Home Drug Guide Cenobamate

Drug Guide

Generic Name

Cenobamate

Brand Names Xcopri

Classification

Therapeutic: Anticonvulsant/Anti-epileptic

Pharmacological: GABA-modulating agent

FDA Approved Indications

  • Partial-onset seizures in adults

Mechanism of Action

Cenobamate enhances GABAergic inhibitory transmission and inhibits voltage-gated sodium channels, reducing neuronal excitability.

Dosage and Administration

Adult: Start at 12.5 mg once daily, titrate slowly by 12.5–25 mg/week to a target dose of 200 mg/day based on response and tolerability.

Pediatric: Not approved for pediatric use.

Geriatric: Start at lower doses, titrate cautiously due to increased susceptibility to adverse effects.

Renal Impairment: Use with caution; no specific dose adjustment recommended, but monitor closely.

Hepatic Impairment: Use with caution; no specific dose adjustment recommended, but consider liver function tests.

Pharmacokinetics

Absorption: Well-absorbed orally.

Distribution: Widely distributed, crosses blood-brain barrier.

Metabolism: Primarily metabolized in the liver via glucuronidation and oxidation, involving CYP2E1 and other enzymes.

Excretion: Excreted mainly in urine (via metabolites), small amount unchanged in feces.

Half Life: Approximately 50 hours, allowing once-daily dosing.

Contraindications

  • Hypersensitivity to cenobamate or components.
  • History of hypersensitivity reactions.

Precautions

  • Monitor for hypersensitivity, including skin reactions and eosinophilia-associated syndromes; avoid in patients with certain seizure types until more data available.

Adverse Reactions - Common

  • Sedation or fatigue (Common)
  • Dizziness (Common)
  • Headache (Common)
  • Nausea (Common)

Adverse Reactions - Serious

  • DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) leading to progression of severe skin reactions, hepatotoxicity, and hematologic abnormalities. (Rare but serious.)

Drug-Drug Interactions

  • Concomitant use with other central nervous system depressants may increase sedation.
  • Cenobamate may alter the metabolism of other drugs metabolized by CYP2C19 and CYP3A4.

Drug-Food Interactions

  • No significant food interactions identified.

Drug-Herb Interactions

  • Limited data; consult current resources.

Nursing Implications

Assessment: Monitor seizure frequency, neurological status, liver function tests, and skin for signs of serious adverse reactions.

Diagnoses:

  • Ineffective airway clearance related to seizures, risk of injury related to adverse effects.

Implementation: Administer as prescribed, titrate doses carefully, and educate about adherence and side effect monitoring.

Evaluation: Assess seizure control and adverse reactions, including skin reactions and liver function periodically.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any signs of rash, allergic reactions, or unusual symptoms immediately.
  • Avoid alcohol and CNS depressants unless approved by the healthcare provider.
  • Do not discontinue abruptly.

Special Considerations

Black Box Warnings:

  • Serious skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, can occur.
  • Hepatotoxicity is possible; liver function should be monitored.
  • Potential for interactions affecting other medications.

Genetic Factors: Genetic variations in enzymes involved in drug metabolism may influence individual response.

Lab Test Interference: No specific interference reported.

Overdose Management

Signs/Symptoms: Dizziness, somnolence, ataxia, agitation, or loss of consciousness.

Treatment: Supportive care, monitor respiratory and cardiac function, activated charcoal if ingestion is recent, and maintain airway.

Storage and Handling

Storage: Store at room temperature, 20–25°C (68–77°F), protected from moisture and light.

Stability: Stable under recommended storage conditions.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.