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.
Drug facts
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.
Side effects of Xcopri (cenobamate)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Sleepiness (22%)
- Dizziness (22%)
- Feeling low energy (14%)
- Headache (12%)
Less Common Side Effects
- Nausea
- Constipation
- Vomiting
- Double vision
- Feeling off balance
- Quick, uncontrollable eye movements
- Loss of coordination
- Cold-like symptoms
- Urinary tract infection (UTI)
Note: Side effects listed were reported by people who took the recommended maintenance dose of 200 mg per day.
Xcopri (cenobamate) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- 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
The following Xcopri (cenobamate) 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
- Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
- Rash, fever, and swollen lymph nodes
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
Side effects that usually do not require medical attention (report these 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
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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.
Common questions about Xcopri (cenobamate)
Yes, Xcopri (cenobamate) is a schedule 5 controlled substance (C-V). This is because the medication has the potential to be misused (used for non-medical reasons for its desirable physical or emotional effects). Taking Xcopri (cenobamate) long term can also lead to dependence (when you rely on a medication to function normally), which raises the risk for having withdrawal symptoms if you stop the medication suddenly. Controlled medications have special rules and laws that prescribers of the medication and the people taking the medication must follow. For example, you can only get a limited supply of Xcopri (cenobamate) every month. Keep the medication in a safe place away from children and other people.
No, Xcopri (cenobamate) isn't a benzodiazepine. The way it works to treat partial-onset seizures isn't clear. But it's different than how benzodiazepines work to treat seizures.
Yes, you can crush Xcopri (cenobamate) tablets and mix it with water. Then, you can drink the mixed solution. You can also give the mixed solution through a nasogastric (NG) tube with an appropriate syringe. Ask your prescriber if you should crush your dose and mix it with water if you have trouble swallowing the pills whole or if you have an NG tube.
You won't notice the effects of Xcopri (cenobamate) overnight. Keep in mind that it takes several weeks for you to get up to the recommended maintenance dose. This also means that it can take several weeks of treatment before you notice the full effects of this medication. On average, people had 55% fewer seizures per month when they took the maintenance dose of 200 mg each day for several weeks. Since everyone responds differently, this medication might work faster or slower for you. Let your prescriber know if you're having more seizures while you're taking Xcopri (cenobamate). They can reassess your treatment plan to control your seizures.
Weight gain isn't a commonly reported side effect of Xcopri (cenobamate). In fact, 1 to 2% of participants in clinical trials noticed weight loss after they took Xcopri (cenobamate), though it's not clear how much weight they lost. Keep in mind that Xcopri (cenobamate) can cause stomach upset and low appetite as side effects, which can contribute to weight loss if severe. Speak with your prescriber if you have concerning changes in your weight while you're taking Xcopri (cenobamate).
Although hair loss (alopecia) isn't a commonly reported side effect of Xcopri (cenobamate), there are some reports of it happening. In general, it seems like reports of hair loss with Xcopri (cenobamate) are less common than with some other antiseizure medications. Speak with your prescriber if you're noticing hair loss after you start taking Xcopri (cenobamate). They can work with you to figure out a cause and a potential solution for the hair loss.
Yes, sleepiness and tiredness are some of the more common side effects of Xcopri (cenobamate). Avoid driving or tasks that require you to be alert until you know how the medication affects you. Also avoid drinking alcohol while you're taking Xcopri (cenobamate) because it could make you feel even sleepier or even more tired.
Xcopri (cenobamate) can stay in your system for a while (e.g., over a week). Xcopri (cenobamate) has a long half-life, which is an estimation of how long it takes to get rid of the medication in your body. Xcopri (cenobamate) might linger around even longer if your liver doesn't work as well as it should (the liver helps get rid of the medication from the body). Talk with your prescriber if how long Xcopri (cenobamate) stays in your system concerns you.
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Xcopri (cenobamate) dosage
Typical dosage 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?
$20.00
Xcopri (cenobamate) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Xcopri (cenobamate) will not be safe for you to take.
- Familial short QT syndrome
What are alternatives to Xcopri (cenobamate)?
Xcopri (cenobamate) images
