Balestrini, S;
Hart, Y;
Thunell, S;
Sisodiya, SM;
(2016)
Safe use of perampanel in a carrier of variegate porphyria.
Practical Neurology
10.1136/practneurol-2015-001305.
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Abstract
Objectives. Treatment of chronic epilepsy in acute porphyrias may be difficult because many antiepileptic drugs can cause activation of clinically-latent conditions. Methods. A 44 year-old lady with drug-resistant chronic epilepsy and a previous genetic diagnosis of variegate porphyria was referred to our epilepsy centre. We started her on perampanel, a structurally novel selective non-competitive AMPA receptor antagonist recently approved for the treatment of partial and secondarily generalized seizures in humans. There are no previous reports about the outcome of exposure to perampanel of carriers of acute porphyria. Results. Perampanel was assessed in silico to be probably not porphyrogenic. Administration of the drug up to 4 mg/day did not lead to elevation of urinary porphobilinogen excretion, nor to any symptoms of acute porphyria after more than 23 months of treatment. Conclusions. Perampanel up to 4 mg/day was tolerated in long-term therapy in this carrier of protoporphyrinogen oxidase deficiency. However, since perampanel is a weak inducer of cytochrome P450 enzymes, vigilance should be maintained for clinical and biochemical signs of activation of acute porphyria when used in a carrier of acute porphyria.
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