Xcopri is the brand name for cenobamate, a prescription antiseizure medicine used to treat partial-onset seizures in adults. It is taken by mouth, usually once daily, and the dose is increased slowly over time to reduce the risk of serious side effects.
Xcopri is not a medicine to start, stop or adjust on your own. It can cause drowsiness, dizziness, balance problems, serious allergic reactions, liver injury, mood or behavior changes and drug interactions. Always follow your neurologist’s instructions and do not stop Xcopri suddenly unless a healthcare professional tells you to.
What is Xcopri?
Xcopri is a prescription medicine that contains the active ingredient cenobamate. It belongs to a group of medicines called antiseizure medicines or antiepileptic drugs.
Xcopri is approved for the treatment of partial-onset seizures in adult patients. Partial-onset seizures, also called focal seizures, begin in one area of the brain. They may remain localized or spread to affect awareness, movement, sensation or behavior.
Xcopri is a controlled substance in the United States. It should be used only by the person for whom it was prescribed and should be stored safely away from children, pets and anyone who might misuse it.
What is Xcopri used for?
Xcopri is used to treat partial-onset seizures in adults. It may be used as monotherapy or as adjunctive therapy depending on the treatment plan and the healthcare provider’s judgment.
A neurologist may consider Xcopri when seizure control is not adequate with current therapy, when another antiseizure medicine is being adjusted or when a patient needs a different seizure management plan.
Xcopri does not cure epilepsy. It may help reduce seizures, but continued medical follow-up is important.
How does Xcopri work?
The exact way Xcopri works is not fully understood. Cenobamate is believed to affect abnormal electrical activity in the brain through actions on sodium channels and inhibitory signaling. These effects may help reduce the tendency of nerve cells to fire in patterns that trigger seizures.
Because epilepsy and seizure treatment are complex, Xcopri should be used as part of a personalized treatment plan from a neurologist or qualified healthcare professional.
Xcopri dosage basics
Xcopri dosing is usually started low and increased slowly. The recommended initial dose is 12.5 mg once daily. The dose is then titrated over several weeks toward a recommended maintenance dose of 200 mg once daily. In some patients, the dose may be increased further based on response and tolerability, up to a maximum of 400 mg once daily.
| Treatment stage | Common Xcopri dose | Important note |
|---|---|---|
| Weeks 1 and 2 | 12.5 mg once daily | Starting dose. Do not skip ahead in the titration schedule. |
| Weeks 3 and 4 | 25 mg once daily | Dose is increased gradually. |
| Weeks 5 and 6 | 50 mg once daily | Continue only as prescribed. |
| Weeks 7 and 8 | 100 mg once daily | Monitor for dizziness, sleepiness and coordination problems. |
| Weeks 9 and 10 | 150 mg once daily | Report side effects to your healthcare provider. |
| Week 11 and after | 200 mg once daily | Recommended maintenance dose for many adults. |
| If needed | Up to 400 mg once daily | Only if prescribed based on clinical response and tolerability. |
This table is for general education only. Your own dose may be different. Do not change your dose without your prescriber’s instructions.
Why is Xcopri increased slowly?
Xcopri is increased slowly to reduce the risk of serious adverse reactions. One important concern is DRESS, which stands for drug reaction with eosinophilia and systemic symptoms. DRESS is a rare but serious multi-organ hypersensitivity reaction.
Possible symptoms of DRESS may include fever, rash, swollen lymph nodes, facial swelling, liver problems, kidney problems, blood abnormalities or symptoms that resemble a viral illness. Seek medical help promptly if these symptoms occur.
Do not speed up the titration schedule. Taking a higher dose too soon can increase the risk of side effects and may be dangerous.
How should Xcopri be taken?
Xcopri is usually taken once daily, with or without food. Take it at the same time each day unless your healthcare provider gives different instructions.
Official labeling allows Xcopri tablets to be taken whole or crushed and mixed with water for immediate administration by mouth. Crushed tablets may also be administered through a nasogastric tube in appropriate medical situations. Do not store a crushed tablet-water mixture for later use.
Follow your prescription label carefully. If you have trouble swallowing tablets, ask your pharmacist or doctor how to take Xcopri safely.
What if you miss a dose of Xcopri?
If you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose and return to your regular schedule. Do not take two doses at the same time to make up for a missed dose.
If you miss more than one dose or are unsure what to do, contact your healthcare provider or pharmacist. Missing doses can increase seizure risk in some people.
Do not stop Xcopri suddenly
Do not stop taking Xcopri without talking to your healthcare provider. Stopping antiseizure medicines suddenly can increase seizure frequency or cause worsening seizures.
If Xcopri needs to be stopped, the dose is usually reduced gradually over a period of at least two weeks unless a serious safety concern requires faster discontinuation.
