Fycompa
Fycompa (perampanel) is an antiseizure medication that's used to control certain types of seizures. It's available as a liquid and tablet that's taken by mouth. While it's convenient because the dosage is taken once per day, Fycompa (perampanel) is a schedule III controlled substance and can have a lot of side effects, including sleepiness, dizziness, and weight gain. This medication is not yet available as a lower-cost generic.
What is Fycompa (perampanel)?
What is Fycompa (perampanel) used for?
Partial-onset seizures in people ages 4 years and older
Generalized tonic-clonic seizures in people ages 12 years and older (add-on therapy to other seizure medications)
How Fycompa (perampanel) works
Fycompa (perampanel) is an antiepileptic (anti-seizure) medication. It's not exactly clear how the medication works. But it's thought to block glutamate from attaching to its receptors in the brain. Glutamate is a chemical in the brain that causes a lot of brain activity and plays a role in seizures. By stopping the actions of glutamate in the brain, Fycompa (perampanel) causes nerve cells to become less active, which helps prevent seizures.
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What are the risks and warnings for Fycompa (perampanel)?
Fycompa (perampanel) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Abnormal mood, thoughts, or behavior
Risk factors: History of mental health problems | Alcohol | Taking higher doses of Fycompa (perampanel)
Fycompa (perampanel) can raise your risk of having abnormal mood, thoughts, or behavior. Changes in mood or behavior can include being aggressive, irritable, unfriendly, angry, or anxious. Sometimes, people might even have thoughts of hurting other people. Some people have also reported having hallucinations (seeing or hearing things that aren't real), delusions, and paranoia.
These changes in mood, thoughts, and behavior are more likely to happen when you're first starting Fycompa (perampanel) or after switching to a higher dose. Don't drink alcohol with this medication since it can make the effects worse. Let your provider know right away if you notice a change in your mood or thoughts or if your child is behaving abnormally while taking Fycompa (perampanel). Call your provider even if these changes happen a couple months after stopping the medication.
Suicidal thoughts or behavior
Risk factors: Taking other anti-seizure medications
Fycompa (perampanel) can raise your risk of having thoughts of suicide or harming yourself. You can be at higher risk of having these thoughts as early as 1 week after you start taking Fycompa (perampanel). Get medical help right away if you or anyone around you notices that you have any worsening depression, suicidal thoughts, or unusual behavior (e.g., anxiety, panic attacks, trouble sleeping, feeling angry or irritated, restlessness) while you're taking Fycompa (perampanel).
Difficulty concentrating, extreme sleepiness, dizziness, and loss of balance
Risk factors: Taking high doses of Fycompa (perampanel) | Taking other medications that can cause sleepiness | Drinking alcohol | People over 65 years of age
Fycompa (perampanel) can cause extreme dizziness and sleepiness, which can lower your ability to think, react, and focus. These effects can raise your risk for falls. You might also feel off balance or uncoordinated, which can also lead to falls. Your risk might be higher if you're taking other medications that can make you feel sleepy (e.g., benzodiazepines, muscle relaxants). Make sure you know how this medication affects you before driving a car or doing activities that require your concentration. Talk to your healthcare provider right away if you feel too sleepy from taking Fycompa (perampanel) or if you experience a fall during treatment.
Severe allergic and skin reactions
Severe allergic reactions to Fycompa (perampanel) are possible. These can include life-threatening reactions like facial swelling and anaphylaxis (e.g., closing of the throat). Fycompa (perampanel) can also cause rare, but serious skin reactions, such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). Stop using Fycompa (perampanel) and get medical attention right away if you experience swelling in your face, trouble breathing, fever, or changes in your skin (e.g., rash, blisters, swollen lymph nodes, skin reddening, skin peeling).
Risk of seizures and withdrawal symptoms if stopped suddenly
Because Fycompa (perampanel) helps control your seizures, stopping the medication suddenly can cause more seizures to happen. Suddenly stopping the medication can also cause other withdrawal symptoms, such as anxiety, nervousness, and trouble sleeping. To help prevent these withdrawal symptoms, don't change your dose or stop taking Fycompa (perampanel) without talking to your provider first. They'll help you lower your dose slowly over time before stopping completely.
