Perampanel (Oral)

Perampanel is a tablet or suspension form of medication sold in the US as Fycompa and prescribed for the treatment and control of epileptic seizures.

Overview

Perampanel is a medication prescribed to patients who are older than 12 to control and treat partial-onset seizures that occur with epilepsy. This medication does not cure epilepsy, but can control the frequency and severity of seizures with regular use and may be combined with other treatments. Sold in the US as Fycoma, Perampanel is available in a tablet or in an oral liquid suspension format.

The first anti-epileptic type drug that was classed as a selective non-competitive AMPA receptor antagonist, Perampanel affects the brain by blocking certain enzymes from agitating the synapses in brain function that are hyperactive in patients diagnosed with epilepsy. Perampanel affects the motor cortex of the brain, which is the area that controls movement, both voluntary and involuntary. Perampanel is believed to stop the involuntary energy conduction activity in the brain cells of a patient having a seizure. By traveling through the neuron cell membranes, Perampanel acts as a damper for abnormal energy synapses, normalizing activity and calming the seizure. Perampanel works to stop seizure activity from spreading, reducing the chance of the seizure becoming full-blown, also known as grand mal.

While the entire effect on the brain is not entirely known, Perampanel has been approved for use in epileptic patients since 2012 but has been discontinued as a therapy for patients with migraines, Parkinson's disease, MS and neuropathic pain symptoms after studies indicated its lack of effectiveness.

Epilepsy is a brain condition that gives the patient seizures on a semi-regular basis. All brain activity is electrical, consisting of communication back and forth from cell to cell to create our movement, speech and all bodily functions. When a person has a seizure, it is the result of an explosion of electrical activity in the brain cells, which temporarily disrupts normal function.

The type of seizure a person has depends on the part of the brain that is affected by the energy burst. Not all seizures are epileptic in nature and not all seizures are controlled with drugs such as Perampanel.

Conditions Treated

  • Epileptic seizure, partial
  • Tonic-clonic seizure

Type Of Medication

  • Anti-epileptic agent
  • Central nervous system agent
  • AMPA inhibitor
  • Anti-convulsant

Side Effects

Perampanel directly affects certain functions of the brain and in doing so may cause unwanted effects on aspects of your health unrelated to your condition. If you have the following adverse health symptoms, get in touch with your doctor or nurse immediately:

  • Anxious feelings
  • Angry or aggressive behavior
  • Unsteady, clumsy actions
  • Dry mouth
  • Irregular rhythm of the heart
  • Hyperventilating
  • Irritable mood
  • Restless mood
  • Shaky, unsteady walk
  • Gasping for breath
  • Drowsy or sleepy in unusual circumstances
  • Difficulty sleeping or insomnia
  • Muscle coordination or control is off
  • Weak muscles
  • Fatigue
  • Decrease in sense of touch
  • Pins and needles or tingling, burning feelings
  • Behavioral changes
  • Depressed mood
  • Suicidal thoughts or tendencies

Other adverse effects on your health may be temporary in nature, resolving themselves after your system gets used to the medication. Report these symptoms to your physician in case there are methods you can take to ease these effects:

  • Lightheaded, dizzy feeling
  • Headaches
  • Vertigo
  • Nausea
  • Pain in abdomen or stomach
  • Back pain
  • Bloated, swollen face, feet, lower legs, hands or arms
  • Vision changes, double or blurred vision
  • Speech pattern changes
  • Aches or pains in the body or bones
  • Chills
  • Confused demeanor
  • Coughing
  • Urine output decreases
  • Constipation
  • Difficulty moving
  • Congested ears
  • Irregular or fast heart rhythm
  • Elevated body temperature
  • Thirst increases
  • Little to no physical strength
  • Vocal changes, slurred speech or trouble speaking
  • Cramped, painful or stiff muscles
  • Nasal stuffiness, runniness or sneezing
  • Vomiting
  • Upset stomach
  • Leg or arm pain
  • Join pain
  • Throat soreness
  • Memory loss
  • Weight changes
  • Difficulty waking
  • Dull, drowsy, sluggish feeling

Some patients may have unwanted health effects that are different than those listed here. Report any changes to your health, your mood or your wellbeing to your physician when taking Perampanel.

