Perampanel

Mechanism :

Exact mechanism is not known. It is a non-competitive antagonist of AMPA glutamate receptor on postsynaptic neurons.

Indication :

Partial-onset seizures: who are Perampanel ≥4 years of age
Primary generalized tonic-clonic seizures: who are ≥12 years of age.

Contraindications :

Hypersensitivity to perampanel or any component of the formulation.

Dosing :

Initial:

2 mg PO once daily at bedtime; may increase by 2 mg at weekly intervals. Maintenance dose: 8 to 12 mg PO once daily at bedtime.

Adverse Effect :

Peripheral edema, dizziness, hostility, aggressive behaviour, abnormal gait, fatigue, irritability, skin rash, weight gain, hyponatremia, vomiting, nausea, abdominal pain, constipation, UTI, bruise, back pain, URTI.

Interaction :

CNS Depressants: Perampanel may enhance the CNS depressant effect of CNS Depressants.
CYP3A4 Inducers: May decrease the serum concentration of Perampanel.
Mefloquine: May diminish the therapeutic effect of Anticonvulsants.
Selective Serotonin Reuptake Inhibitors: CNS Depressants may enhance the adverse/toxic effect of Selective Serotonin Reuptake Inhibitors.

Hepatic Dose :

Mild to moderate hepatic impairment: Start with 2 mg/day PO and then increase by 2 mg after 2 weeks based on patient’s response. The therapy should not exceed 6 mg/day for mild impairment and 4 mg/day for moderate impairment.
Severe hepatic impairment: Use is not recommended.