Fycompa (Perampanel) - Oral

Warning:

Warning: Fycompa (perampanel) has caused severe psychiatric and behavioral responses, such as aggression, hostility, irritability, anger, and homicidal ideation and threats. A caregiver or family member should monitor your behaviors for any abnormal mood, behavior, or personality changes. If these adverse effects become severe, immediately contact a healthcare provider.

What Is Fycompa?

Fycompa (perampanel) is a prescription anti-seizure medication used to prevent several types of seizures that can occur due to epilepsy.

This medication is a non-competitive AMPA glutamate receptor antagonist that inhibits the action of the glutamate receptor in the brain. Glutamate is an excitatory neurotransmitter, and inhibiting its receptor may prevent overactivity of specific brain areas, such as the brain activity involved in epilepsy.

Perampanel is listed as a Schedule III controlled substance due to its potential to lead to moderate or low physical or high psychological dependence. Controlled substances are more strictly regulated than other noncontrolled substances in how they are used, handled, stored, and distributed.

Fycompa is available as a tablet and in an oral suspension formulation.

Drug Facts

Generic Name: Perampanel

Brand Name(s): Fycompa

Drug Availability: Prescription

Administration Route: Oral

Therapeutic Classification: Anticonvulsant

Available Generically: No

Controlled Substance: Schedule III

Active Ingredient: Perampanel

Dosage Form(s): Tablet, solution

What Is Fycompa Used For?

Fycompa is used for preventing focal and generalized seizures. Its approval for different seizure types has specifications with respect to age and use with other anti-epilepsy medications.

The Food and Drug Administration (FDA) approved Fycompa for:

  • Preventing partial-onset seizures with or without secondary generalization for adults and children 4 years and older: Partial onset seizures begin with abnormal nerve activity in one area of the brain, with symptoms that only correspond to that area (such as blinking or shaking one arm or leg). Partial onset seizures can sometimes generalize (spread throughout the brain) within seconds, causing impaired consciousness and movements of both sides of the body.
  • Adjunctive therapy for preventing primary generalized tonic-clonic seizures for adults and children 12 years and older: Primary generalized tonic-clonic seizures begin with abnormal nerve activity on both sides of the brain and involuntary movements of both sides of the body. Adjunctive epilepsy therapy is used as add-on therapy with one or more other anti-epilepsy drugs. 

How to Take Fycompa

You should take Fycompa as prescribed, usually every day at bedtime.

To take the suspension:

  • Before you take it, shake the container.
  • Use the adapter and dosing syringe provided with the medication to measure it out.
  • Firmly insert the adaptor into the neck of the bottle before use and keep it in place for as long as you use that bottle.
  • Insert the dosing syringe into the adapter and withdraw the liquid from the inverted bottle.
  • Replace the cap after each use.

Storage

Store this medication in its original container and out of the reach of children or pets:

  • Tablets: Store at a temperature of 68 F to 77 F. You can take the tablets for excursions at a temperature of 59 F to 86 F.
  • Oral suspension: Keep this below a temperature of 86 F and do not freeze. Discard any unused oral suspension 90 days after opening the bottle.

Off-Label Uses

Healthcare providers may prescribe perampanel for off-label uses, meaning for conditions not specifically indicated by the FDA.

This medication has been examined for potential off-label use for:

  • Amyotrophic lateral sclerosis (ALS): A neurodegenerative disease that causes severe weakness of the muscles of the face and body
  • Dystonia: A movement disorder characterized by involuntary muscle contractions
  • Refractory status epilepticus: A type of prolonged and dangerous seizure that requires treatment with emergency anti-seizure medication.

How Long Does Fycompa Take to Work?

On average, Fycompa begins to work around 24 hours (with a range of eight to 48 hours) after you start taking it.

What Are the Side Effects of Fycompa?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 800-FDA-1088.

Fycompa can cause side effects, including potentially harmful reactions.

Common Side Effects

The most common side effects of Fycompa include:

  • Dizziness or vertigo
  • Fatigue
  • Irritability
  • Anxiety
  • Balance problems or falls
  • Nausea or vomiting
  • Weight gain
  • Headaches
  • Abdominal pain

Talk to your healthcare provider if you experience side effects. You may benefit from treatment for side effects that are bothering you.

Severe Side Effects

Less often, Fycompa can cause serious side effects that can be dangerous or life-threatening. Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency.

