[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Antiseizure medicines](https://durgical.com/en/pharmacology/classes/antiseizure-medicines/) › Perampanel

# Perampanel

## Antiseizure medicines?

Antiseizure medicines

The first AMPA glutamate receptor blocker for epilepsy, taken once a day at bedtime. It can cause hostility and aggression.

Updated Nov 1, 2026

## Quick facts

**Group**
[Antiseizure medicines](https://durgical.com/en/pharmacology/classes/antiseizure-medicines/)

**Target**
AMPA-type ionotropic glutamate receptor (GluA2)

**Used for**
Partial-onset

**Key effects**
Dizziness · Poor coordination and falls · Irritability

**Monitor**
Mood · Falls and balance · Weight

**ATC**
N03AX22

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

◎**AMPA-type ionotropic glutamate receptor (GluA2)**Perampanel

ⓘ The figure shows perampanel bound to the AMPA receptor GluA2 of the rat, whose binding site matches the human receptor's.

**Target in 3D:** AMPA-type ionotropic glutamate receptor (GluA2). PDB structure 5L1F (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/5L1F) · Drag to rotate · pinch to zoom

Perampanel is a first-in-class, selective, noncompetitive antagonist of the AMPA-type glutamate receptor. By damping fast excitatory transmission it prevents repetitive neuronal firing, and it appears to act more on the spread of seizures than on their start.

- Perampanel binds the AMPA receptor outside the glutamate site
- Fast excitatory currents shrink
- Seizure spread is limited
- Fewer focal and tonic-clonic seizures

## Indications

- Partial-onset (focal) seizures [Epilepsy and seizures →](https://durgical.com/en/conditions/epilepsy-and-seizures/)
- Primary generalized tonic-clonic seizures, as add-on treatment [Epilepsy and seizures →](https://durgical.com/en/conditions/epilepsy-and-seizures/)

## Adverse effects

### Common

- Dizziness, a spinning sensation and drowsiness
- Poor coordination and falls, especially in older adults
- Irritability
- Weight gain
- Nausea, headache and tiredness

### Serious (rare, important)

- Psychiatric reactions: hostility, aggression, homicidal thoughts, mood or personality changes
- Suicidal thoughts or behaviour
- DRESS: rash, fever, swollen glands, liver involvement

## Contraindications

- Allergy to perampanel or any component of the product

## Key interactions

**Carbamazepine, oxcarbazepine and topiramate**
Lower perampanel levels

**Contraceptives with levonorgestrel or other progestins**
May work less well; another method is used during treatment and for 1 month after

**St John's wort**
May lower perampanel levels

**Alcohol**
Worse dizziness, sedation and behavioural effects

## What is monitored

- Mood, behaviour and aggression, during treatment and for a month after stopping
- Falls and balance
- Weight
- Seizure diary

## Administration and safety

- Oral tablet or suspension at bedtime; the suspension is measured with the syringe supplied
- Raised gradually, not more often than once a week
- It can be habit-forming

## Pregnancy and breastfeeding

Its safety in pregnancy is not established; contraception is discussed because perampanel can reduce progestin effectiveness.

## Nursing care

- Ask about psychiatric history and aggressive behaviour before starting
- Tell the family to report any change in mood or behaviour at once
- Assess fall risk in older adults
- Advise a contraceptive method other than progestin-based ones

## Pharmacokinetics

**Absorption**
Well absorbed by mouth

**Distribution**
Highly bound to plasma albumin

**Metabolism**
In the liver by CYP3A and glucuronidation

**Half-life**
Very long, which allows once-daily use

## Memory aid

«PERAMPanel = PERMANENT AMPA Pause»: one bedtime dose, long half-life, and eyes on the mood.

## Test yourself

Think of the answer, then tap the question to see it.

## What is the mechanism of perampanel?

Selective noncompetitive antagonism of AMPA-type glutamate receptors.

## Which boxed warning applies to perampanel?

Serious psychiatric and behavioural reactions, including hostility and aggression.

## Why can perampanel be given once a day?

Its half-life is very long.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/perampanel/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 4

- [Levetiracetam](https://durgical.com/en/pharmacology/levetiracetam/)
- [Carbamazepine](https://durgical.com/en/pharmacology/carbamazepine/)
- [Topiramate](https://durgical.com/en/pharmacology/topiramate/)
- [Lamotrigine](https://durgical.com/en/pharmacology/lamotrigine/)

## Related conditions 1

- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)

[← Back to the class: Antiseizure medicines](https://durgical.com/en/pharmacology/classes/antiseizure-medicines/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Perampanel: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a614006.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N03AX22) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [RCSB PDB - 5L1F: AMPA subtype ionotropic glutamate receptor GluA2 in complex with noncompetitive inhibitor Perampanel](https://www.rcsb.org/structure/5L1F) (RCSB Protein Data Bank, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/perampanel/
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