Common side effects of Xcopri
Xcopri can cause side effects. Some are more likely during titration or at higher doses.
Common side effects may include:
- Sleepiness or drowsiness.
- Dizziness.
- Fatigue.
- Double vision.
- Headache.
- Problems with balance or coordination.
- Blurred vision.
- Nausea or stomach discomfort.
- Constipation or diarrhea.
- Dry mouth.
- Confusion or trouble concentrating.
Do not drive, operate machinery or do hazardous activities until you know how Xcopri affects you.
Serious side effects and warning signs
Some Xcopri side effects need urgent medical attention. Contact your healthcare provider right away or seek emergency care if you notice:
- Rash, fever or swollen lymph nodes.
- Facial swelling.
- Sores in or around the mouth or eyes.
- Hives or trouble breathing.
- Yellowing of the skin or eyes.
- Dark urine or pale stools.
- Severe nausea, vomiting or upper right abdominal pain.
- Unusual bruising or bleeding.
- Irregular heartbeat, fainting or severe dizziness.
- New or worsening depression, anxiety, agitation or suicidal thoughts.
- Seizures that worsen or change in pattern.
Severe allergic reaction symptoms, breathing problems, fainting, suicidal thoughts or signs of liver injury should be treated as urgent.
Xcopri and DRESS reaction
DRESS is one of the most important serious warnings for Xcopri. It can involve several organs and may begin with symptoms such as fever or swollen lymph nodes even before a rash appears.
Call your healthcare provider immediately if you develop fever, rash, facial swelling, swollen glands, unusual tiredness, yellow skin or eyes, dark urine or other concerning symptoms after starting or increasing Xcopri.
Xcopri may need to be stopped and not restarted if DRESS is suspected and no other cause is found.
Xcopri and QT shortening
Xcopri can shorten the QT interval, which is part of the heart’s electrical rhythm measured on an ECG. People with familial short QT syndrome should not take Xcopri.
Tell your healthcare provider if you have a known heart rhythm disorder, fainting episodes, a family history of sudden cardiac death or if you take medicines that may shorten the QT interval.
Xcopri and liver injury
Clinically significant liver injury has been reported with Xcopri. Healthcare providers may obtain liver blood tests, including ALT, AST and total bilirubin, before starting treatment and during treatment if clinically indicated.
Call your doctor promptly if you develop symptoms that may suggest liver injury, such as:
- Unexplained nausea or vomiting.
- Upper right abdominal pain.
- Loss of appetite.
- Unusual tiredness or weakness.
- Yellowing of the skin or eyes.
- Dark urine.
- Pale stools.
Xcopri and mood changes
Antiseizure medicines, including Xcopri, may increase the risk of suicidal thoughts or behavior in some people. Mood and behavior changes should be taken seriously.
Tell your healthcare provider right away if you or your family notice:
- New or worsening depression.
- Anxiety or panic attacks.
- Agitation or restlessness.
- Irritability or aggression.
- Acting on dangerous impulses.
- Insomnia or unusual behavior changes.
- Thoughts about self-harm or suicide.
If there is an immediate risk of self-harm, use emergency services or a crisis line in your country.
Xcopri interactions
Xcopri can interact with other medicines. This is especially important because many people with epilepsy take more than one antiseizure medication.
Important interaction concerns include:
- Phenytoin: levels may increase and dose reduction may be needed.
- Phenobarbital: dose reduction may be needed if side effects occur.
- Clobazam: active metabolite levels may increase and dose adjustment may be needed.
- Lamotrigine or carbamazepine: levels may decrease and dose changes may be considered.
- Hormonal oral contraceptives: effectiveness may be reduced.
- Alcohol or CNS depressants: sedation and sleepiness may increase.
- Medicines that shorten the QT interval: caution is needed.
Always give your doctor and pharmacist a complete list of prescription medicines, over-the-counter products, supplements and herbal products.
Xcopri and birth control
Xcopri may reduce the effectiveness of hormonal oral contraceptives. If you can become pregnant, ask your healthcare provider about additional or alternative non-hormonal birth control while taking Xcopri.
Do not rely on assumptions about birth control effectiveness. Medication interactions can increase the risk of unintended pregnancy.
Xcopri and pregnancy
Tell your healthcare provider if you are pregnant, planning pregnancy or become pregnant while taking Xcopri. Seizure control during pregnancy is important, but antiseizure medicines may also carry risks that need individualized medical guidance.
There is a pregnancy exposure registry for people exposed to antiseizure medicines such as Xcopri during pregnancy. Your healthcare provider can help you decide whether enrollment is appropriate.
Xcopri and alcohol
Alcohol can make Xcopri side effects worse, especially sleepiness, dizziness, slowed reaction time, impaired coordination and sedation.
Ask your healthcare provider whether alcohol is safe for you. Many people taking antiseizure medicine are advised to avoid alcohol because it may worsen side effects and can affect seizure control.
