An anti-epileptic (anti-seizure) medicine
Perampanel
An anti-epileptic medicine used, usually with other treatments, to help control focal and some generalised seizures.
What is Perampanel?
Perampanel is an anti-epileptic (anti-seizure) medicine used, usually alongside other treatments, for focal seizures and some generalised seizures. It calms over-active brain signalling to reduce seizures. It does not cure epilepsy, can cause drowsiness and serious mood or behaviour changes such as aggression, and should not be stopped suddenly.
Education and reference only. This is a plain-language guide to Perampanel — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Perampanel is a newer anti-epileptic medicine used as an add-on (alongside other medicines) to help control focal (partial) seizures and certain generalised seizures, including some tonic-clonic seizures. It does not cure epilepsy but aims to reduce how often seizures happen. It is taken long-term, usually once a day at bedtime.
How it works
Seizures happen when brain cells become over-excited and fire abnormal electrical signals. Perampanel blocks a particular receptor (the AMPA receptor) that the excitatory brain chemical glutamate acts on. By reducing this over-excitation, it makes seizures less likely to build up and spread.
Company & origin
Originated / developed by: Eisai (originator).
A newer anti-seizure medicine used as an add-on for focal seizures and some generalised seizures.
What it treats
Conditions Perampanel is used for
Practical use
How to take Perampanel
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is usually taken once a day at bedtime, which helps with the drowsiness it can cause.
- It can be taken with or without food; a liquid form is available if tablets are hard to swallow.
- Take it at about the same time each night to keep levels steady.
- Do not stop taking it suddenly; any changes should be made slowly under your doctor's guidance.
- If you miss a dose, leave it and take the next one as usual; do not take two doses together.
Weighing it up
Advantages & disadvantages of Perampanel
Advantages
- Helps reduce focal and some generalised seizures as an add-on treatment.
- Taken just once a day, usually at bedtime, which is convenient.
- Works in a different way to many other anti-seizure medicines, offering another option.
Disadvantages
- Does not cure epilepsy and must be taken consistently long-term.
- Commonly causes drowsiness, dizziness and unsteadiness, especially as the dose rises.
- Can cause serious mood and behaviour changes, including aggression, that need close watching.
Practical use
Good to know
Perampanel is usually taken once a day at bedtime, because drowsiness and dizziness are common, especially when starting or increasing the dose. An important safety point is that it can cause serious changes in mood and behaviour, including irritability, anger and aggression, and rarely thoughts of self-harm; these should be reported promptly to the person's doctor, and family or carers are often asked to watch for them. The dose is increased slowly to reduce side effects. Like all anti-seizure medicines, it must not be stopped suddenly, as this can trigger seizures, and pregnancy plans should be discussed with the specialist in advance.
Who should not take it / use with caution
- People with a history of serious aggression, severe mood problems or psychiatric illness need careful assessment.
- People with severe liver problems may be unsuitable or need a lower dose and closer monitoring.
- People who have had an allergic reaction to perampanel should not take it.
Monitoring
- Mood and behaviour are watched closely, often with help from family or carers, especially early on.
- Seizure frequency, drowsiness and steadiness are reviewed as the dose is adjusted.
- Weight and overall wellbeing are monitored at follow-up appointments.
Side effects
- Common: drowsiness, dizziness, unsteadiness, tiredness, headache and weight gain.
- Report serious mood or behaviour changes such as irritability, anger, aggression or thoughts of self-harm.
- Seek advice for falls due to unsteadiness, or marked confusion, especially in older people.
Key interactions
- Alcohol can greatly worsen drowsiness, mood changes and aggression and should be avoided.
- Other sedating medicines add to drowsiness and the risk of falls.
- Some anti-seizure medicines and other drugs can lower perampanel levels, and it can reduce the effect of hormonal contraception, so tell your doctor about all medicines.
Available as: Tablets and an oral liquid (suspension).
Answers
Perampanel: frequently asked questions
Why is it taken at bedtime?
Perampanel commonly causes drowsiness and dizziness, so taking it at night helps reduce the impact during the day.
Can it affect mood or behaviour?
Yes. It can cause serious changes including irritability, anger, aggression and rarely thoughts of self-harm. Report these promptly; carers are often asked to watch for them.
Can I drink alcohol with it?
It is best avoided. Alcohol can greatly increase drowsiness and worsen mood and aggression while taking perampanel.
Could it affect my contraception?
Yes, it can reduce the effectiveness of hormonal contraception. Discuss reliable alternatives with your doctor.
Can I stop it suddenly?
No. Stopping suddenly can trigger seizures. Any change must be made gradually and only on your specialist's advice.
The wider class
About Antiepileptic medicines
Perampanel belongs to the antiepileptic medicines class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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