Perampanel is an anti-epileptic drug indicated for:

• Treatment of partial-onset seizures, with or without secondary generalized seizures, in patients with epilepsy aged 4 years and older.
• Adjunctive therapy for primary generalized tonic-clonic seizures in patients with epilepsy aged 12 years and older.

Perampanel is a non-competitive antagonist of the ionotropic α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) glutamate receptor located on postsynaptic neurons. Glutamate is the main excitatory neurotransmitter in the central nervous system and is involved in several neurological disorders caused by excessive neuronal excitation. The exact mechanism by which Perampanel produces its antiepileptic effect in humans is not fully understood.

Perampanel can be taken without regard to food. The dosage of Perampanel is as follows

• Starting dose: 2 mg once daily at bedtime. May increase dose based on clinical response and tolerability by increments of 2 mg once daily no more frequently than at weekly intervals.
• Recommended maintenance dose in monotherapy or adjunctive therapy for partial-onset seizures: 8 mg to 12 mg once daily at bedtime.
• Recommended maintenance dose in adjunctive therapy for primary generalized tonic-clonic seizures: 8 mg once daily at bedtime.

Mild and Moderate Hepatic Impairment: Maximum recommended daily dose is 6 mg (mild) and 4 mg (moderate) once daily at bedtime.

Severe Hepatic Impairment: Not recommended.

Severe Renal Impairment: Not recommended.

Elderly: Increase dose no more frequently than every 2 weeks.

• Contraceptives: Perampanel 12 mg once daily may reduce the effectiveness of hormonal contraceptives containing levonorgestrel.
• Moderate and strong CYP3A4 inducers (e.g. carbamazepine, oxcarbazepine, phenytoin) increase the clearance of Perampanel and reduce its plasma concentration.

None.

Perampanel may cause serious psychiatric and behavioral reactions, suicidal ideation, dizziness, somnolence, fatigue, irritability, falls, nausea, ataxia, and balance disorder.

Based on animal data, may cause fetal harm. There are no adequate human data on breast milk excretion or effects on the breastfed infant.

• Monitor for suicidal behavior and thoughts.
• Monitor for dizziness, somnolence, gait disturbance, and fatigue.
• Risk of falls and injury.
• Discontinue if severe hypersensitivity (DRESS) occurs.
• Do not stop suddenly in epilepsy patients due to risk of increased seizures.

Adjunct anti-epileptic drugs

Protect from light and moisture, store below 30°C. Keep out of reach of children.