Perampanel

FYCOMPA

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What it isSelective non-competitive AMPA receptor antagonist; focal and generalized seizures.

Why this oneA mechanism no other antiepileptic uses, so it adds where others have failed, and it is once daily at night.

What limits itSerious psychiatric and behavioral reactions, including aggression. Dizziness; CYP3A4-dependent.

FDA-approved for

seizures (2012)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Serious or life-threatening psychiatric and behavioral reactions (aggression, hostility, irritability, anger, homicidal ideation/threats); monitor especially during titration and at higher doses.

FDA dosing	Population	Start	Target	Max
Partial-onset seizures (monotherapy or adjunctive)	>=4 yr	2 mg QHS	8-12 mg QHS	12 mg QD
Primary generalized tonic-clonic seizures (adjunctive)	>=12 yr	2 mg QHS	8 mg QHS	12 mg QD

Titration Increase by 2 mg/day no more than weekly (no more than every 2 weeks in elderly).

Renal Mild: no adjustment. Moderate: use with caution, consider slower titration. Severe or hemodialysis: not recommended.

Hepatic Mild: max 6 mg/day. Moderate: max 4 mg/day. Severe: not recommended.

With moderate/strong CYP3A4 inducers (e.g., carbamazepine, phenytoin, oxcarbazepine): start 4 mg QHS.

Instructions

Take once daily at bedtime
With moderate/strong CYP3A4 inducers, start at 4 mg QHS
Do not withdraw abruptly (seizure risk)
Avoid alcohol

Cautions

Serious psychiatric and behavioral reactions (see Boxed Warning)
Suicidal behavior and ideation
Dizziness, gait disturbance, somnolence, fatigue - caution driving/operating machinery
Falls with serious injury
DRESS/multiorgan hypersensitivity
Do not withdraw AEDs abruptly

Adverse reactions

Dizziness, somnolence, fatigue
Irritability, anxiety
Falls
Nausea, vomiting, abdominal pain
Weight gain
Vertigo, ataxia, headache

Pregnancy No adequate human data; animal studies show developmental toxicity - may cause fetal harm.

Lactation No human data; present in rat milk - weigh benefits against risk.

⚠ BOXED WARNING

Serious psychiatric and behavioral reactions

Cost, est. cash$300–$2,500/month

Generic entry2025

Classes and tags

Clinical profile

Therapeutic safety burden2 / 4

Overdose danger2 / 4

Weight-gain liability1 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryC

Defining liabilitySedation, dizziness and agent-specific rash, behavioral, hepatic, hematologic or teratogenic toxicity.

Mechanism of action: Perampanel ballicule

Perampanel ballicule: receptor binding, kinetics and half-life diagram

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Memory aids: mascots and interaction avatars

Perampanel FYCOMPA mascot mnemonic cartoon — **“FICO Perm panel”**
Perampanel has AMPA in its name → AMPA receptor antagonist
Gun → boxed warning for severe behavioral reactions, including homicidal ideation

CYP3A4 substrate

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