Xcopri
Xcopri (cenobamate) is an antiepileptic (antiseizure) medication that treats partial-onset seizures in adults. The tablets are taken by mouth once daily. This medication can cause side effects, like sleepiness, dizziness, and fatigue. You'll start at a low dose and then your dose will be raised slowly over several weeks to the recommended dosage to help with side effects. Xcopri (cenobamate) is a controlled substance, so there can be restrictions on how many refills your prescription can have.
What is Xcopri (cenobamate)?
What is Xcopri (cenobamate) used for?
Partial-onset (focal) seizures in adults
How Xcopri (cenobamate) works
Xcopri (cenobamate) is an antiepileptic (antiseizure) medication. It's not entirely known how the medication works to treat partial-onset seizures. But it's thought to work on sodium and gamma-aminobutyric acid (GABA) channels in your brain cells. This helps lower the electrical activity in the brain and lessen the number of seizures you might have.
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What are the risks and warnings for Xcopri (cenobamate)?
Xcopri (cenobamate) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious skin reaction
Risk factors: Raising the dose of Xcopri (cenobamate) too fast (every week or sooner)
Xcopri (cenobamate) can cause a rare but serious skin reaction called Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. Symptoms of DRESS syndrome include rash, fever, and swollen lymph nodes. In some rare cases, DRESS syndrome can also affect your liver, kidneys, or heart. Get medical attention right away if you develop any symptoms of DRESS syndrome while you're taking Xcopri (cenobamate).
Heart rhythm problems
Risk factors: Familial short QT syndrome | Taking other medications that cause irregular heart rhythm
Xcopri (cenobamate) can cause changes in your electrocardiogram (EKG), or a test of your heart's electrical activity. These changes can potentially lead to abnormal heart rhythms that are life-threatening. Let your care team know if you have a racing heart that doesn't seem to go away or if you've fainted. These can be signs of heart rhythm problems.
Tell your prescriber if you have any history of heart rhythm problems. You can't take Xcopri (cenobamate) if you have a rare, genetic heart condition called familial short QT syndrome. Also, make sure your prescriber and pharmacist know about all the medications that you take. Taking Xcopri (cenobamate) with other medications that affect your heart rhythm can raise your risk of this problem even more.
Suicidal thoughts or behavior
Antiepileptic (antiseizure) medications like Xcopri (cenobamate) can raise your risk of having thoughts of suicide or harming yourself. In general, this high risk can start as early as one week after starting an antiepileptic medication. Watch for new or worsening signs of depression and any unusual changes in mood during treatment, especially after a dose change. Let your prescriber know if anything concerning happens. Call 911 or get medical help right away if you have thoughts of hurting yourself.
Side effects related to the nervous system (e.g., drowsiness, fatigue, difficulty controlling movements)
Xcopri (cenobamate) can cause drowsiness, fatigue, weakness, confusion, and vision changes. It can also cause you to have problems with movement, coordination, speech, and memory. These side effects might be more likely to happen as you take higher doses.
Avoid activities that require you to be alert, such as riding a bike, driving, or operating machinery, until you know how Xcopri (cenobamate) affects you. Tell your prescriber if you have these side effects and they start to negatively affect your everyday life. Also discuss with your care team if you have concerns about these side effects.
Worsening of seizures if you stop the medication suddenly
Don't stop taking Xcopri (cenobamate) without talking to your prescriber first. Your prescriber will need to work with you to lower your dose slowly over time if you'd like to stop taking the medication or if it's necessary for you to stop.
It's important not to stop taking antiepileptic (antiseizure) medications too suddenly since this can lead to more frequent seizures or seizures that won't stop (status epilepticus). In general, it's a good idea to have a plan with family and friends about how to help (and when to call 911) during a seizure attack.
What are the side effects of Xcopri (cenobamate)?
Common Side Effects
- Sleepiness (22%)
- Dizziness (22%)
- Feeling low energy (14%)
- Headache (12%)
Other Side Effects
- Nausea
- Constipation
- Vomiting
- Double vision
- Feeling off balance
- Quick, uncontrollable eye movements
- Loss of coordination
- Cold-like symptoms
- Urinary tract infection (UTI)
Serious Side Effects
- Abnormal heart rhythm (QT shortening): racing heart, fainting
- Serious allergic reaction: rash, fever, trouble breathing, swollen lymph nodes, swelling in your face
- Suicidal thoughts or behavior
Source: DailyMed
The following side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Heart rhythm changes—fast or irregular heartbeat, dizziness, feeling faint or lightheaded, chest pain, trouble breathing
- Rash, fever, and swollen lymph nodes
- Thoughts of suicide or self-harm, worsening mood, or feelings of depression
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Blurry vision
- Difficulty with paying attention, memory, or speech
- Dizziness
- Double vision
- Drowsiness
- Fatigue
- Headache
- Loss of balance or coordination
Pros and cons of Xcopri (cenobamate)
Pros
Many tablet strengths available, so your prescriber can adjust your dose based on your individual needs
Only taken once a day
Can cut the number of seizures you have per month by half (when taking the maintenance dose)
Can take by itself or together with other seizure medications
Cons
Can take several weeks to reach the maintenance dose and see the full effects of the medication
Can make you sleepy, tired, and dizzy
Not approved for use in children
No lower-cost generic available; only as a brand-name medication
Pharmacist tips for Xcopri (cenobamate)
You'll first start taking Xcopri (cenobamate) at a low dose and then your dose will be raised slowly to avoid side effects. Each tablet strength is a different color and has the dose marked on it (e.g., the 25 mg tablet has a "25" on it). The color and markings can help you tell apart the different dosage strengths as you follow the dosing schedule. Ask your prescriber or pharmacist if you're not sure what dose to take.
