Home Drug Guide Perampanel

Drug Guide

Generic Name

Perampanel

Brand Names Fycompa

Classification

Therapeutic: Anticonvulsant, Antiepileptic

Pharmacological: AMPA receptor antagonist

FDA Approved Indications

  • Partial-onset seizures with or without secondarily generalized seizures in patients 4 years and older
  • Primary generalized tonic-clonic seizures in patients 12 years and older

Mechanism of Action

Perampanel is a selective, non-competitive antagonist of the alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor, which inhibits excitatory neurotransmission mediated by glutamate, reducing seizure activity.

Dosage and Administration

Adult: Initial dose: 2 mg once daily at bedtime, titrate up in 2 mg increments weekly to a target dose of 8-12 mg daily, as tolerated.

Pediatric: Starting dose varies based on age and concomitant medications; typically 2 mg at bedtime, titrated as needed.

Geriatric: Start at the lower end of the dosing range, with cautious titration, considering comorbidities and concomitant medications.

Renal Impairment: No dose adjustment recommended for mild to moderate impairment; data limited for severe impairment.

Hepatic Impairment: Use with caution; consider starting at lower doses due to potential increased sensitivity.

Pharmacokinetics

Absorption: Rapidly absorbed, with peak plasma concentrations reached approximately 0.5-2 hours after administration.

Distribution: High protein binding (~85%), primarily to albumin.

Metabolism: Metabolized mainly by CYP3A4/5 enzymes.

Excretion: Primarily excreted in urine and feces as metabolites.

Half Life: Approximately 105 hours, supporting once-daily dosing.

Contraindications

  • Known hypersensitivity to perampanel or any component of the formulation.

Precautions

  • Use with caution in patients with a history of psychiatric disorders, including depression, psychosis, and suicidal thoughts; monitor closely.
  • Potential for cognitive and psychiatric adverse effects; dose adjustments may be necessary.

Adverse Reactions - Common

  • Dizziness (Often)
  • somnolence (Often)
  • fatigue (Often)
  • irritability (Often)
  • gait disturbance (Often)

Adverse Reactions - Serious

  • Serious neuropsychiatric events (e.g., aggression, hostility, irritability, homicidal thoughts) (Less common but serious)
  • Severe hypersensitivity reactions (Rare)

Drug-Drug Interactions

  • CYP3A4 inducers (e.g., carbamazepine, phenytoin) may decrease perampanel levels; co-administration may require dose adjustments.
  • CYP3A4 inhibitors (e.g., ketoconazole) may increase perampanel levels.
  • Other CNS depressants may have additive sedative effects.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor seizure frequency, psychiatric status, mood changes, and signs of adverse effects.

Diagnoses:

  • Risk for injury related to dizziness or gait disturbance.
  • Risk for injury due to neuropsychiatric effects.

Implementation: Administer once daily at bedtime to reduce dizziness; titrate slowly; monitor for adverse psychiatric effects.

Evaluation: Assess for seizure control, monitor for adverse reactions, including behavioral changes.

Patient/Family Teaching

  • Explain the purpose of the medication and the importance of adherence.
  • Warn about potential side effects like dizziness, somnolence, mood changes, andBehavioral effects.
  • Advise to avoid alcohol and CNS depressants.
  • Encourage report of mood changes, agitation, or suicidal thoughts.

Special Considerations

Black Box Warnings:

  • Serious neuropsychiatric events, including aggression, hostility, and suicidal thoughts and behaviors, have been reported.
  • Patients should be closely monitored, especially during initiation and titration.

Genetic Factors: Pharmacogenetic testing is not routinely required.

Lab Test Interference: None known.

Overdose Management

Signs/Symptoms: Dizziness, somnolence, ataxia, agitation, hallucinations, somnolence, coma in severe cases.

Treatment: Supportive care; gastric decontamination if recent ingestion; activated charcoal if within 1 hour of ingestion; hemodialysis is not effective due to high protein binding.

Storage and Handling

Storage: Store at room temperature between 20°C to 25°C (68°F to 77°F).

Stability: Stable up to the expiration date when stored properly.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.