What are the side effects of Fycompa (perampanel)?
Common Side Effects
- Dizziness (up to 43%)
- Sleepiness (up to 18%)
- Headache (up to 13%)
- Feeling irritable (up to 12%)
- Tiredness (up to 12%)
- Falls (up to 10%)
- Nausea or vomiting (up to 8%)
- Difficulty with movement or coordination (up to 8%)
Other Side Effects
- Muscle, joint, or back pain
- Constipation
- Weight gain
- Upper respiratory tract infection
- Numbness
- Slurred speech
- Vision changes
- Difficulty walking
- Spinning sensation
- Anxiety
Serious Side Effects
- Suicidal thoughts or behavior
- Serious allergic and skin reactions: fever, fatigue, rash, hives, peeling skin, swollen lymph nodes
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Aggression or anger
clumsiness or unsteadiness
deep or fast breathing with dizziness
irregular heartbeat
irritability
numbness of the feet, hands, and around the mouth
restlessness
shakiness
sleepiness or unusual drowsiness
trouble sleeping
unsteadiness, trembling, or other problems with muscle control or coordination
unsteady walk
unusual tiredness or weakness
Less common
Abnormal or decreased touch sensation
burning, crawling, itching, numbness, prickling, "pins and needles", or tingling feelings
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Dizziness or lightheadedness
feeling of constant movement of self or surroundings
headache
sensation of spinning
stomach pain
Less common
Back pain
bloating or swelling of the face, arms, hands, lower legs, or feet
blurred vision
body aches or pain
bone pain
changes in speech patterns
chills
confusion
decreased urine output
difficulty having a bowel movement
difficulty with moving
double vision
ear congestion
fast or irregular heartbeat
increased thirst
lack or loss of strength
loss of voice
muscle pain, cramps, or stiffness
pain in the arms, joints, or legs
slurred speech
trouble remembering
trouble with speaking
unusual weight gain or loss
unusually deep sleep
vomiting
Incidence not known
Unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Fycompa (perampanel)
Pros
Works well for seizures
Only taken once per day
Available as a liquid and tablet
Cons
Causes dizziness and raises your risk of falls
Can cause dangerous changes in mood, thoughts, or behavior
Might not be a safe choice for pregnant women
Pharmacist tips for Fycompa (perampanel)
Take Fycompa (perampanel) once per day at bedtime with or without food. But if it upsets your stomach, try taking it with food to help.
Side effects from Fycompa (perampanel) are more likely to happen if you're taking higher doses. These side effects might return if your dose is raised. Let your provider know if you experience bothersome side effects. They might lower your dose.
Fycompa (perampanel) can raise the risk of suicidal thoughts. Contact your provider right away if you or your loved ones notice any new or worsening changes in your behavior or mood while taking the medication.
Fycompa (perampanel) commonly causes sleepiness, tiredness, and dizziness. Don't drive or do anything requiring concentration until you know how this medication affects you. Also, avoid drinking alcohol because it can worsen these effects.
Don't change your dose or stop taking Fycompa (perampanel) without talking to your provider first. Doing so can cause more seizures or other withdrawal symptoms like anxiety and sleeping problems. Follow your provider's instructions to lower your dose slowly over a period of time to stop the medication completely.
If you use birth control, talk to your provider about which methods of birth control is right for you while you're taking Fycompa (perampanel). You'll need to use a backup method of protection during treatment until 1 month after you've stopped taking the medication if you're using hormonal birth control containing levonorgestrel (e.g., Vienva). This type of birth control might not work as well when taken with Fycompa (perampanel) and raise the risk for an unplanned pregnancy.
Make sure to tell your provider and pharmacist about all of the medications you're taking or planning to take with Fycompa (perampanel). Fycompa (perampanel) can interact with some common medications, including other anti-seizure medications (e.g., carbamazepine (Tegretol), phenytoin (Dilantin)).
If you miss a dose of Fycompa (perampanel), skip the missed dose. Wait to take your next dose at your next regularly scheduled time. Don't double-up to make up for the missed dose. Call your provider to see what to do next if you forget to take Fycompa (perampanel) for more than a day.
