Perampanel

Class
Anticonvulsants
Subclass
AMPA receptor antagonists
Substance name
Perampanel
Brand names
Fycompa®
Common formulations
Tablet
Dosage and administration
Adults patients
Treatment
Focal seizures
•
2-12 mg PO daily
Adjunctive treatment
Adjunctive treatment for generalized tonic-clonic seizures
•
2-12 mg PO daily
Indications for use
Labeled indications
Adults
•
Treatment of focal seizures
•
Adjunctive treatment for generalized tonic-clonic seizures
Children
•
Adjunctive treatment for focal seizures
Safety risks
Boxed warnings
Behavioral disorders
•
Use extreme caution with pre-existing aggressive behavior or psychosis.
Warnings and precautions
Drug abuse
•
Use caution with known, suspected, or a history of substance abuse or drug addiction.
Suicidal ideation
•
Use caution with psychiatric disorders or a history of suicide attempt.
Specific populations
Renal impairment
eGFR 30-50 mL/min/1.73 m²
•
Reduce starting dose. Titrate slowly.
eGFR 10-30 mL/min/1.73 m²
•
Reduce starting dose. Titrate slowly.
eGFR < 10 mL/min/1.73 m²
•
Reduce starting dose. Titrate slowly.
Renal replacement therapy
Continuous renal replacement
•
Reduce starting dose. Dose as in eGFR 10-30 mL/min/1.73 m². Titrate with caution.
Intermittent hemodialysis
•
Reduce starting dose. Dose as in eGFR < 10 mL/min/1.73 m². Titrate with caution.
Peritoneal dialysis
•
Reduce starting dose. Dose as in eGFR < 10 mL/min/1.73 m². Titrate with caution.
Hepatic impairment
Child-Pugh A (mild)
•
Reduce dose. Start at dose of 2 mg PO qHS initially; increase by 2 mg/day increments no more frequently than q2weeks to the target dose. Maximal dose of 6 mg per day. Titrate slowly.
Child-Pugh B (moderate)
•
Reduce dose. Start at dose of 2 mg PO qHS initially; increase by 2 mg/day increments no more frequently than q2weeks to the target dose. Maximal dose of 4 mg per day. Titrate slowly.
Child-Pugh C (severe)
•
Do not use.
Pregnancy and breastfeeding
Pregnancy
All trimesters
•
Use only if benefits outweigh potential risks. Evidence of fetal harm in animals.
Breastfeeding
Acceptable for use during breastfeeding.
Very low levels in breastfed infants (< 5%).
Unlikely to cause adverse effects in breastfed infants.
Adverse reactions
Very common > 10%
•
Dizziness, fatigue, headache, irritability, somnolence
Common 1-10%
•
Ataxia, contusion, ↓ serum sodium, dysarthria, head trauma, hypersomnia, peripheral edema, abdominal pain, aggressive behavior, anxiety, arthralgia, asthenia, back pain, blurred vision, confusion, constipation, cough, diplopia, euphoria, falls, hypoesthesia, limb pain, memory impairment, musculoskeletal pain, myalgia, nausea, paresthesia, skin rash, throat pain, vertigo, vomiting, weight gain, skin laceration, urinary tract infections, upper respiratory tract infections
Unknown frequency
•
Agitation, altered mental status, DRESS syndrome, DRESS syndrome, delirium, drug withdrawal syndrome, ↑ serum triglycerides, psychosis, homicidal ideation, suicidal ideation
Interactions
Drug(s)
Check Interactions
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