Dr. C P Ravi Kumar
Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology, The Krishna Institute of Medical Sciences (KIMS), Mahadevapura, Bangalore
What is Perampanel?
Perampanel is an anti-seizure medication used to reduce the frequency of seizures.
What is Perampanel used for (Indications)?
- Used for focal seizures (which may or may not spread across the brain) in children above 4 years.
- Also helps control primary generalized tonic-clonic seizures in patients above 12 years, usually as an add-on to other medicines.
How is Perampanel available?
- Tablet.
- Extended-release tablet and film coated tablet
- Oral suspension (liquid).
How does Perampanel act (mechanism of action)?
Perampanel works by blocking certain brain receptors (called AMPA receptors) that trigger excessive nerve activity (hence the name perAMPAnel), Glutamate acts on AMPA receptors and cause excitation. Effectively it blocks hyper excited neurons, thereby by reducing or stopping seizures.
Think of your brain like a room full of light bulbs (brain cells). During a seizure, some bulbs flash too much — like a power surge. A brain chemical called glutamate causes this by using switches called AMPA receptors. Perampanel blocks those switches, so the bulbs don’t go wild. This helps prevent or reduce seizures.
How much time does Perampanel take to act?
Perampanel starts working within a few hours after ingestion, as it is well absorbed in the body. It may take 2 to 6 weeks to show noticeable seizure reduction, as the body gradually adjusts to the medication. It reaches a steady concentration in the blood after about 2-3 weeks of daily use.
What is the ideal time to take Perampanel?
Perampanel should usually be taken once daily at bedtime due to its potential to cause drowsiness and dizziness. In order to create a routine and reduce the possibility of skipping a dose, it is best to administer it at the same time each day.
When should Perampanel be taken?
Perampanel can be taken either before or after food, so it is up to you when it is most convenient. However, it’s a good idea to take it at the same time each day to help you remember.
How should I give the medicine?
Oral suspension (liquid): To ensure the drug is mixed evenly, give the suspension a good shake just before using. To remove the appropriate amount of suspension from the bottle, use the oral dosage syringe that comes with the medication. The suspension can be taken directly from the syringe or dissolved in a small glass of water and then swallowed. After usage, rinse the syringe with warm water and let it air dry completely.
Avoid splitting, chewing, or crushing the extended-release tablets; instead, swallow them whole with water.
Would my child experience any undesirable effects from this medication?
Every medicine has both good effects and the chance of some unwanted effects. These problems are usually rare, but being aware of them keeps you safe. If you ever notice unusual or severe symptoms, don’t wait—contact your doctor immediately.
Side effects of Perampanel (Adverse drug reactions):
Nervous System: Dizziness (Vertigo), Sleepiness (Somnolence), Headache, Tiredness (Fatigue), Mood changes (Irritability), Difficulty with coordination (Ataxia), Spinning sensation (Vertigo), Trouble with balance (Balance disorder), Worry or nervousness (Anxiety)
Stomach and Digestion: Loss of appetite, Nausea, Vomiting
Muscles and Bones: Back pain
General: Falling more often, Weight gain
Does Perampanel cause weight gain?
Perampanel can cause both weight gain and weight loss, but weight gain is more commonly reported, especially with long-term use and higher doses, but individual responses vary. Report any noticeable changes in your weight to your healthcare provider
Is it safe to take other common medications while taking Perampanel?
Yes, many common medicines can be taken with Perampanel, but it is important to be careful. Some medications can interact with Perampanel and affect how well it works or increase the risk of side effects.
For example:
- Other anti-seizure medications may require dose adjustments because they can either make Perampanel less effective or increase side effects.
- Medications for sleep or anxiety (like benzodiazepines) might increase drowsiness or dizziness when taken with Perampanel.
- Certain antibiotics or antifungals can interact with Perampanel, so you might need to adjust the dose or be monitored more closely.
It’s always best to check with your doctor or pharmacist before starting any new medication, including over-the-counter medications, to make sure it is safe with Perampanel.
What foods to avoid while taking Perampanel?
There aren’t any specific foods you need to avoid while taking Perampanel. However, it is always a good idea to follow general health guidelines to support the effectiveness of the medication.
Here are a few things to consider:
- Grapefruit and grapefruit juice: Some medications interact with grapefruit, and it is usually safe to avoid grapefruit unless your doctor says otherwise.
- Alcohol: Drinking alcohol while on Perampanel can increase the risk of side effects like dizziness, drowsiness, and difficulty concentrating. It’s best to limit alcohol.