More tips for the oral suspension (liquid) only:
Each 1 milliter (mL) of liquid contains 0.5 mg of Fycompa (perampanel). Ask your pharmacist or provider if you're not sure how many mL of the suspension you need to take.
Shake the bottle well for a few seconds before each dose. Make sure to only use a medication dose cup or syringe from the package or from the pharmacy to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
Keep the oral suspension at room temperature. Once the bottle is opened, it's good for 3 months before the medication expires. Throw out any remaining medication after this time.
Frequently asked questions about Fycompa (perampanel)
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Fycompa (perampanel) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 340ml | 1 bottle | $1512.96 | $1512.96 |
Typical dosing for Fycompa (perampanel)
The typical starting dose is 2 mg by mouth once daily at bedtime. The maintenance dose ranges from 8 mg to 12 mg once daily.
Your dose might differ if you have liver problems or if you take other medications that interact with Fycompa (perampanel).
Interactions between Fycompa (perampanel) and other drugs
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Alfentanil
- Alprazolam
- Benzhydrocodone
- Bosentan
- Bromazepam
- Buprenorphine
- Butorphanol
- Calcifediol
- Calcium Oxybate
- Cannabidiol
- Carbamazepine
- Ceritinib
- Cetirizine
- Clarithromycin
- Clobazam
- Codeine
- Dihydrocodeine
- Doxylamine
- Efavirenz
- Enzalutamide
- Esketamine
- Eslicarbazepine Acetate
- Etravirine
- Fentanyl
- Flibanserin
- Fosphenytoin
- Gabapentin
- Gabapentin Enacarbil
- Hydrocodone
- Hydromorphone
- Ketamine
- Lemborexant
- Levocetirizine
- Levorphanol
- Lofexidine
- Lorlatinib
- Loxapine
- Lumacaftor
- Magnesium Oxybate
- Meperidine
- Methadone
- Metoclopramide
- Midazolam
- Mitotane
- Modafinil
- Morphine
- Morphine Sulfate Liposome
- Nafcillin
- Nalbuphine
- Orlistat
- Oxcarbazepine
- Oxycodone
- Oxymorphone
- Pentazocine
- Periciazine
- Phenobarbital
- Phenytoin
- Potassium Oxybate
- Pregabalin
- Primidone
- Remifentanil
- Remimazolam
- Rifampin
- Scopolamine
- Sodium Oxybate
- St John's Wort
- Sufentanil
- Tapentadol
- Tramadol
- Trazodone
- Zolpidem
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Fycompa (perampanel) cost?
What are alternatives to Fycompa (perampanel)?
Partial-onset seizures in people ages 4 years and older
Generalized tonic-clonic seizures in people ages 12 years and older (add-on therapy to other seizure medications)
Focal aware (partial-onset) seizures in people ages 1 month and older
Add-on treatment for myoclonic seizures from juvenile myoclonic epilepsy in people ages 12 years and older
Add-on treatment for generalized tonic-clonic seizures in people ages 6 years and older
Seizures (partial seizures, tonic-clonic seizures)
Seizures of Lennox-Gastaut syndrome - immediate-release only
Bipolar disorder - immediate-release only
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References
Best studies we foundBarker-Haliski, M., et al. (2015). Glutamatergic mechanisms associated with seizures and epilepsy. Cold Spring Harbor Perspectives in Medicine.
Catalyst Pharmaceuticals, Inc. (2023). Fycompa- perampanel tablet; perampanel suspension [package insert]. DailyMed.
Catalyst Pharmaceuticals, Inc. (2023). Taking Fycompa®.
Centers for Disease Control and Prevention. (n.d.). Protect your child - Use the right tool to give the right dose.
French, J.A., et al. (2015). Perampanel for tonic-clonic seizures in idiopathic generalized epilepsy: A randomized trial. Neurology.
Greenwood, J., et al. (2016). Perampanel (Fycompa): A review of clinical efficacy and safety in epilepsy. Pharmacy and Therapeutics.
Joshi, C. (2020). Epilepsy generalized tonic clonic seizures alone. Epilepsy Foundation.
Kiriakopoulos, E. (n.d.). Focal aware seizures (simple partial seizures). Epilepsy Foundation.
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