CENOBAMATE - NEW ANTI-EPILEPTIC DRUG

CENOBAMATE - A NEW ANTI-EPILEPTIC DRUG

By, BALA KRISHNAN

In November 2019,the FDA approved cenobamate (Xcopri)  for the treatment of partial-onset seizures in adult patients 18 years of age or older. 

Partial-onset seizure 

A partial-onset seizure is an uncontrolled activation of neurons in a single location in the brain. Many patients may need up to 3 anti-convulsants and they may still experience breakthrough seizures.

Symptoms of Partial-onset seizure 

• Tingling
• Jerking movements
• Numbness
• Staring into space
• Rapid eye movement
• Muscle tightening
• Aura sensation or hallucinations
• Smells
• Taste
• Sight
• Sounds or voices
• Tactile sensation

Cenobamate

Cenobamate is a tetrazole carbamate anticonvulsant. It is a positive GABAA modulator.

The recommended initial dose is 12.5 mg once daily with subsequent Titration, recommended maintenance dose is 200 mg daily, and maximum daily dose is 400 mg.

     

Mechanism of action

The precise mechanism of action of cenobamate is unknown. Cenobamate inhibits voltage gated sodium channels and increases the threshold for generating action potentials and decreases the number of action potentials.

Adverse effects

Common:  fatigue, somnolence, dizziness, diplopia and headaches

Serious: Shortened QT interval, Drug reaction with eosinophilia and systemic symptoms,

Abnormal gait, Dizziness, Impaired cognition, Somnolence, Abnormal vision, Suicidal thoughts

Safety information

Monitor patients for suicidal behavior and thoughts. Advise patients not to drive or operate machinery until the effect of XCOPRI is known. Gradually taper treatment, if possible, due to risk of increased seizure frequency and status epilepticus

Discontinue drug for severe hepatic impairment patients and dose adjustment is necessary for mild to moderate renal impairment and hepatic impairment patients.