Who should not take Xcopri?
Do not take Xcopri if you are allergic to cenobamate or any ingredient in the product. Do not take Xcopri if you have familial short QT syndrome.
Before starting Xcopri, tell your healthcare provider if you have:
- Liver disease.
- Kidney disease.
- A heart rhythm disorder.
- Depression, suicidal thoughts or mood disorder history.
- A history of drug allergy or severe rash.
- A history of substance misuse.
- Pregnancy, planned pregnancy or breastfeeding.
Use in severe hepatic impairment is not recommended, and caution may be needed in kidney or liver impairment.
Xcopri vs Keppra
Xcopri and Keppra are both antiseizure medicines, but they are not the same drug and they do not work in exactly the same way. Keppra is the brand name for levetiracetam, while Xcopri is cenobamate.
| Feature | Xcopri | Keppra |
|---|---|---|
| Generic name | Cenobamate | Levetiracetam |
| Common use | Partial-onset seizures in adults. | Several seizure types, depending on age and indication. |
| Dosing schedule | Usually once daily after titration. | Often twice daily, depending on formulation and prescription. |
| Important concerns | DRESS, QT shortening, liver injury, sedation, interactions. | Mood or behavior changes, sleepiness, dizziness and other risks. |
One medicine is not automatically better for every patient. The best choice depends on seizure type, other medicines, side effects, medical history and treatment response.
What happens if you take too much Xcopri?
Taking too much Xcopri may increase the risk of serious side effects, including severe drowsiness, dizziness, confusion, coordination problems, abnormal heartbeat, breathing problems or worsening neurological symptoms.
If an overdose is possible, contact Poison Control or emergency services right away. In the United States, Poison Control can be reached at 1-800-222-1222. If the person has collapsed, had a seizure, has trouble breathing or cannot be awakened, call emergency services immediately.
Questions to ask your neurologist
If Xcopri is prescribed, useful questions include:
- Why are you recommending Xcopri for my seizure type?
- What dose am I starting with?
- How quickly will my dose be increased?
- Which side effects should I report immediately?
- Will I need liver blood tests?
- Could Xcopri interact with my other seizure medicines?
- Does Xcopri affect my birth control?
- Can I drive while taking Xcopri?
- What should I do if I miss a dose?
- How will we know if Xcopri is working?
When to seek urgent medical help
Seek urgent medical care if you have:
- Rash with fever or swollen glands.
- Facial swelling or trouble breathing.
- Severe dizziness, fainting or irregular heartbeat.
- Yellow skin or eyes, dark urine or severe abdominal pain.
- Seizures that become more frequent or severe.
- Thoughts of self-harm or suicide.
- Severe confusion, hallucinations or inability to stay awake.
Use emergency services for life-threatening symptoms, breathing problems, collapse, severe allergic reaction or immediate self-harm risk.
Quick summary
- Xcopri contains cenobamate.
- It is used to treat partial-onset seizures in adults.
- It is usually taken once daily.
- The dose is started low and increased slowly.
- Common side effects include sleepiness, dizziness, fatigue, double vision and headache.
- Serious warnings include DRESS, QT shortening, suicidal thoughts, liver injury and neurological side effects.
- Do not stop Xcopri suddenly without medical guidance.
- Xcopri can interact with other seizure medicines, alcohol, CNS depressants and hormonal oral contraceptives.
Frequently asked questions
What is Xcopri used for?
Xcopri is used to treat partial-onset seizures in adults. It is a prescription antiseizure medicine containing cenobamate.
Is Xcopri the same as cenobamate?
Yes. Xcopri is the brand name, and cenobamate is the active ingredient.
How long does Xcopri take to work?
Xcopri is titrated slowly over weeks. Some people may notice changes during titration, while others need more time. Your neurologist will monitor seizure frequency, side effects and dose response.
Can Xcopri make you sleepy?
Yes. Sleepiness, fatigue, dizziness and coordination problems are common side effects. Avoid driving or hazardous activities until you know how Xcopri affects you.
Can I drink alcohol with Xcopri?
Alcohol can increase sleepiness, dizziness and neurological side effects from Xcopri. Ask your healthcare provider whether alcohol is safe for you.
Can Xcopri affect birth control?
Yes. Xcopri may reduce the effectiveness of hormonal oral contraceptives. Ask your healthcare provider about additional or alternative non-hormonal birth control.
Can I stop Xcopri suddenly?
No. Do not stop Xcopri suddenly unless a serious safety issue requires it and a healthcare professional instructs you. Stopping antiseizure medicine suddenly can worsen seizures.
What are the most serious Xcopri warnings?
Important warnings include DRESS or multi-organ hypersensitivity, QT shortening, suicidal thoughts or behavior, liver injury, neurological side effects and worsening seizures if stopped suddenly.