You can take Xcopri (cenobamate) with or without food. Food doesn't affect how well the medication works.
Swallow the Xcopri (cenobamate) tablet(s) whole with something to drink.
If you have trouble swallowing the Xcopri (cenobamate) tablet, ask your prescriber whether it's okay for you to crush the tablet and mix it with water. Drink the mixture right away; don't save it for later.
If you have a nasogastric (NG) tube, your prescriber will instruct you or your caregiver to crush the Xcopri (cenobamate) tablet(s) for your dose and then mix it with water. Draw up the mixture into a syringe and give it through the tube. Ask the prescriber if you have questions about taking the medication through an NG tube.
Xcopri (cenobamate) can make you sleepy and dizzy. It can also slow your thinking or motor skills. Don't drive or perform any dangerous activities until you know how this medication affects you.
Avoid drinking alcohol while you're taking Xcopri (cenobamate). Alcohol can make side effects like sleepiness, dizziness, and fatigue worse.
Don't stop taking Xcopri (cenobamate) all of a sudden because you could have more seizures or have seizures that don't stop (status epilepticus). It can also lead to other withdrawal symptoms, like trouble sleeping, depressed mood, tremor, and memory loss. Talk to your prescriber if you feel like Xcopri (cenobamate) isn't working for you. They'll work with you to stop the mediation slowly and safely over at least 2 weeks.
Xcopri (cenobamate) can interact with birth control pills and make them work less well. If you can become pregnant and are sexually active, make sure to use a back-up or alternative method of birth control while you're taking this medication.
Tell your care team if you become pregnant while you're taking Xcopri (cenobamate). There isn't enough information available to know whether the medication is safe during pregnancy. You're encouraged to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry if you become pregnant during treatment. This pregnancy registry helps researchers follow your health and your baby's health. Enroll by calling 1-888-233-2334 or by visiting the registry website.
Frequently asked questions about Xcopri (cenobamate)
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Xcopri (cenobamate) dosage forms
Typical dosing for Xcopri (cenobamate)
You'll first start at a low dose of Xcopri (cenobamate). Then, your prescriber will raise your dose every 2 weeks until you reach the recommended maintenance dose of 200 mg once a day.
Weeks 1 and 2: Take 12.5 mg by mouth once daily.
Weeks 3 and 4: Take 25 mg by mouth once daily.
Weeks 5 and 6: Take 50 mg by mouth once daily.
Weeks 7 and 8: Take 100 mg by mouth once daily.
Weeks 9 and 10: Take 150 mg by mouth once daily.
Week 11 and thereafter: Take 200 mg by mouth once daily.
The maximum dose is 400 mg by mouth once a day.
Your dose might differ if you have liver or kidney problems.
How much does Xcopri (cenobamate) cost?
Xcopri (cenobamate) contraindications
Familial short QT syndrome
What are alternatives to Xcopri (cenobamate)?
Partial-onset (focal) seizures in adults
Focal aware (partial-onset) seizures in people ages 1 month and older
Add-on treatment for myoclonic seizures from juvenile myoclonic epilepsy in people ages 12 years and older
Add-on treatment for generalized tonic-clonic seizures in people ages 6 years and older
Xcopri (cenobamate) images
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References
Best studies we foundKienitz, R., et al. (2022). Benzodiazepines in the management of seizures and status epilepticus: A review of routes of delivery, pharmacokinetics, efficacy, and tolerability. Central Nervous System Drugs.
Kiriakopoulos, E. (n.d.). Focal aware seizures (simple partial seizures). Epilepsy Foundation.
Latimer, D. R., et al. (2021). Cenobamate, a sodium channel inhibitor and positive allosteric modulator of GABAA ion channels, for partial onset seizures in adults: A comprehensive review and clinical implications. Neurology International.
MedlinePlus. (2013). Short QT syndrome.
National Organization for Rare Disorders. (2021). Short QT syndrome.
Pitton Rissardo, J., et al. (2023). Antiseizure medication-induced alopecia: A literature review. Medicines.
SK Life Science, Inc. (2024). Xcopri® (cenobamate tablets) CV receives FDA approval for alternate methods of administration that include crushed tablet in liquid suspension taken orally or through a nasogastric tube.
SK Life Science, Inc. (2024). Xcopri titration pack- cenobamate kit; Xcopri- cenobamate tablet, film coated; Xcopri maintenance pack- cenobamate kit [package insert]. DailyMed.
Sperling, M. R., et al. (2021). Efficacy of cenobamate for uncontrolled focal seizures: Post hoc analysis of a Phase 3, multicenter, open-label study. Epilepsia.
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