Serious side effects and their symptoms can include the following:

  • Suicidal thoughts and behavior
  • Drug reaction with eosinophilia and systemic symptoms (DRESS)/multi-organ hypersensitivity, which can cause a rash, fevers, bleeding, swelling, and organ failure
  • Severe psychiatric and behavioral responses, such as aggression, hostility, irritability, anger, and homicidal ideation and threats

Fycompa is a controlled substance, meaning it has the potential for physical and psychological dependence. It may cause dependence and withdrawal symptoms, such as:

  • Anxiety and nervousness
  • Irritability
  • Fatigue and lethargy
  • Weakness
  • Mood swings
  • Trouble sleeping (insomnia)

Additionally, abruptly stopping treatment with Fycompa can cause an increase in seizure frequency.

You may need emergency treatment for the above-listed side effects. Your healthcare provider may stop this medication if you experience severe side effects and start you on another anti-epilepsy medication.

Long-Term Side Effects

The effects of this medication should wear off within a week after you stop taking it. However, severe injuries or physical harm that occurred as a side effect can lead to long-term problems (such as organ failure) even after discontinuing the medication.

Report Side Effects

Fycompa may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your healthcare provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).

Dosage: How Much of Fycompa Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (suspension or tablets):
    • For generalized tonic-clonic seizures:
      • Adults and children 12 years of age and older—At first, 2 milligrams (mg) once a day, taken at bedtime. Your doctor may increase your dose as needed and tolerated. However, the dose is usually not more than 12 mg per day.
      • Children younger than 12 years of age—Use and dose must be determined by your doctor.
    • For partial-onset seizures:
      • Adults and children 4 years of age and older—At first, 2 milligrams (mg) once a day, taken at bedtime. Your doctor may increase your dose as needed and tolerated. However, the dose is usually not more than 12 mg per day.
      • Children younger than 4 years of age—Use and dose must be determined by your doctor.

Modifications

Your dosage of Fycompa may vary based on factors such as clinical response, tolerability, health conditions, and whether you are taking other medications. In addition, the following circumstances can influence dosage and administration:

  • Moderate or strong CYP3A4 inhibitor use: Taking CYP3A4 inhibitors may affect how Fycompa works. Depending on the drug, your medication may need a dosage adjustment. Your healthcare provider will let you know whether you need a different dosage. Moderate or potent CYP3A4 inhibitors include other certain anti-epilepsy drugs, such as Dilantin (phenytoin) and Tegretol (carbamazepine).
  • Mild or moderate liver impairment: If you have liver problems, your healthcare provider will instruct you on how to take this medication. People with mild or moderate liver disease should not exceed Fycompa doses of 6 milligrams (mg) and 4 milligrams, respectively, per day.
  • Pregnancy: There is limited data regarding using Fycompa during pregnancy. However, people with uncontrolled seizure disorders are at increased risk of pregnancy-related complications due to the inherent dangers associated with seizures. Nonhuman animal data has suggested a link that perampanel may cause fetal harm; however, these data are preliminary and should be interpreted with caution. Talk to your healthcare provider if you become pregnant or plan to become pregnant; you may need to be closely monitored during treatment.

Missed Dose

If you miss a dose, take it as soon as you remember. However, if it is close enough to your next dose, skip the missed dose and resume your regular dosing schedule. Contact your healthcare provider if you miss multiple doses.

Overdose: What Happens If I Take Too Much Fycompa?

Harmful effects from taking too much Fycompa can be prolonged while the medication is metabolized (processed and eliminated) from your body.

Effects of an overdose can include:

  • Severe tiredness
  • Dizziness
  • Trouble walking
  • Psychiatric effects
  • Confusion
  • Unresponsiveness
  • Coma

Treatment of an overdose includes careful observation of vital signs and heart function. Treatment can include management of symptoms, airway management to improve breathing, and oxygen supplementation as necessary.

What Happens If I Overdose on Fycompa?

If you think you or someone else may have overdosed on Fycompa, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Fycompa, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is very important that your doctor check your progress at regular visits. This will allow your doctor to see if the medicine is working properly and to decide if you should continue to take it.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. Also tell your doctor if you or your child have sudden or strong feelings, such as feeling nervous, angry, restless, violent, or scared. If you, your child, or your caregiver notice any of these side effects, tell your doctor right away.

This medicine may cause some people to become dizzy, drowsy, clumsy, faint, unsteady, or less alert than they are normally. It may also cause trouble with controlling body movements, which may lead to falls, fractures, or other injuries. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

Check with your doctor right away if you have a fever, chills, cough, sore throat, swollen, painful, or tender lymph glands in the neck, armpit, or groin, or yellow skin or eyes while using this medicine. These could be symptoms of a serious condition, called drug reaction with eosinophilia and systemic symptoms (DRESS).

This medicine may be habit-forming. If you feel that the medicine is not working as well, do not use more than your prescribed dose. Call your doctor for instructions.

Do not stop taking this medicine without checking first with your doctor. Stopping the medicine suddenly may cause your seizures to return or to occur more often. Your doctor may want you to gradually reduce the amount you are taking before stopping it completely.

