Perampanel

Actions

• Noncompetitive antagonist of postsynaptic AMPA receptors.

Metabolism

Hepatic

Enzymes involved

• CYP3A4

Elimination

Fecal ~48%

Half-life

105 hours

Plasma protein binding

95-96%

Important side-effects

Serious or life-threatening psychiatric and behavioral adverse reactions including aggression, hostility, irritability, anger, homicidal and suicidal ideation and behavior.

Indications

Adjunctive treatment of focal seizures with or without generalization.

Dosing recommendation

Start with 2 mg/day in a single dose.

Increase by increments of 2 mg once daily every week.

Target dose: 8-12 mg/day in a single dose.

Renal impairment

Slower titration and monitoring of serum levels is recommended in patients with impaired renal function.

Hepatic impairment

Slower titration is recommended in patients with mildly or moderately impaired hepatic function. Maximum recommended dose is 6 mg/day for patients with mild hepatic impairment and 4 mg/day for patients with moderate hepatic impairment. Parampanel is not recommended in patients with severe hepatic impairment.