lHEPATIC IMPAIRMENTCaution in severe impairment—no
information available.
lRENAL IMPAIRMENT
Dose adjustmentsHalve initial dose if estimated
glomerularfiltration rate less than 30 mL/minute/ 1. 73 m^2 ,
increase according to response at intervals of at least
1 week.
lPRE-TREATMENT SCREENINGTest for HLA-B 1502 allele in
individuals of Han Chinese or Thai origin (avoid unless no
alternative—risk of Stevens-Johnson syndrome in
presence of HLA-B 1502 allele).
lMONITORING REQUIREMENTS
▶Monitor plasma-sodium concentration in patients at risk
of hyponatraemia.
▶Monitor body-weight in patients with heart failure.
lPRESCRIBING AND DISPENSING INFORMATIONPatients
may need to be maintained on a specific manufacturer’s
branded or generic oxcarbazepine product.
Switching between formulationsCare should be taken when
switching between oral formulations. The need for
continued supply of a particular manufacturer’s product
should be based on clinical judgement and consultation
with the patient or their carer, taking into account factors
such as seizure frequency and treatment history.
lPATIENT AND CARER ADVICE
Blood, hepatic, or skin disordersPatients or their carers
should be told how to recognise signs of blood, liver, or
skin disorders, and advised to seek immediate medical
attention if symptoms such as lethargy, confusion,
muscular twitching, fever, rash, blistering, mouth ulcers,
bruising, or bleeding develop.
Medicines for Children: Oxcarbazepine for preventing seizures
http://www.medicinesforchildren.org.uk/oxcarbazepine-for-
preventing-seizures
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension
Oral suspension
CAUTIONARY AND ADVISORY LABELS3, 8
EXCIPIENTS:May contain Propylene glycol
▶Trileptal(Novartis Pharmaceuticals UK Ltd)
Oxcarbazepine 60 mg per 1 mlTrileptal 60 mg/ml oral suspension
sugar-free| 250 mlP£ 48. 96 DT = £ 48. 96
Tablet
CAUTIONARY AND ADVISORY LABELS3, 8
▶Oxcarbazepine (Non-proprietary)
Oxcarbazepine 150 mgOxcarbazepine 150 mg tablets|
50 tabletP£ 11. 14 DT = £ 8. 37
Oxcarbazepine 300 mgOxcarbazepine 300 mg tablets|
50 tabletP£ 22. 61 DT = £ 6. 43
Oxcarbazepine 600 mgOxcarbazepine 600 mg tablets|
50 tabletP£ 45. 19 DT = £ 38. 71
▶Trileptal(Novartis Pharmaceuticals UK Ltd)
Oxcarbazepine 150 mgTrileptal 150 mg tablets| 50 tabletP
£ 12. 24 DT = £ 8. 37
Oxcarbazepine 300 mgTrileptal 300 mg tablets| 50 tabletP
£ 24. 48 DT = £ 6. 43
Oxcarbazepine 600 mgTrileptal 600 mg tablets| 50 tabletP
£ 48. 96 DT = £ 38. 71
Perampanel
lINDICATIONS AND DOSE
Adjunctive treatment of focal seizures with or without
secondary generalised seizures
▶BY MOUTH
▶Child 12–17 years:Initially 2 mg once daily, dose to be
taken before bedtime, then increased, if tolerated, in
steps of 2 mg at intervals of at least every 2 weeks,adjusted according to response; maintenance 4 – 8 mg
once daily; maximum 12 mg per day
DOSE ADJUSTMENTS DUE TO INTERACTIONS
▶Titrate at intervals of at least 1 week with concomitant
carbamazepine, fosphenytoin, oxcarbazepine, or
phenytoin.lINTERACTIONS→Appendix 1 : antiepileptics
lSIDE-EFFECTS
▶Common or very commonAnxiety.appetite abnormal.
back pain.behaviour abnormal.confusion.dizziness.
drowsiness.dysarthria.fatigue.gait abnormal.irritability
.movement disorders.nausea.vertigo.vision disorders.
weight increased
lPREGNANCYManufacturer advises avoid.
MonitoringThe dose should be monitored carefully during
pregnancy and after birth, and adjustments made on a
clinical basis.
lBREAST FEEDINGAvoid—present in milk inanimalstudies.
lHEPATIC IMPAIRMENTAvoid in severe impairment.
Dose adjustmentsIncrease at intervals of at least 2 weeks,
up to max. 8 mg daily in mild or moderate impairment.
lRENAL IMPAIRMENTAvoid in moderate or severe
impairment.
lPRESCRIBING AND DISPENSING INFORMATION
Switching between formulationsCare should be taken when
switching between oral formulations. The need for
continued supply of a particular manufacturer’s product
should be based on clinical judgement and consultation
with the patient or their carer, taking into account factors
such as seizure frequency and treatment history.
Patients may need to be maintained on a specific
manufacturer’s branded or generic perampanel product.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug.
Tablet
CAUTIONARY AND ADVISORY LABELS3, 8, 25
▶Fycompa(Eisai Ltd)
Perampanel 2 mgFycompa 2 mg tablets| 7 tabletP£ 35. 00 DT =
£ 35. 00 | 28 tabletP£ 140. 00 DT = £ 140. 00
Perampanel 4 mgFycompa 4 mg tablets| 28 tabletP£ 140. 00
DT = £ 140. 00
Perampanel 6 mgFycompa 6 mg tablets| 28 tabletP£ 140. 00
DT = £ 140. 00
Perampanel 8 mgFycompa 8 mg tablets| 28 tabletP£ 140. 00
DT = £ 140. 00
Perampanel 10 mgFycompa 10 mg tablets| 28 tabletP
£ 140. 00 DT = £ 140. 00
Perampanel 12 mgFycompa 12 mg tablets| 28 tabletP£ 140. 00
DT = £ 140. 00Phenytoin 19-Apr-2017
lINDICATIONS AND DOSE
Tonic-clonic seizures|Focal seizures
▶BY MOUTH
▶Child 1 month–11 years:Initially 1. 5 – 2. 5 mg/kg twice
daily, then adjusted according to response to
2. 5 – 5 mg/kg twice daily (max. per dose 7. 5 mg/kg twice
daily), dose also adjusted according to plasma-
phenytoin concentration; maximum 300 mg per day
▶Child 12–17 years:Initially 75 – 150 mg twice daily, then
adjusted according to response to 150 – 200 mg twice
daily (max. per dose 300 mg twice daily), dose also
adjusted according to plasma-phenytoin
concentration continued→BNFC 2018 – 2019 Epilepsy and other seizure disorders 205
Nervous system4