Peranel

Indications

Perampanel is an anti-epileptic medicine. It is used to control focal (partial-onset) seizures, with or without spread to both sides of the brain, and as an add-on treatment for primary generalised tonic-clonic seizures. It is used in adults and in children above a certain age, as decided by the doctor.

How It Works

Glutamate is a chemical messenger that excites nerve cells. Perampanel blocks AMPA receptors, one of the main sites where glutamate acts. This calms the over-excited nerve activity in the brain that causes seizures.

Dosage and Administration

Take as prescribed. It is taken once a day at bedtime, with or without food. Treatment is started at a low dose and increased slowly, usually every 1 to 2 weeks, until seizures are controlled; your doctor will set your dose. Swallow the tablet whole with water. Do not stop suddenly, as this can trigger seizures; the doctor will reduce the dose gradually if it needs to be stopped.

Interactions

Carbamazepine, Oxcarbazepine and Phenytoin speed up the breakdown of Perampanel and lower its effect, so a higher dose may be needed. Alcohol and other medicines that cause drowsiness add to its effects and may worsen mood, anger and alertness. At higher doses it may make hormonal contraceptives containing Levonorgestrel less reliable, so an extra non-hormonal method is advised.

Contraindications

• Allergy to Perampanel or any ingredient
• Severe liver disease
• Severe kidney disease or dialysis, unless a doctor advises

Side Effects

Common side effects are dizziness, sleepiness, tiredness, irritability, unsteadiness, falls, blurred or double vision, nausea, weight gain and changes in appetite. Mood and behaviour changes such as aggression, anger, hostility, anxiety or confusion can occur, especially at higher doses.

Get urgent medical help if you or your family notice thoughts of self-harm or suicide, serious aggression or violent behaviour, unusual changes in mood or thinking, or a serious skin reaction with fever, rash, swollen glands or blistering.

Pregnancy and Lactation

Information in pregnancy is limited. Do not stop it on your own if you become pregnant, because uncontrolled seizures can harm mother and baby; talk to your doctor promptly, ideally before planning pregnancy. It is not known if it passes into breast milk; ask your doctor before breastfeeding.

Precautions and Warnings

Families and carers should watch for changes in mood or behaviour, especially in the first weeks and after dose increases. Dizziness and sleepiness can affect driving and using machines; avoid these until you know how it affects you. Older people have a higher risk of falls. Take care with mild to moderate liver or kidney problems.

Overdose

Overdose may cause severe drowsiness, confusion, changes in mental state and aggressive behaviour. Seek emergency medical help; treatment is supportive and the effects may last for some time because the medicine stays long in the body.

Therapeutic Class

Anti-epileptic (AMPA receptor antagonist)

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.