Dosage

Your prescription of Perampanel has been specifically written for you based on your overall health, your condition and other factors known to your physician through observation and testing. Do not alter the prescribed amount, frequency or term of your written instructions from your physician in any way or you risk adverse effects to your health that may be harmful. Read and understand all information provided to you with your prescription and ask any questions of your physician or pharmacist that are necessary for your clear knowledge of how Perampanel works.

If you are on the oral liquid suspension form of Perampanel, use only the syringe or cup to measure your dosage rather than any household containers, as these can vary widely. Shake the solution well before measuring your dose.

Adult patients and children who are over 12 years old will generally be prescribed two milligrams as a once-daily bedtime dose. Your dose may be adjusted according to your response to Perampanel, but will typically not exceed 12 milligrams total per daily dose. Children who are less than 12 years old will have the effective dose if any, determined by their physician.

Missing a dose of Perampanel should not compel you to double your dose. Take the missing dose as soon as you remember if it is far enough away from your next dose. Resume your regular dosing schedule as soon as possible.

Interactions

If you have ever experienced any hypersensitivity to a medication, including Perampanel, mention this to your physician. It is also best to disclose any sensitivity you have to animals, foods, perfumes, dyes or preservatives at this time.

Pediatric patients who are 12 years old and up should experience the same risk factors as adult patients and also have the same rate of effectiveness. Children under 12 have not been studied with sufficient data to prove their safety in taking Perampanel. Use in this age group should be avoided.

Geriatric patients may have age-related health conditions that could pose a risk for use of Perampanel that is higher than that of an average aged person. These health conditions will be taken into account by the prescribing physician, who may decide on another form of treatment or may reduce the dosage of Perampanel.

Women who are pregnant should not take Perampanel, as it has been determined that this drug has adverse health risks that are passed on to the fetus. Women who may become pregnant during their treatment with Perampanel should practice non-hormonal formulations of birth control, as this medication can interfere with the effectiveness of IUD as well as some oral contraceptives.

Women who are breastfeeding have not been studied scientifically to determine if they pass a risk-related amount of Perampanel on to their infants. Avoiding Perampanel treatment or discontinuing breastfeeding during treatment is recommended.

Some medications can be used together without issue, but others cause adverse health effects when combined. If you are taking any other drugs, inform your physician prior to treatment with Perampanel. Include any vitamins, over the counter remedies and even any herbal or holistic treatments you take.

Mention specifically if you are taking the following drugs, which are known to interact poorly with Perampanel but may be continued with an altered dose amount:

  • Buprenorphine
  • Bromazepam
  • Calcifediol
  • Butorphanol
  • Ceritinib
  • Carbamazepine
  • Codeine
  • Clarithromycin
  • Doxylamine
  • Dihydrocodeine
  • Fentanyl
  • Enzalutamide
  • Fosphenytoin
  • Flibanserin
  • Idelalisib
  • Hydrocodone
  • Orlistat
  • Meperidine
  • Oxycodone
  • Oxcarbazepine
  • Periciazine
  • Pentazocine
  • Remifentanil
  • Phenytoin
  • Rifampin
  • Rifabutin
  • Sodium Oxybate
  • Rifapentine
  • Sufentanil
  • St John's Wort
  • Zolpidem
  • Tramadol

The medication below may increase certain adverse health effects when taken in combination with Perampanel. Alert your doctor to your prescription of this medication in case of adjustment to one or both dosages:

  • Levonorgestrel

Check with your physician if you should avoid certain foods, alcoholic beverages or tobacco products prior to your treatment with Perampanel. It is specifically recommended that you avoid Ethanol and products that contain it while on this medication. Your physician will give you a list, special diet instructions or recommendations to be followed while taking Perampanel.