PREGNANCY AND LACTATION:
Doctors usually avoid prescribing Perampanel during pregnancy unless the benefits clearly outweigh the risks.
Breastfeeding is not recommended, but if continued, the baby should be closely monitored for side effects. Always consult a doctor before using Perampanel during pregnancy or while breastfeeding to weigh the risks and benefits!
Is there any risk if I conceive while taking Perampanel?
If you become pregnant while taking Perampanel, there may be risks, but the decision to continue or stop the medication should be carefully made with your doctor. Managing your condition safely is critical for both your health and the baby’s development.
Can I stop taking Perampanel? (withdrawal)
Perampanel should not be stopped suddenly, as it may trigger more seizures. Your doctor will usually guide you to reduce the dose step by step.
Where should you store Perampanel?
Keep the medicine at normal room temperature, in a cool, dry place, away from moisture and heat.
MONITORING PARAMETERS:
- Sedation and Neurological Status
- Behavioural and Psychiatric Symptoms
- Liver Function Tests (LFTs)
How to cope with side effects of Perampanel?
Drowsiness or Fatigue
- Adjust the timing of doses to coincide with naps or bedtime, as advised by the doctor.
- Create a calm and restful environment for the child.
- Monitor activity levels to avoid overexertion.
- If excessive sedation persists, consult the doctor for dose adjustments.
Irritability or Mood Changes
- Encourage calming activities like reading, drawing, or quiet play.
- Use relaxation techniques, such as deep breathing or soothing music, if age-appropriate.
- Keep a diary to track behavioural changes and discuss them with the doctor.
- Severe mood changes or aggression should be reported immediately.
Dizziness or Unsteady Coordination
- Ensure the child avoids activities requiring balance or coordination (e.g., climbing, running on uneven surfaces).
- Provide supervision to prevent falls or injuries.
- Encourage hydration to prevent dizziness caused by dehydration.
Nausea or Vomiting
- Give Perampanel with food or immediately after a meal to reduce stomach upset.
- Offer smaller, more frequent meals and avoid greasy or spicy foods.
- Ask the doctor about using an anti-nausea medication if symptoms are severe.
Feeding or Appetite Issues
- Monitor the child’s weight and growth regularly.
- Offer nutrient-dense snacks to maintain proper nutrition.
- If appetite suppression persists, discuss with the doctor for possible dietary supplements or adjustments.
Headaches
- Provide plenty of fluids to stay hydrated.
- Use cold compresses on the forehead or encourage rest in a dark, quiet room.
Sleep Disturbances
- Establish a consistent bedtime routine to promote better sleep.
- Avoid screen time after 6PM.
- Inform the doctor if the child has persistent difficulty sleeping.
Rash or Allergic Reactions (Rare but Serious)
Stop the medication immediately and seek medical attention if a rash, swelling, or difficulty breathing occurs.
General Tips for Parents
Record any symptoms or changes in behaviour, appetite, or mood to share with the healthcare provider.
Regularly update your doctor about side effects, even if they seem minor. This helps with timely dose adjustments.
Missing doses can lead to seizure recurrence, and doubling doses increases the risk of side effects.
For older children, explain what to expect and encourage them to communicate how they’re feeling.
When to Contact the Doctor:
If side effects worsen or become severe (e.g., excessive sedation, persistent vomiting, or behavioural changes).
For signs of an allergic reaction (rash, swelling, difficulty breathing).
If seizures increase or new symptoms appear.
SUMMARY:
Perampanel is used to treat seizures by calming overactive brain signals and can be taken with or without food at the same time each day. Common side effects include dizziness, sleepiness, headache, tiredness, mood changes, loss of appetite, nausea, and back pain. It may interact with other seizure medicines and alcohol, so avoid alcohol and grapefruit juice. If you are pregnant, planning pregnancy, or breastfeeding, talk to your doctor about the risks. Always use Perampanel as advised by your doctor.
Let us know if this was useful!
REFERENCE:
Author:
- Dr. Likitha B S, Pharm. D, Clinical Pharmacologist, Aster Hospitals, Bengaluru
- Dr Praveen Kumar, B. Pharm, Pharm D(PB), Lead Clinical Pharmacologist, REGIONAL HEAD KIMS Hospitals, Bengaluru
- Dr. C. P. Ravi Kumar Lead & Senior Consultant – Paediatric Neurology KIMS HOSPITALS BENGALURU
