Perampanel: Uses, Behavioural Warnings and Interactions

Uses depend on the licensed product

Perampanel blocks AMPA glutamate receptors and is prescribed for particular epileptic seizure types. The reviewed UK G.L. Pharma tablet is an add-on treatment for focal seizures, with or without progression to bilateral convulsions, from four years of age. Its UK indication also includes primary generalised tonic-clonic seizures in idiopathic generalised epilepsy from seven years. These age limits must not be applied worldwide: the cited US Fycompa label specifies twelve years for the latter add-on indication.

Tablet and suspension instructions must not be interchanged without checking. Treatment changes require specialist supervision. Seizure control and tolerability can change when another antiseizure medicine is introduced or removed.

Behaviour, alertness and urgent warning signs

The US label carries a boxed warning about serious psychiatric and behavioural reactions, including aggression, hostility and thoughts or threats of harming others. The UK information also describes significant changes in mood or behaviour. Patients and caregivers should seek urgent professional help for threatening behaviour, thoughts of self-harm or harm to others, or major personality changes.

Dizziness and sleepiness are prominent adverse effects. Balance problems, falls, fatigue, nausea and weight gain can also occur. Do not drive while impaired. A new widespread rash, blistering, mouth sores or fever with swollen glands needs urgent assessment because severe skin reactions, including DRESS and Stevens-Johnson syndrome, have been reported.

Interaction and reproductive precautions

Carbamazepine, phenytoin and oxcarbazepine can lower perampanel exposure through enzyme induction. Other enzyme inducers or inhibitors may also alter its level, so changes to combined treatment require monitoring. Alcohol and other central nervous system depressants can add impairment; alcohol may also worsen mood and anger.

The hormonal-contraceptive warning is dose dependent: the labels describe reduced levonorgestrel exposure with the twelve-milligram daily regimen. A clinician should check the actual regimen and contraception rather than assume every dose has the same effect. Pregnancy or breastfeeding requires specialist advice because human safety information is limited.

Sources

• Perampanel G.L. Pharma tablets — UK SmPC — UK text revised 8 July 2026
• FYCOMPA — US prescribing information — US prescribing information revised June 2023

Sources checked on 30 October 2026. This date records a source check, not a clinical review by a doctor or pharmacist. Follow the leaflet supplied with your product and consult a qualified healthcare professional about personal treatment.