II. Indications
- Refractory partial-onset Seizures
- Generalized Tonic Clonic Seizures (adjunct)
III. Contraindications
- Severe renal disease
- Severe liver disease
- Combination with strong CYP3A4 Inducers
IV. Mechanism
- Antiepileptic
- Glutamate receptor Antagonist (first in the class)
V. Precautions
- FDA Schedule III
- Abuse potential due to associated euphoria
VI. Adverse Effects
- Mood changes
- Euphoria
- Anger, irritability or hostility
- Dizziness, Vertigo or Ataxia
- Headache
- Weight gain
- Sedation
- Caution when combined with other CNS Depressants
VII. Dosing: Adults and Children over Age 12 years
- FDA approved for age over 12 years
- Initial: 2 mg orally at bedtime
- Titrate To: 4-8 mg orally at bedtime (increase by 2 mg/day on a weekly basis)
- Slow dose titration to every 2 weeks or less in the elderly
- Slow dose titration in moderate renal Impairment (avoid in severe renal Impairment)
- Maximum: 12 mg/day
- Hepatic Impairment: 6 mg/day max in mild disease, 4 mg max in moderate disease (avoid in severe liver disease)
VIII. Drug Interactions
-
Levonorgestrel containing contraceptives
- Perampanel at maximum dose (12 mg/day) decreases the contraceptive efficacy
- Use alternative Contraception
-
CYP3A4 Inducers
- Increase starting dose to 4 mg in moderate enzyme inducers
- Avoid with strong enzyme inducers
IX. Safety
- Unknown Safety in Pregnancy
- Developmental toxicity in animals
- Unknown Safety in Lactation
X. Resources
XI. References
- (2014) Presc Lett 21(11): 65
- (2022) Presc Lett, Resource #361206, Antiseizure Medications
- Olson (2020) Clinical Pharmacology, Medmaster Miami, p. 56-7
- Hamilton (2020) Tarascon Pocket Pharmacopoeia
- French (2012) Neurology 79(6):589-96 [PubMed]
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