Perampanel Dosage

Medically reviewed by Drugs.com. Last updated on Feb 27, 2024.

Usual Adult Dose for Epilepsy

Partial-Onset Seizures: Monotherapy or Adjunctive Therapy
Initial Dose: 2 mg orally once a day at bedtime

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: 8 to 12 mg/day; some patients may respond to 4 mg/day
Maximum Dose: 12 mg/day

Primary Generalized Tonic-Clonic Seizures: Adjunctive therapy:
Initial Dose: 2 mg orally once a day at bedtime.

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: 8 mg/day; some patients may benefit from a dose up to 12 mg/day based on clinical response and tolerability
Maximum Dose: 12 mg/day

CONCOMITANT USE OF MODERATE OR STRONG CYP450 3A4 ENZYME INDUCERS:
Initial Dose: 4 mg orally once a day at bedtime

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: Has not been established
Maximum Dose: Highest dose studied 12 mg/day

Comments:

• At the higher dose of 12 mg/day, a somewhat greater reduction in seizure rates was observed than at 8 mg/day; however, a substantial increase in adverse reactions was reported.
• When moderate or strong CYP450 3A4 inducers are introduced or withdrawn from a patient's regimen, closely monitor clinical response and tolerability; dose adjustments may be necessary.

Uses: For the treatment of partial-onset seizures with or without secondarily generalized seizures and for the treatment of primary generalized tonic-clonic seizures in patients with epilepsy.

Usual Adult Dose for Seizures

Partial-Onset Seizures: Monotherapy or Adjunctive Therapy
Initial Dose: 2 mg orally once a day at bedtime

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: 8 to 12 mg/day; some patients may respond to 4 mg/day
Maximum Dose: 12 mg/day

Primary Generalized Tonic-Clonic Seizures: Adjunctive therapy:
Initial Dose: 2 mg orally once a day at bedtime.

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: 8 mg/day; some patients may benefit from a dose up to 12 mg/day based on clinical response and tolerability
Maximum Dose: 12 mg/day

CONCOMITANT USE OF MODERATE OR STRONG CYP450 3A4 ENZYME INDUCERS:
Initial Dose: 4 mg orally once a day at bedtime

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: Has not been established
Maximum Dose: Highest dose studied 12 mg/day

Comments:

• At the higher dose of 12 mg/day, a somewhat greater reduction in seizure rates was observed than at 8 mg/day; however, a substantial increase in adverse reactions was reported.
• When moderate or strong CYP450 3A4 inducers are introduced or withdrawn from a patient's regimen, closely monitor clinical response and tolerability; dose adjustments may be necessary.

Uses: For the treatment of partial-onset seizures with or without secondarily generalized seizures and for the treatment of primary generalized tonic-clonic seizures in patients with epilepsy.

Usual Pediatric Dose for Epilepsy

Partial-Onset Seizures: Monotherapy or Adjunctive Therapy
4 years or older:
Initial Dose: 2 mg orally once a day at bedtime

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: 8 to 12 mg/day; some patients may respond to 4 mg/day
Maximum dose: 12 mg/day

Primary Generalized Tonic-Clonic Seizures: Adjunctive therapy
12 years or older:
Initial Dose: 2 mg orally once a day at bedtime.

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: 8 mg/day; some patients may benefit from a dose up to 12 mg/day based on clinical response and tolerability
Maximum dose: 12 mg/day

CONCOMITANT USE OF MODERATE OR STRONG CYP450 3A4 ENZYME INDUCERS:
Initial Dose: 4 mg orally once a day at bedtime

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: Has not been established
Maximum Dose: Highest dose studied 12 mg/day

Comments:

• At the higher dose of 12 mg/day, a somewhat greater reduction in seizure rates was observed than at 8 mg/day; however, a substantial increase in adverse reactions was reported.
• When moderate or strong CYP450 3A4 inducers are introduced or withdrawn from a patient's regimen, closely monitor clinical response and tolerability; dose adjustments may be necessary.

Uses:

• For the treatment of partial-onset seizures with or without secondarily generalized seizures in patients with epilepsy 4 years or older
• For the treatment of primary generalized tonic-clonic seizures in patients with epilepsy 12 years or older.

Usual Pediatric Dose for Seizures

Partial-Onset Seizures: Monotherapy or Adjunctive Therapy
4 years or older:
Initial Dose: 2 mg orally once a day at bedtime

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: 8 to 12 mg/day; some patients may respond to 4 mg/day
Maximum dose: 12 mg/day

Primary Generalized Tonic-Clonic Seizures: Adjunctive therapy
12 years or older:
Initial Dose: 2 mg orally once a day at bedtime.