Birth control pills containing levonorgestrel may not work as well while you are using this medicine. Use another form of birth control together with your pills during treatment and for at least 1 month after the last dose to avoid getting pregnant. Talk to your doctor if you have questions.

This medicine will add to the effects of alcohol and other CNS depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines, medicines for hay fever, allergies or colds, sedatives, tranquilizers, or sleeping medicines, prescription pain medicines or narcotics, and other medicines for seizures. Check with your doctor before taking any of these medicines together with perampanel.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.

What Are Reasons I Shouldn’t Take Fycompa?

Fycompa has no contraindications or specific scenarios in which this medication would be harmful. However, it is not recommended to use Fycompa if you have severe liver disease. Additionally, you may need to stop using this medication if it causes severe side effects, especially abnormal behavior or mood changes that may be dangerous.

What Other Medications Interact With Fycompa?

Using Fycompa with alcohol or any medications that cause drowsiness can make you very sleepy or can lead to confusion or loss of consciousness.

Additionally, Fycompa can interact with:

  • Contraceptives containing levonorgestrel: These contraceptives can be less effective if you are taking Fycompa.
  • Moderate and strong CYP3A4 inducers: Examples include carbamazepine, Trileptal (oxcarbazepine), and phenytoin. These medications can lower your concentration of Fycompa, reducing its activity. This may require a dose adjustment. And if you stop taking these medications while continuing Fycompa, the level of Fycompa in your body may increase.

This is not a complete list of all drug interactions that may occur with Fycompa. Share your medical history and use of prescription and over-the-counter (OTC) medications, vitamins, and herbal supplements with a healthcare provider or pharmacist. They can help you avoid important drug or supplement interactions.

What Medications Are Similar?

Fycompa is one of many anti-epilepsy medications. Its mechanism of action is unique. 

Commonly used anticonvulsants (i.e., anti-seizure medications) that have different mechanisms include:

Frequently Asked Questions

  • What is Fycompa used for?

    Fycompa is prescribed for use in preventing two types of seizures: Partial-onset seizures and primary generalized tonic-clonic seizures.

  • How does Fycompa work?

    Fycompa inhibits glutamate, an excitatory neurotransmitter, by blocking glutamate receptors in the brain. This helps reduce and prevent seizure activity.

  • What drugs should not be taken with Fycompa?

    This medication can reduce the action of contraceptives containing levonorgestrel. Additionally, taking Fycompa with alcohol or other sedating substances can cause severe fatigue or loss of consciousness. Medications classified as strong or moderate CYP3A4 inducers can decrease your Fycompa level.

  • What are the side effects of Fycompa?

    This medication can cause varying degrees of dizziness, balance problems, fatigue, nausea, vomiting, anxiety, and headaches. It also poses a risk of suicidal thoughts or actions or a severe hypersensitivity reaction.

  • How do I safely stop taking Fycompa?

    You should not suddenly stop taking Fycompa. If you need to stop this medication, you should follow the instructions provided to you by your healthcare provider. Abruptly stopping can induce a seizure.

How Can I Stay Healthy While Taking Fycompa?

The following steps can help you stay healthy while taking Fycompa:

  • Take the medication exactly as prescribed.
  • Do not abruptly stop taking Fycompa, as this can lead to increased seizure frequency.
  • Tell your healthcare provider about any side effects that you are having. They may be able to help manage them.
  • Seek medical attention if you take too much Fycompa or experience severe side effects.
  • Avoid possible seizure triggers, including alcohol, lack of sleep, skipping meals, severe blood glucose fluctuations, and very high fevers.
  • Get in touch with your healthcare provider if you develop an infection, fever, or illness because these can trigger a seizure.
  • Talk to your healthcare provider about whether you need to restrict driving, climbing on ladders, or using heavy machinery.
  • Be especially careful about activities that could cause an injury if this medication makes you feel drowsy.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended to replace medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Drug Enforcement Administration. Controlled substance schedules.

  4. Lizarraga KJ, Al-Shorafat D, Fox S. Update on current and emerging therapies for dystonia. Neurodegener Dis Manag. 2019:135-147. doi:10.2217/nmt-2018-0047

  5. Newey CR, Mullaguri N, Hantus S, Punia V, George P. Super-refractory status epilepticus treated with high dose perampanel: case series and review of the literature. Case Rep Crit Care. 2019:3218231. doi:10.1155/2019/3218231

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  7. Vazquez B, Tomson T, Dobrinsky C, Schuck E, O'Brien TJ. Perampanel and pregnancy. Epilepsia. 2021;62(3):698-708. doi:10.1111/epi.16821

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.