Adults and pediatric patients
Perampanel must be titrated, according to individual patient response, in order to optimize the balance between efficacy and tolerability.
Perampanel should be taken orally once daily at bedtime or as prescribed by the physician.
The physician should prescribe the most appropriate formulation and strength according to weight and dose. Alternate formulations of perampanel are available, including oral suspension.
Partial-Onset Seizures
Monotherapy or Adjunctive Therapy
Perampanel at doses of 4 mg/day to 12 mg/day has been shown to be effective therapy in partial‑onset seizures.
The following table summarises the recommended posology for adults, adolescents and children from 4 years of age. More details are provided below the table.
| Adult/ adolescent (12 years and older) |
Children (4 – 11 years); weighing: | |||
| ≥ 30 kg | 20 – < 30 kg | < 20 kg | ||
| Recommended starting dose |
2 mg/day | 2 mg/day | 1 mg/day | 1 mg/day |
| Titration (incremental steps) |
2 mg/day (no more frequently than weekly intervals) |
2 mg/day (no more frequently than weekly intervals) |
1 mg/day (no more frequently than weekly intervals) |
1 mg/day (no more frequently than weekly intervals) |
| Recommended maintenance dose |
4 – 8 mg/day | 4 – 8 mg/day | 4 – 6 mg/day | 2 – 4 mg/day |
| Titration (incremental steps) |
2 mg/day (no more frequently than weekly intervals) |
2 mg/day (no more frequently than weekly intervals) |
1 mg/day (no more frequently than weekly intervals) |
0.5 mg/day (no more frequently than weekly intervals) |
| Recommended maximum dose |
12 mg/day | 12 mg/day | 8 mg/day | 6 mg/day |
Adults, adolescents age ≥ 12 years
Treatment with Perampanel should be initiated with a dose of 2 mg/day. The dose may be increased based on clinical response and tolerability by increments of 2 mg (either weekly or every 2 weeks as per half-life considerations described below) to a maintenance dose of 4 mg/day to 8 mg/day. Depending upon individual clinical response and tolerability at a dose of 8 mg/day, the dose may be increased by increments of 2 mg/day to 12 mg/day. Patients who are taking concomitant medicinal products that do not shorten the half-life of perampanel should be titrated no more frequently than at 2-week intervals. Patients who are taking concomitant medicinal products that shorten the half-life of perampanel should be titrated no more frequently than at 1-week intervals.
Children (from 4 to 11 years) weighing ≥ 30 kg
Treatment with Perampanel should be initiated with a dose of 2 mg/day. The dose may be increased based on clinical response and tolerability by increments of 2 mg (either weekly or every 2 weeks as per half life considerations described below) to a maintenance dose of 4 mg/day to 8 mg/day. Depending upon individual clinical response and tolerability at a dose of 8 mg/day, the dose may be increased by increments of 2 mg/day to 12 mg/day. Patients who are taking concomitant medicinal products that do not shorten the half life of perampanel should be titrated no more frequently than at 2 week intervals. Patients who are taking concomitant medicinal products that shorten the half life of perampanel should be titrated no more frequently than at 1 week intervals.
Children (from 4 to 11 years of age) weighing 20 kg and < 30 kg
Treatment with Perampanel should be initiated with a dose of 1 mg/day. The dose may be increased based on clinical response and tolerability by increments of 1 mg (either weekly or every 2 weeks as per half life considerations described below) to a maintenance dose of 4 mg/day to 6 mg/day. Depending upon individual clinical response and tolerability at a dose of 6 mg/day, the dose may be increased by increments of 1 mg/day to 8 mg/day. Patients who are taking concomitant medicinal products that do not shorten the half life of perampanel should be titrated no more frequently than at 2 week intervals. Patients who are taking concomitant medicinal products that shorten the half life of perampanel should be titrated no more frequently than at 1 week intervals.
Children (from 4 to 11 years of age) weighing < 20 kg
Treatment with Perampanel should be initiated with a dose of 1 mg/day. The dose may be increased based on clinical response and tolerability by increments of 1 mg (either weekly or every 2 weeks as per half life considerations described below) to a maintenance dose of 2 mg/day to 4 mg/day. Depending upon individual clinical response and tolerability at a dose of 4 mg/day, the dose may be increased by increments of 0.5 mg/day to 6 mg/day. Patients who are taking concomitant medicinal products that do not shorten the half life of perampanel should be titrated no more frequently than at 2 week intervals. Patients who are taking concomitant medicinal products that shorten the half life of perampanel should be titrated no more frequently than at 1 week intervals.
Primary Generalized Tonic-Clonic Seizures
Adjunctive Therapy
Perampanel at a dose up to 8 mg/day has been shown to be effective in primary generalised tonic-clonic seizures.
