Perampaneldosage

Dosing in the absence of moderate or strong CYP3A4 inducers Starting dose: 2 mg once daily orally at bedtime May increase dose based on clinical response and tolerability by increments of 2 mg once daily no more frequently than at weekly intervals Recommended maintenance dose in monotherapy or adjunctive therapy for partial-onset seizures: 8 mg to 12 mg once daily at bedtime Recommended maintenance dose in adjunctive therapy for primary generalized tonic-clonic seizures: 8 mg once daily at bedtime Dosing in the presence of concomitant moderate or strong CYP3A4 inducers: see section

2.3 Specific

Populations Mild and Moderate Hepatic Impairment: Maximum recommended daily dose is 6 mg (mild) and 4 mg (moderate) once daily at bedtime Severe Hepatic Impairment: Not recommended Severe Renal Impairment or on Hemodialysis: Not recommended Elderly: Increase dose no more frequently than every 2 weeks

2.1 Dosage for

Partial-Onset Seizures Monotherapy or Adjunctive Therapy The recommended starting dosage of perampanel in adults and pediatric patients 4 years of age and older is 2 mg once daily taken orally at bedtime. Increase dosage no more frequently than at weekly intervals by increments of 2 mg once daily based on individual clinical response and tolerability. The recommended maintenance dose range is 8 mg to 12 mg once daily, although some patients may respond to a dose of 4 mg daily. A dose of 12 mg once daily resulted in somewhat greater reductions in seizure rates than the dose of 8 mg once daily, but with a substantial increase in adverse reactions. Dosage adjustment is recommended with concomitant use of moderate or strong CYP3A4 enzyme inducing drugs, which include certain antiepileptic drugs (AEDs).

2.2 Dosage for

Primary Generalized Tonic-Clonic Seizures Adjunctive Therapy The recommended starting dosage of perampanel in adults and pediatric patients 12 years of age and older is 2 mg once daily taken orally at bedtime. Increase dosage no more frequently than at weekly intervals by increments of 2 mg once daily based on individual clinical response and tolerability. The recommended maintenance dose is 8 mg once daily taken at bedtime. Patients who are tolerating perampanel at 8 mg once daily and require further reduction of seizures may benefit from a dose increase up to 12 mg once daily if tolerated. Dosage adjustment is recommended with concomitant use of moderate or strong CYP3A4 enzyme inducing drugs, which include certain AEDs.

2.3 Dosage Modifications with

Concomitant Use of Moderate or Strong CYP3A4 Enzyme Inducers Moderate and strong CYP3A4 inducers, including enzyme-inducing AEDs such as phenytoin, carbamazepine, and oxcarbazepine, cause a reduction in perampanel plasma levels. Therefore, in adults and pediatric patients 4 years of age and older receiving these concomitant enzyme-inducing drugs, the recommended starting dosage of perampanel is 4 mg once daily taken orally at bedtime. Increase dosage by increments of 2 mg once daily based on individual clinical response and tolerability, no more frequently than at weekly intervals. A maintenance dose has not been established in clinical trials. The highest dose studied in patients on concomitant enzyme-inducing AEDs was 12 mg once daily. When moderate or strong CYP3A4 inducers are introduced or withdrawn from a patient's treatment regimen, the patient should be closely monitored for clinical response and tolerability. Dose adjustment of perampanel may be necessary.

2.4 Dosage Adjustment in

Patients with Hepatic Impairment In patients with mild and moderate hepatic impairment, the starting dose of perampanel is 2 mg once daily. Increase dosage by increments of 2 mg once daily no more frequently than every 2 weeks. The maximum recommended daily dose is 6 mg for patients with mild hepatic impairment and 4 mg for patients with moderate hepatic impairment. Perampanel is not recommended for use in patients with severe hepatic impairment.

2.5 Dosage Information for

Patients with Renal Impairment Perampanel tablets can be used in patients with moderate renal impairment with close monitoring. A slower titration may be considered, based on clinical response and tolerability. Perampanel tablets are not recommended in patients with severe renal impairment or patients undergoing hemodialysis.

2.6 Dosage Information for

Elderly Patients In elderly patients, increase dosage no more frequently than every 2 weeks during titration.