CASE REPORT article
Front. Psychiatry
Sec. Psychopharmacology
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1621598
A case report of seizure worsening after perampanel add-on to oxcarbazepine: possible role of metabolic interaction and pharmacogenetics
Provisionally accepted
- Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
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Objective: To investigate the factors contributing to increased seizure frequency in patients treated with a combination of oxcarbazepine (OXC) and perampanel. Methods: The influence of the combined use of perampanel and oxcarbazepine on pharmacokinetics was analysed, and the results were further confirmed by scoring the Naranjo Adverse Reaction Scale. The influence of race on antiseizure medications (ASMs) was also analysed. Results: The concomitant use of perampanel and oxcarbazepine increased the plasma concentration of oxcarbazepine. Scoring with the Naranjo adverse reaction scale indicated that the deterioration of seizures in patients following the addition of perampanel may be associated with the interaction of the two drugs. Conclusion: The exacerbation of epilepsy in patients may be attributed to the increased blood concentration of oxcarbazepine resulting from its combination with perampanel, which potentially triggers a worsening of seizures. Variations in gene mutations related to Asian factors, as well as differences in drug metabolism enzymes and transporters, may also contribute to alterations in the concentration of ASMs.
Keywords: Perampanel, oxcarbazepine, Combination medication, increased seizures, Ethnic factors
Received: 01 May 2025; Accepted: 04 Sep 2025.
Copyright: © 2025 Fang, Zhu and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Menglu Zhu, Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Yiwu, China
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