The following table summarises the recommended posology for adults, adolescents and children from 7 years of age. More details are provided below the table.
| Adult/ adolescent (12 years and older) |
Children (7 – 11 years); weighing: | |||
| ≥ 30 kg | 20 – < 30 kg | < 20 kg | ||
| Recommended starting dose |
2 mg/day | 2 mg/day | 1 mg/day | 1 mg/day |
| Titration (incremental steps) |
2 mg/day (no more frequently than weekly intervals) |
2 mg/day (no more frequently than weekly intervals) |
1 mg/day (no more frequently than weekly intervals) |
1 mg/day (no more frequently than weekly intervals) |
| Recommended maintenance dose |
Up to 8 mg/day | 4 – 8 mg/day | 4 – 6 mg/day | 2 – 4 mg/day |
| Titration (incremental steps) |
2 mg/day (no more frequently than weekly intervals) |
2 mg/day (no more frequently than weekly intervals) |
1 mg/day (no more frequently than weekly intervals) |
0.5 mg/day (no more frequently than weekly intervals) |
| Recommended maximum dose |
12 mg/day | 12 mg/day | 8 mg/day | 6 mg/day |
Adults, adolescents age ≥ 12 years
Treatment with Perampanel should be initiated at a dose of 2 mg/day. The dose may be increased based on clinical response and tolerability by increments of 2 mg (either weekly or every 2 weeks, as per half-life considerations described below) to a maintenance dose of up to 8 mg/day. Depending upon individual clinical response and tolerability at a dose of 8 mg/day, the dose may be increased up to 12 mg/day, which may be effective in some patients. Patients who are taking concomitant medicinal products that do not shorten the half-life of perampanel should be titrated no more frequently than at 2-week intervals. Patients who are taking concomitant medicinal products that shorten the half-life of perampanel should be titrated no more frequently than at 1-week intervals.
Children (from 7 to 11 years) weighing ≥ 30 kg
Treatment with Perampanel should be initiated with a dose of 2 mg/day. The dose may be increased based on clinical response and tolerability by increments of 2 mg (either weekly or every 2 weeks as per half life considerations described below) to a maintenance dose of 4 mg/day to 8 mg/day. Depending upon individual clinical response and tolerability at a dose of 8 mg/day, the dose may be increased by increments of 2 mg/day to 12 mg/day. Patients who are taking concomitant medicinal products that do not shorten the half life of perampanel should be titrated no more frequently than at 2 week intervals. Patients who are taking concomitant medicinal products that shorten the half life of perampanel should be titrated no more frequently than at 1 week intervals.
Children (from 7 to 11 years of age) weighing 20 kg and < 30 kg
Treatment with Perampanel should be initiated with a dose of 1 mg/day. The dose may be increased based on clinical response and tolerability by increments of 1 mg (either weekly or every 2 weeks as per half life considerations described below) to a maintenance dose of 4 mg/day to 6 mg/day. Depending upon individual clinical response and tolerability at a dose of 6 mg/day, the dose may be increased by increments of 1 mg/day to 8 mg/day. Patients who are taking concomitant medicinal products that do not shorten the half life of perampanel should be titrated no more frequently than at 2 week intervals. Patients who are taking concomitant medicinal products that shorten the half life of perampanel should be titrated no more frequently than at 1 week intervals.
Children (from 7 to 11 years of age) weighing < 20 kg
Treatment with Perampanel should be initiated with a dose of 1 mg/day. The dose may be increased based on clinical response and tolerability by increments of 1 mg (either weekly or every 2 weeks as per half life considerations described below) to a maintenance dose of 2 mg/day to 4 mg/day. Depending upon individual clinical response and tolerability at a dose of 4 mg/day, the dose may be increased by increments of 0.5 mg/day to 6 mg/day. Patients who are taking concomitant medicinal products that do not shorten the half life of perampanel should be titrated no more frequently than at 2 week intervals. Patients who are taking concomitant medicinal products that shorten the half life of perampanel should be titrated no more frequently than at 1 week intervals.
Withdrawal
It is recommended that discontinuation be undertaken gradually to minimise the potential for rebound seizures. However, due to its long half-life and subsequent slow decline in plasma concentrations, perampanel can be discontinued abruptly if absolutely needed.
Missed doses
Single missed dose: As perampanel has a long half-life, the patient should wait and take their next dose as scheduled.If more than 1 dose has been missed, for a continuous period of less than 5 half-lives (3 weeks for patients not taking perampanel metabolism-inducing AEDs, 1 week for patients taking perampanel metabolism inducing AEDs, consideration should be given to re-start treatment from the last dose level.
If a patient has discontinued perampanel for a continuous period of more than 5 half-lives, it is recommended that initial dosing recommendations given above should be followed.
Elderly (65 years of age and above)
Clinical studies of perampanel in epilepsy did not include sufficient numbers of patients aged 65 and over to determine whether they respond differently from younger patients. Analysis of safety information in 905 perampanel-treated elderly patients (in double-blind studies conducted in non-epilepsy indications) revealed no age-related differences in the safety profile. In combination with the lack of age-related difference in perampanel exposure, the results indicate that dose adjustment in the elderly is not required. Perampanel should be used with caution in elderly taking into account the drug interaction potential in polymedicated patients.
Renal impairment
Dose adjustment is not required in patients with mild renal impairment. Use in patients with moderate or severe renal impairment or patients undergoing hemodialysis is not recommended.
Hepatic impairment
Dose increases in patients with mild and moderate hepatic impairment should be based on clinical response and tolerability. For patients with mild or moderate hepatic impairment, dosing can be initiated at 2 mg. Patients should be up-titrated using 2 mg doses no faster than every 2 weeks based on tolerability and effectiveness. Perampanel dosing for patients with mild and moderate impairment should not exceed 8 mg. Use in patients with severe hepatic impairment is not recommended.
Paediatric patients
The safety and efficacy of perampanel have not yet been established in children below 4 years of age in the POS indication or in children below 7 years of age in the PGTCS indication.
Method of administration
Perampanel should be taken as single oral dose at bedtime. It may be taken with or without food but preferably always under the same conditions. The film-coated tablet should be swallowed whole with a glass of water. It should not be chewed, crushed or split. The film-coated tablets cannot be split accurately as there is no break line. To ensure the patient receives the entire dose, the tablets should be swallowed whole without chewing or crushing.