Certain medical conditions may also interact poorly with Perampanel; either by becoming worse themselves or render the medication ineffective or at a greater health risk to you. Inform your doctor of any illnesses you've had in the past or suspect that you have, with special attention to:

Warnings

Your condition will be monitored by regular office visits to your doctor to ensure that Perampanel is controlling your symptoms without causing any effects on your health that are dangerous. Your blood or urine may be sampled and tested to note any changes or effects of Perampanel.

Perampanel may affect the mental status of some patients in that they can become irritable, agitated or angry on an elevated basis. Patients just beginning their drug therapy or those who are changing their dosage amount report psychotic symptoms most frequently. Patients who feel hopelessly sad, get upset or hostile quickly or who feel nervous should report these feelings to their physician or to someone close to them who will get them assistance right away. Some patients experience thoughts of suicide, which should prompt you to seek help urgently.

Before you drive or operate tools or machinery, make sure you know how Perampanel affects your alertness or if it makes you less coordinated than normal. Do not put yourself or others at risk by driving or performing other tasks that require your full concentration and reaction.

Do not stop taking this medication without consulting your doctor and following the specific instructions given to you. Additionally, do not take more of this medication without a doctor's recommendation. Perampanel can be a habit-forming medication and should be taken as directed and your condition should be monitored on a regular basis.

Women who are taking hormonal forms of birth control should alert their physician to what type they are taking, as some will not be effective when combined with Perampanel. Your physician may put you on another form of birth control or offer other instruction while you are in treatment.

Medications and other substances that affect your central nervous system may be amplified when combined with Perampanel. These substances include other seizure medications, tranquilizers, sleep aids, cold and allergy medications and pain relievers. Inform your doctor prior to taking any other medication with Perampanel or avoid taking it if you can.

Storage

Perampanel is available through prescription only and should be taken only as directed. Keep this and other medicines out of sight and reach of children as a precaution. Perampanel should be kept in its original, labeled container at room temperature and not exposed to heat, moisture or direct light. Do not allow Perampanel to freeze. Outdated or unused Perampanel should be disposed of, with proper disposal at the advice of your health care professional or pharmacist.

Summary

Perampanel is an anticonvulsant drug prescribed to control seizures in epileptic patients. This medication works by altering electronic impulses in the brain to calm seizures before they begin. Perampanel is not a cure for epilepsy or any other seizure disorder.

Taken by mouth in liquid suspension or tablet form, this medication may be combined with other drug therapies for an overall health effect. Perampanel should be taken at the same times every day for the best results. Skipping or doubling doses or changing the prescribed amount of this medication is not recommended.

Patients who are hypersensitive to other medications or those with liver or kidney disease, history of mental illness, depression or drug addiction should not take Perampanel. Children who are younger than 12 and women who are pregnant or breastfeeding are other groups that should not take Perampanel due to the risk of health effects.

Perampanel may interact adversely with drugs such as pain relievers, sleep aids, other anti-seizure medications and alcoholic beverages. Avoid these substances when being treated with Perampanel or consult your doctor if you have questions about interactions. Women with some hormonal types of birth control should be aware that they can be rendered ineffective during therapy with Perampanel. Other forms of birth control should be used during treatment with this drug.

Perampanel has been linked to higher reports of psychotic episodes in some patients. Be aware of any changes in your behavior, mood or mental status including suicidal thoughts and seek immediate help if you experience any of these changes. Your caregiver and those close to you should be made aware of this possibility and assist you when appropriate.

Some effects may be mild and temporary and include drowsiness or lack of alertness, unsteadiness or weak muscles. Avoid driving or other dangerous situations until you are sure of your alertness. Report any changes to your health or demeanor to your physician right away.