Adjunctive treatment of focal seizures with or without
secondary generalised seizures
▶BY MOUTH
▶Child 12–17 years: Initially 2 mg once daily, dose to be
taken before bedtime, then increased, if tolerated, in
steps of 2 mg at intervals of at least every 2 weeks,
adjusted according to response; maintenance 4–8 mg
once daily; maximum 12 mg per day
▶Adult: Initially 2 mg once daily, dose to be taken before
bedtime, then increased, if tolerated, in steps of 2 mg
at intervals of at least every 2 weeks, adjusted
according to response; maintenance 4–8 mg once
daily; maximum 12 mg per day
Adjunctive treatment of primary generalised tonic-clonic
seizures
▶BY MOUTH
▶Child 12–17 years: Initially 2 mg once daily, dose to be
taken before bedtime, then increased, if tolerated, in
steps of 2 mg at intervals of at least every 2 weeks,
adjusted according to response, maintenance up to
8 mg once daily; maximum 12 mg per day
▶Adult: Initially 2 mg once daily, dose to be taken before
bedtime, then increased, if tolerated, in steps of 2 mg
at intervals of at least every 2 weeks, adjusted
according to response, maintenance up to 8 mg once
daily; maximum 12 mg per day
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DUE TO INTERACTIONS
▶Titrate at intervals of at least 1 week with concomitant
carbamazepine, fosphenytoin, oxcarbazepine, or
phenytoin.
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Switching between formulations Care should be taken when
switching between oral formulations. The need for
continued supply of a particular manufacturer’s product
should be based on clinical judgement and consultation
with the patient or their carer, taking into account factors
such as seizure frequency and treatment history.
Patients may need to be maintained on a specific
manufacturer’s branded or generic perampanel product.
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Scottish Medicines Consortium (SMC) decisions
SMC No. 819/12
The Scottish Medicines Consortium has advised (December
2012) that perampanel (Fycompa ®) is accepted for
restricted use within NHS Scotland as a second-line
adjunctive treatment in patients with refractory focal
seizures, with or without secondary generalised seizures.
Treatment should be initiated only by physicians who have
appropriate experience in the treatment of epilepsy. This
advice is contingent upon the continuing availability of
the patient access scheme or a list price that is equivalent
or lower.
SMC No. SMC2172
The Scottish Medicines Consortium has advised (August
2019) that perampanel (Fycompa ®) oral suspension is
accepted for restricted use within NHS Scotland as a
second-line adjunctive treatment in patients with
refractory focal seizures, with or without secondary
generalised seizures, who are unable to swallow
perampanel tablets. Treatment should be initiated only by
physicians who have appropriate experience in the
treatment of epilepsy.
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