A monograph on Perampanel

Perampanel is a non-competitive antagonist at the AMPA (alpha-amino-3-hydroxy-5-methyl-4-isoxazoleproprionic acid) subtype of ionotropic glutamate receptor. It is approved as an adjunctive therapy in focal epilepsy with or without secondarily generalised seizures in patients aged >12 years. This in-depth review describes the structure, mechanism of action, pharmacokinetic profile, indications, dosage and efficacy, contraindications, possible drug interactions, adverse effect profile and its management with regards to Perampanel. It is one of the latest additions in the therapeutic armamentarium of an epileptologist being useful in focal as well as generalised epilepsies as an add-on. It has shown high rates of efficacy and a relatively good tolerability. Slow dose titration, patient education and bed time dosing along with downtitration of medications which may aggravate Perampanel associated adverse events improves the patients' compliance and quality of life.