perampanel at a glance
Medicine class
Anti-seizure treatment and selective, non-competitive AMPA receptor antagonist
Licensed role
Add-on treatment for focal-onset seizures and primary generalised tonic-clonic seizures in eligible age groups
Food
May be taken with or without food, preferably consistently
Important practical risk
Dizziness, sleepiness, balance problems and behavioural changes can occur
What is perampanel used for?
Selected UK products are licensed as add-on treatment for:
Focal-onset seizures, with or without progression to bilateral tonic-clonic seizures, from 4 years of age.
Primary generalised tonic-clonic seizures associated with idiopathic generalised epilepsy, from 7 years of age.
How does perampanel work?
Perampanel blocks AMPA receptors without competing with glutamate. This reduces fast excitatory signalling between brain cells; its precise anti-seizure mechanism in humans is not fully established.
perampanel preparations and strengths
Oral suspension
Route: Oral
Strengths: 0.5 mg/mL
Tablet
Route: Oral
Strengths: 2 mg, 4 mg, 6 mg, 8 mg, 10 mg, 12 mg
How to take perampanel
Follow the product instructions and prescriber's directions. Keep administration consistent in relation to food.
Swallow tablets whole with water; do not chew, crush or split them.
Shake the oral suspension before use and measure it with the supplied oral syringe and bottle adapter.
Leave the suspension adapter in the bottle, replace the cap after use and clean the syringe as directed.
Switching between tablets and suspension should be undertaken cautiously.
perampanel side effects
Common or expected effects
- Dizziness or sleepiness
- Aggression, anger, irritability, anxiety or confusion
- Poor coordination, balance or walking problems
- Blurred or double vision, or vertigo
- Nausea, fatigue or back pain
- Appetite or weight changes
- Falls
Get urgent medical advice
- Suicidal thoughts or attempted suicide
- Severe aggression, threatening behaviour, hallucinations or psychosis
- DRESS: rash with fever, swollen glands, blood abnormalities or organ involvement
- Stevens–Johnson syndrome: painful blistering rash, skin peeling or sores affecting the mouth, eyes or genitals
perampanel in pregnancy
Pregnancy information remains limited, so routine use during pregnancy is not recommended in product information. However, uncontrolled seizures can be dangerous, and perampanel may be continued when a specialist judges it necessary. Do not stop it because of pregnancy without prompt epilepsy-specialist review.
perampanel while breastfeeding
It is unknown whether perampanel passes into human milk, and risk to a breastfed infant cannot be excluded. A specialist should weigh seizure control against breastfeeding benefits and possible infant exposure.
perampanel interactions
Check prescribed, over-the-counter and herbal products before starting or stopping them.
Carbamazepine, oxcarbazepine and phenytoin
These enzyme-inducing anti-seizure treatments can substantially reduce perampanel exposure. Clinical response needs reassessment when they are added or withdrawn.
Rifampicin and St John's wort
Strong enzyme induction is expected to reduce perampanel concentrations and potentially reduce seizure control.
CYP3A inhibitors such as ketoconazole
These may increase and prolong perampanel exposure, requiring review for adverse effects.
Common questions about perampanel
Answers are fully visible for fast scanning and source review.
Can perampanel tablets be crushed or split?
No. Selected tablets should be swallowed whole with water and cannot be divided accurately.
Can perampanel be taken with food?
Yes. It may be taken with or without food, but administration should remain consistent.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.