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Perampanel may cause or worsen mental/mood disorders. Tell your doctor right away if you or your family/caregiver notice any unusual behavior changes (including aggression, attempts to hurt others, impulsive actions) or other mental/mood changes (including anxiety, irritability, hostile/angry feelings, paranoia, hallucinations, delusions, thoughts of harming others). Be especially watchful for these symptoms when you first start this medication or when the dose is changed. These symptoms may also occur even after stopping perampanel. Do not drink alcoholic beverages while taking perampanel because alcohol may make these symptoms worse.

See also Warning Section. Dizziness, a feeling of spinning, unsteadiness, trouble walking, loss of balance, drowsiness, weakness, nausea, vomiting, headache, or weight gain may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Tell your doctor right away if you have any serious side effects, including: blurred/double vision, frequent falls. A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself. A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: fever, swollen lymph nodes, rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

A product that may interact with this drug is: orlistat. Other medications can affect the removal of perampanel from your body, which may affect how perampanel works. Examples include rifamycins (such as rifabutin), St. John's wort, among others. This medication may decrease the effectiveness of levonorgestrel-containing birth control. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use reliable non-hormonal backup birth control methods (such as condoms, diaphragm with spermicide) while using perampanel and for a month after you stop using perampanel. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well. Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine). Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.