Perampanel Dosage

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

Applies to the following strengths: 2 mg; 4 mg; 6 mg; 8 mg; 10 mg; 12 mg; 0.5 mg/mL

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When moderate or strong CYP450 3A4 inducers are introduced or withdrawn from a patient's regimen, closely monitor clinical response and tolerability; dose adjustments may be necessary.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

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

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

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

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.