title: Perampanel: a significant liver enzyme inducer in some patients?
abstract: Perampanel is one of the latest released antiepileptic drugs (AEDs). Early studies suggest no significant liver enzyme induction from this compound. We report on two patients with medically resistant epilepsy, who had perampanel added to their usual regimen. Both experienced a worsening of their epilepsy and presented in convulsive status epilepticus; concurrent antiepileptic drug levels (phenytoin, phenobarbital, rufinamide) were significantly decreased (<50%) in comparison with levels prior to perampanel introduction. Intravenous load and significant increase of maintenance dosages were needed to restore therapeutic drug levels. In one patient, further increase of perampanel resulted in a new drop of phenytoin level. This suggests that perampanel could, in some subjects, induce liver enzymes and interact with concomitant AEDs; monitoring levels of concomitant compounds could be useful.
authors.affiliation: Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland.
authors.forename: Jan
authors.initials: J
authors.lastname: Novy
authors.forename: Laura E
authors.initials: LE
authors.lastname: Rothuizen
authors.forename: Thierry
authors.initials: T
authors.lastname: Buclin
authors.forename: Andrea O
authors.initials: AO
authors.lastname: Rossetti
mesh_terms: D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use*; D004827:Epilepsy / Q000188:drug therapy* / Q000201:enzymology*; D006801:Humans; D008099:Liver / Q000187:drug effects* / Q000201:enzymology*; D008297:Male; D009570:Nitriles; D011728:Pyridones / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D009570:Nitriles; D011728:Pyridones; C551441:perampanel