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: 8 mg/day; some patients may benefit from a dose up to 12 mg/day based on clinical response and tolerability
Maximum dose: 12 mg/day

CONCOMITANT USE OF MODERATE OR STRONG CYP450 3A4 ENZYME INDUCERS:
Initial Dose: 4 mg orally once a day at bedtime

• Increase dose by increments of 2 mg/day no more frequently than once a week based on individual clinical response and tolerability

Maintenance Dose: Has not been established
Maximum Dose: Highest dose studied 12 mg/day

Comments:

• At the higher dose of 12 mg/day, a somewhat greater reduction in seizure rates was observed than at 8 mg/day; however, a substantial increase in adverse reactions was reported.
• When moderate or strong CYP450 3A4 inducers are introduced or withdrawn from a patient's regimen, closely monitor clinical response and tolerability; dose adjustments may be necessary.

Uses:

• For the treatment of partial-onset seizures with or without secondarily generalized seizures in patients with epilepsy 4 years or older
• For the treatment of primary generalized tonic-clonic seizures in patients with epilepsy 12 years or older.

Renal Dose Adjustments

• Mild Renal Impairment: No adjustment recommended
• Moderate Renal Impairment: Use with caution; consider slower dose titration based on clinical response and tolerability
• Severe Renal Impairment: Not recommended

Liver Dose Adjustments

Mild and Moderate Hepatic Impairment:

• Initial Dose: 2 mg orally once a day at bedtime
• Maintenance Dose: Increase dosage by increments of 2 mg/day, no more frequently than every 2 weeks.
• Maximum Dose: 6 mg/day (Mild Hepatic Impairment); 4 mg/day (Moderate Hepatic Impairment)

Severe Hepatic Impairment: Not recommended

Dose Adjustments

Elderly Patients: Dose titration should occur no more frequently than every 2 weeks

Concomitant Use of Moderate or Strong CYP450 3A4 inducers:

• Initial dose: 4 mg orally once a day at bedtime
• Dose adjustments may be necessary when moderate or strong CYP450 3A4 inducers are introduced or withdrawn from a patient's treatment regimen.

Precautions

US BOXED WARNING: SERIOUS PSYCHIATRIC AND BEHAVIORAL REACTIONS

• Serious or life-threatening psychiatric and behavioral adverse reactions including aggression, hostility, irritability, anger, and homicidal ideation and threats have been reported in patients taking this drug.
• These reactions occurred in patients with and without prior psychiatric history, prior aggressive behavior, or concomitant use of medications associated with hostility and aggression.
• Advise patients and caregivers to contact a healthcare provider immediately if any of these reactions or changes in mood, behavior, or personality that are not typical for the patient are observed during or after treatment.
• Closely monitor patients, particularly during the titration period and at higher doses.
• Reduce the dose if these symptoms occur; immediately discontinue this drug if symptoms are severe or are worsening.

Safety and efficacy have not been established in patients younger than 4 years.

Consult WARNINGS section for additional precautions.

US Controlled Substance: Schedule III

Dialysis

Hemodialysis: Not recommended.
Peritoneal dialysis: Data not available.

Other Comments

Administration Advice:

• Take orally once a day at bedtime

Oral suspension:

• Shake well before every administration
• Use the provided adapter and graduated oral dosing syringe measure dose; a household teaspoon or tablespoon is not an adequate measuring device
• Discard unused suspension 90 days after first opening the bottle

Missed dose: In the event of a single missed dose, skip that dose and take the next dose the following day as scheduled

• Patients who miss more than 1 dose should contact their healthcare provider

Storage Requirements:

• Oral Suspension: Do not store above 86F (30C); Do not freeze
• Discard any unused suspension 90 days after first opening the bottle

General:

• This drug is a controlled substance that can be misused and abused.

Monitoring:

• Monitor for psychiatric and behavioral reactions, especially during the initial few weeks and with any increase in dose; monitor for at least 1 month after last dose
• Monitor for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior
• Monitor weight

Patient Advice:

• Read the US FDA-approved patient labeling (Medication Guide and Instructions for Use).
• Patients/caregivers should understand that serious psychiatric and behavioral reactions may occur and if they occur, they should be reported promptly to their health care provider.
• Patients/caregivers should be instructed to report any unusual changes in mood or behavior, suicidal thoughts, depression or worsening depression to their healthcare provider.
• Patients should be instructed to avoid alcohol while taking this drug as the impairment effects of alcohol may be enhanced.
• Patients should understand that this drug may cause dizziness, gait disturbance, somnolence, and fatigue; they should be instructed to avoid potentially dangerous activities such as driving and operating machinery until they know how this drug affects them.
• Patients should be instructed to report any fever associated with other organ involvement (e.g., rash, lymphadenopathy, hepatic dysfunction) to their healthcare provider promptly.

See also:

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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