From the FDA Drug Label
Counsel patients that XCOPRI causes somnolence, fatigue, dizziness, and gait disturbance. Counsel females of reproductive potential that XCOPRI may decrease the efficacy of oral contraceptives and advise them to use additional or alternative non-hormonal birth control XCOPRI is a federally controlled substance (CV) because it can be abused or lead to dependence Instruct patients to inform their healthcare provider of all of the medications, over-the-counter medications, and herbal supplements that they are taking. Instruct patients to notify their healthcare provider if they have any symptoms of shortening of the QT interval, including prolonged heart palpitations or a loss of consciousness
The counseling point that is NOT correct about Xcopri (cenobamate) for a patient with refractory complex partial epilepsy is:
- C: Patient should be tested for the John Cunningham Virus (JCV) prior to starting therapy, as there is no information in the provided drug labels that supports this counseling point 1, 1, 1.
From the Research
The counseling point that is NOT correct about Xcopri (cenobamate) is that the patient should be tested for the John Cunningham Virus (JCV) prior to starting therapy, as there is no evidence in the provided studies to support this recommendation 2, 3, 4, 5, 6.
The correct counseling points for Xcopri include:
- Starting at a low dose and gradually titrating to minimize adverse effects, particularly DRESS syndrome (a serious hypersensitivity reaction) 4
- Taking with or without food
- Monitoring for somnolence, dizziness, and fatigue 3, 5
- Avoiding alcohol
- Being aware of potential drug interactions with other anticonvulsants
- Not driving until they know how the medication affects them, as it commonly causes CNS depression
- Cenobamate may decrease the effectiveness of oral contraceptives, so patients should be advised to use alternative forms of birth control 2
- Typical side effects of cenobamate are drowsiness and fatigue, and slow titration is advisable in most patients 3
- Xcopri is considered a controlled substance and QT changes can be seen on EKG in some patients, but they are typically not clinically significant 2
Xcopri works by inhibiting voltage-gated sodium channels and enhancing GABA receptor function, providing dual mechanisms to control seizure activity in patients with refractory epilepsy 2, 4. The most recent and highest quality study 6 supports the effectiveness and safety of cenobamate in patients with highly refractory focal epilepsy.