Perampanel

FYCOMPA

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Pronunciation: per-AM-pa-nel (fye-KOM-pa)

Perampanel ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Perampanel ballicule

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

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 itDizziness, somnolence and ataxia limit titration; enzyme inducers (carbamazepine, phenytoin) cut levels sharply.

Pearls

Half-life about 105 h; titrate no faster than weekly.
Weight gain occurs.
Schedule III.

Perampanel molecular structure (skeletal formula) — Molecular structure: Perampanel

Perampanel prescription history

Animated chart of estimated U.S. prescriptions per year, Antiseizure meds (1869–2026). Perampanel enters in 2014 (estimated).

FDA-approved for

seizures (2012)

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.

FDA label

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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

Available strengths

tab 2, 4, 6, 8, 10, 12 mg
susp 0.5 mg/mL

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.

Cost

Perampanel (FYCOMPA)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $	CostPlus
2 mg	tab	30 qd	$192.95/mo	not offered
4 mg	tab	30 qd	$433.02/mo	not offered
6 mg	tab	30 qd	$549.14/mo	not offered
8 mg	tab	30 qd	$551.29/mo	not offered
10 mg	tab	30 qd	$469.30/mo	not offered
12 mg	tab	30 qd	$431.92/mo	not offered
0.5 mg/mL	susp	per unit	$3.95/mL	not offered