacts with several other medicines, so the specialist team checks for these. As a preventer, it does not replace having a plan and medicine to treat breakthrough attacks.
Education and reference only. This is a plain-language guide to Berotralstat — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Berotralstat is a medicine used to prevent attacks in people with hereditary angioedema, an inherited condition in which episodes of severe swelling affect the skin, the gut or the airway. Unlike the injectable treatments, it is taken by mouth as a daily capsule, which some people find more convenient. It is a preventer aimed at reducing how often attacks occur in people with frequent episodes, and it is used alongside a separate plan for treating attacks that still break through. It is prescribed and supervised by a specialist service.
How it works
Attacks of hereditary angioedema are driven by a chemical called bradykinin. Berotralstat blocks an enzyme (plasma kallikrein) involved in making bradykinin, so less is produced and attacks become less frequent. Because it is taken every day, it keeps this enzyme dampened down over time to keep attack rates lower. Like the other preventers, it does not stop an attack already underway, so it is paired with a separate acute treatment plan.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist oral medicine used in the UK to prevent attacks of hereditary angioedema, taken as a daily capsule.
Practical use
How to take Berotralstat
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take one capsule by mouth each day, at about the same time, ideally with food to reduce stomach upset.
- Keep using your separate plan and medicine for treating any attack that breaks through, as this preventer does not treat attacks.
- Give a full list of your other medicines to your team, as berotralstat interacts with several of them.
- Tell your prescriber about any heart-rhythm problems or medicines that affect the heart rhythm.
- Seek emergency help straight away if an attack involves your throat, mouth or breathing.
Weighing it up
Advantages & disadvantages of Berotralstat
Advantages
- Reduces how often hereditary angioedema attacks happen, taken as a convenient daily capsule.
- An oral option for prevention rather than an injection.
- Suits people who would prefer not to use injections.
Disadvantages
- Prevents attacks but does not treat an attack that is already happening.
- Commonly causes stomach upset, especially in the first weeks.
- Can affect the heart's rhythm and interacts with a number of other medicines.
Practical use
Good to know
The main point with berotralstat is that it is an oral preventer: it reduces how often attacks happen but does not treat an attack that is already underway, so people still need a plan and medicine for breakthrough attacks. Stomach upset, such as tummy pain, diarrhoea or nausea, is common in the first weeks and usually eases; taking it with food can help. Two important safety points are that it can affect the heart's electrical rhythm (the QT interval), which the team may check, and that it interacts with a number of other medicines, both by affecting them and being affected by them, so it is important to give a full list of what you take. As with all hereditary angioedema, any attack involving the throat or airway is an emergency. The specialist team reviews how well it is working and checks for side effects and interactions.
Who should not take it / use with caution
- People who have had a serious allergic reaction to berotralstat should not take it.
- It is used with caution in people with certain heart-rhythm problems or those on medicines that affect the QT interval.
- It should only be used under a specialist hereditary angioedema service, with attention to interactions.
Monitoring
- Reviewing how often attacks happen to judge how well it is working.
- Checking for side effects, including heart-rhythm and liver blood tests where appropriate.
- Reviewing other medicines for possible interactions over time.
Side effects
- Stomach pain, diarrhoea, nausea or wind, especially in the first weeks of treatment.
- Headache or back pain in some people.
- Less commonly, changes in the heart's rhythm (the QT interval) or in liver blood tests.
Key interactions
- It can raise or lower the levels of several other medicines, so a full medicines list is important.
- Medicines that affect the heart's QT interval should be reviewed when taking berotralstat.
- Some medicines can change how well berotralstat itself works, so tell your team about everything you take.
Available as: Capsules taken by mouth.
Answers
Berotralstat: frequently asked questions
What is berotralstat used for?
It is taken as a daily capsule to prevent attacks of hereditary angioedema, by reducing production of the chemical that drives the swelling.
Can it treat an attack?
No. Berotralstat is a preventer; it does not treat an attack in progress, so you still need a separate plan and medicine for breakthrough attacks.
Why does it upset my stomach?
Stomach upset such as tummy pain or diarrhoea is common in the first weeks and usually eases; taking it with food can help.
Does it affect the heart?
It can affect the heart's electrical rhythm (the QT interval), so your team may check this and review other medicines that do the same.
Why does my team need my full medicines list?
Berotralstat interacts with a number of other medicines, affecting them or being affected by them, so a complete list helps keep treatment safe.
Authoritative sources
- BNF
- NICE CKS
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