THERAPEUTICS

Brands

• Fycompa

Generic?

• No

Class

• Antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

• Adjunctive therapy for the treatment of partial-onset seizures with or without secondarily generalized seizures in patients with epilepsy aged 12 years and older

• Primary generalized tonic-clonic seizures in patients with epilepsy aged 12 years and older. Lennox-Gastaut syndrome

How the Drug Works

• Perampanel is a non-competitive selective antagonist of the ionotropic α-amino-3-hydroxy-5-methyl-4 isoxazolepropionic acid (AMPA) glutamate receptor on postsynaptic neurons. Its binding stabilizes the resting state of the channel and disrupts channel opening in response to agonist (e.g., glutamate) binding

• The precise mechanism by which perampanel exerts its antiepileptic effects in humans has not been fully elucidated

How Long Until It Works

• Drug steady state is reached in weeks

If It Works

• The goal is seizure remission. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years without seizures, depending on the type of epilepsy

If It Doesn't Work

• Increase to highest tolerated dose

• Consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Drug interactions can complicate multi-drug therapy

Tests

• Not available

ADVERSE EFFECTS (AEs)

How the Drug Causes AEs

• CNS AEs are probably caused by glutamate blockade effects

Notable AEs

• Dizziness, gait disturbance, somnolence, fatigue, falls, nausea, vertigo

• Hostility and aggressive behavior in 10–20% of patients under maximum dosage. They usually appear within the first 6 weeks of treatment

Life-Threatening or Dangerous AEs

• Suicidal behavior and ideation

• Withdrawal epilepsy, although rare due to its long half-life

Weight Gain

• Not unusual