Cenobamate

XCOPRI

Pronunciation: sen-oe-BAM-ayt (ex-KOE-pree)

What it isSodium channel blocker and GABA-A positive modulator; focal seizures.

Why this oneProduces seizure freedom in a substantial minority of refractory patients, which few adjuncts achieve.

What limits itVery slow titration is mandatory to avoid DRESS. QT shortening; it induces CYP3A4 and inhibits CYP2C19.

Pearls

Dose-related somnolence, dizziness, diplopia; taper, since dependence and withdrawal occur.

Animated chart of estimated U.S. prescriptions per year, Antiseizure meds (1869–2026). Cenobamate enters in 2020 (estimated).

Principal riskDRESS unless titration is slow

Therapeutic safety burden3 / 4

Overdose danger3 / 4

Weight-gain liability1 / 4

Sedation liability2 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryNot assigned — PLLR-era drug

Defining liabilityDRESS with rapid titration, profound sedation/interactions and QT shortening.

NO BOXED WARNINGS

FDA dosing	Population	Start	Target	Max
Partial-onset seizures	Adult	12.5 mg QD	200 mg QD	400 mg QD

Titration Increase per schedule no faster than every 2 weeks; above 200 mg, +50 mg QD every 2 weeks

Renal Mild-severe (CLcr <90): use caution, consider dose reduction; not recommended in ESRD/dialysis (CLcr <15)

Hepatic Mild-moderate (Child-Pugh A-B): max 200 mg QD; severe (C): not recommended

Take once daily with or without food
May swallow whole or crush; crushed tablet mixed with water as oral suspension or given via NG tube
Obtain baseline ALT/AST and total bilirubin before starting
Taper to discontinue

Available strengths

Pregnancy No adequate human data; enroll in NAAED Antiepileptic Drug Pregnancy Registry

Lactation No human milk data; present in rat milk

Cenobamate (XCOPRI)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $/mo	brand $/mo	CostPlus
12.5 mg	tab	30 qd		—	not offered
25 mg	tab	30 qd	—	$1,196.46	not offered
50 mg	tab	30 qd	—	$1,195.70	not offered
100 mg	tab	30 qd	—	$1,196.15	not offered
150 mg	tab	30 qd	—	$1,195.89	not offered
200 mg	tab	30 qd	—	$1,196.32	not offered