Perampanel

Perampanel is a non-competitive antagonist of the AMPA receptor, which plays a critical role in glutamate-mediated excitatory neurotransmission in the brain. It is primarily used as an adjunctive treatment for seizures.

Indications

-Adjunctive treatment of partial-onset seizures with or without secondary generalized seizures in patients aged 12 years and older. -Adjunctive treatment for primary generalized tonic-clonic seizures in patients aged 12 years and older.

Dosage

Partial-Onset Seizures: -Start with 2 mg once daily at bedtime. -May increase by 2 mg increments every week based on response and tolerability. Maintenance dose: 4–12 mg once daily. Primary Generalized Tonic-Clonic Seizures: -Start with 4 mg once daily at bedtime. -Increase by 2 mg increments as needed, up to a maximum of 8–12 mg daily.

Contra-Indications

-Hypersensitivity to Perampanel or its components. -Severe hepatic impairment.

Special Precautions

-Use with caution in patients with a history of psychiatric disorders, aggression, or suicidal ideation. -Monitor for mood changes or behavioral disturbances. -Avoid abrupt discontinuation to reduce the risk of increased seizure frequency. -Use cautiously in patients with moderate hepatic or renal impairment.

Side Effects

-Common: Dizziness, somnolence, fatigue, nausea, irritability. -Serious: Behavioral changes, aggression, suicidal thoughts, gait disturbances. -Rare: Serious skin reactions, angioedema.

Drug Interactions

-Concomitant use with strong CYP3A4 inducers (e.g., carbamazepine, phenytoin, or rifampin) may reduce the efficacy of Perampanel. -May increase CNS depressant effects when used with alcohol or sedative drugs.