What is Xcopri (Cenobamate)?
Xcopri, with the active ingredient cenobamate, is an antiepileptic drug (AED) approved by the FDA for the treatment of partial-onset seizures in adults [1.7.1]. While its exact mechanism of action is not fully understood, it is believed to work by regulating irregular electrical signals in the brain [1.7.1]. It is a Schedule V controlled substance, indicating a low potential for abuse [1.7.1]. While effective for many, its use requires careful consideration of other medications and substances to avoid adverse effects. Before starting treatment, it's vital to provide your doctor with a complete list of all prescription drugs, over-the-counter (OTC) medicines, vitamins, and herbal supplements you use [1.11.3, 1.11.4].
How Xcopri Causes Drug Interactions
The primary reasons for Xcopri's interactions are twofold: its effect on the central nervous system (CNS) and its influence on the liver's drug-metabolizing enzymes [1.2.3, 1.2.5].
- CNS Depression: Xcopri itself can cause side effects like drowsiness, dizziness, and fatigue [1.7.1]. When combined with other substances that also depress the central nervous system (like alcohol or certain pain medications), these effects can be dangerously amplified, leading to severe sedation, impaired coordination, and even respiratory depression [1.4.1, 1.7.4].
- CYP450 Enzyme System: Xcopri is extensively metabolized in the liver by cytochrome P450 enzymes [1.6.3]. Crucially, it also affects the function of these enzymes. It is known to induce (speed up) the activity of CYP3A4 and CYP2B6 while inhibiting (slowing down) the activity of CYP2C19 [1.6.3, 1.6.5]. This means it can either decrease the effectiveness of some drugs by clearing them from the body too quickly or increase the toxicity of others by letting them build up [1.2.4].
Critical Interactions: What to Avoid or Use with Caution
Certain substances pose a significant risk when taken with Xcopri and should be avoided or used only under strict medical supervision.
Alcohol and Other CNS Depressants
Combining Xcopri with alcohol is strongly discouraged [1.4.4]. This combination can significantly worsen side effects such as sleepiness, confusion, and problems with balance and coordination [1.4.2]. Similarly, other CNS depressants carry a high risk of additive effects [1.2.3]. These include:
- Opioids (e.g., oxycodone, morphine, tramadol) [1.2.1]
- Benzodiazepines (e.g., alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan)) [1.2.2]
- Sleep aids (e.g., zolpidem (Ambien), eszopiclone (Lunesta)) [1.2.1]
- Muscle relaxants (e.g., cyclobenzaprine) [1.2.2]
- Barbiturates (e.g., phenobarbital) [1.2.3]
- Sedating antihistamines found in many OTC cold and allergy products (e.g., diphenhydramine (Benadryl)) [1.2.2]
Hormonal Contraceptives
Xcopri can make hormonal birth control less effective, increasing the risk of unintended pregnancy [1.5.4]. This is because it induces the CYP3A4 enzyme, which helps break down the hormones in these contraceptives [1.5.5]. This interaction applies to many forms, including pills, patches, implants, and vaginal rings [1.5.3]. Women of childbearing potential should use additional or alternative non-hormonal contraception (like condoms or a copper IUD) while taking Xcopri [1.5.1, 1.5.2].
Other Seizure Medications (AEDs)
Dosage adjustments of other antiepileptic drugs are often necessary when starting Xcopri. Xcopri can increase the levels of drugs like phenytoin and phenobarbital, raising the risk of side effects [1.2.4]. Conversely, it can decrease the levels of others like lamotrigine and carbamazepine, potentially reducing their effectiveness [1.2.1, 1.2.4]. Close monitoring by a physician is essential.
Drugs Metabolized by CYP Enzymes
- CYP2C19 Substrates: Since Xcopri inhibits this enzyme, it can increase the concentration and side effect risk of drugs like the proton pump inhibitors (PPIs) omeprazole (Prilosec) and lansoprazole (Prevacid), as well as the anti-seizure medication clobazam [1.2.1, 1.2.2, 1.2.4, 1.6.1].
- CYP3A4/CYP2B6 Substrates: Xcopri induces these enzymes, which can lower the effectiveness of medications like the antidepressant bupropion and certain statins (e.g., lovastatin) [1.2.1, 1.2.4].
Xcopri Interaction Comparison Table
| Drug/Class | Type of Interaction | Potential Effect | Management Recommendation |
|---|---|---|---|
| CNS Depressants (Alcohol, Opioids, Benzodiazepines) [1.2.1] | Additive Sedation [1.4.1] | Increased dizziness, drowsiness, impaired coordination, breathing problems [1.2.1, 1.4.2]. | Avoid combination. Discuss any use with your doctor [1.4.4]. |
| Hormonal Contraceptives (Pills, Patches, Implants) [1.5.3] | Enzyme Induction (CYP3A4) [1.5.5] | Decreased contraceptive effectiveness, risk of unintended pregnancy [1.2.1, 1.5.4]. | Use additional or alternative non-hormonal birth control [1.5.2]. |
| CYP2C19 Substrates (Omeprazole, Clobazam) [1.2.4] | Enzyme Inhibition [1.6.1] | Increased levels of the other drug, leading to a higher risk of side effects [1.2.1, 1.2.2]. | Doctor may need to lower the dose of the affected medication [1.2.4]. |
| Other AEDs (Phenytoin, Lamotrigine) [1.2.1] | Mixed Enzyme Effects [1.2.4] | Can increase side effects of some (phenytoin) or decrease effectiveness of others (lamotrigine) [1.2.1]. | Dose adjustments and close medical supervision are required [1.2.4]. |
| Drugs that Shorten QT Interval (Rufinamide) [1.2.2] | Additive Cardiac Effect [1.7.3] | Increased risk of irregular heart rhythm [1.2.1]. Xcopri is contraindicated in patients with Familial Short QT syndrome [1.7.3]. | Use with caution; requires physician assessment [1.7.3]. |
Over-the-Counter (OTC) and Herbal Supplements
Always exercise caution with non-prescription products. Sedating antihistamines, often found in allergy or cold remedies, can enhance Xcopri's drowsy side effects [1.3.1, 1.3.3]. While specific interactions with most vitamins are not reported, it's essential to tell your doctor about everything you take [1.2.1, 1.11.2]. Herbal supplements like St. John's wort are known to affect liver enzymes and should be discussed with your healthcare provider before use [1.3.1]. There are no known food interactions with Xcopri [1.2.1].
Conclusion: Safety First Through Open Communication
The potential for drug interactions with Xcopri is significant but manageable. The cornerstone of safety is open and honest communication with your healthcare team [1.11.1]. Never start or stop any medication without consulting your doctor. By providing a comprehensive list of all drugs, supplements, and lifestyle habits like alcohol use, you empower your doctor to tailor your treatment plan, adjust dosages as needed, and keep your seizure management both safe and effective.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a qualified healthcare professional before making any decisions about your health or treatment. Find more information at the official Xcopri website.
