Xcopri (cenobamate)
An approved treatment for Focal Epilepsy.
The same compound appears under different names depending on the context. Here is how to identify Cenobamate wherever you encounter it, plus the key facts at a glance.
- Generic name
- Cenobamate
- Brand name
- Xcopri
- Development code
- YKP3089
- Drug class
- Dual-mechanism antiseizure medication (sodium current + GABA-A)
- Manufacturer
- SK Life Science
- How it's taken
- Taken by mouth once daily.
One of the most effective add-on seizure drugs to reach the market in recent years, with unusually high rates of seizure freedom in trials. Its two-pronged mechanism comes with a need for very slow, careful dose build-up to avoid a serious allergic reaction.
Where Cenobamate fits
Among the most effective recent add-on options, with standout seizure-freedom rates in drug-resistant patients, but it requires a slow titration starting very low to avoid a serious hypersensitivity reaction (DRESS), and it interacts with several other drugs.
How Cenobamate works
Cenobamate attacks seizures on two fronts at once. First, it tamps down the 'persistent' sodium current, a small, steady leak of sodium that keeps overactive neurons firing repetitively, which calms runaway electrical activity. Second, it gently boosts the brain's main calming system by acting on GABA-A receptors at a site different from benzodiazepines.
Combining an excitation-reducing action with an inhibition-boosting one is thought to explain why cenobamate produced higher seizure-freedom rates in trials than is typical for add-on drugs[3].
Mechanism: Dual mechanism, inhibits persistent sodium current and acts as a positive allosteric modulator of GABA-A receptors
Side effects and safety
The most serious risk is a rare but potentially life-threatening allergic reaction called DRESS (drug reaction with eosinophilia and systemic symptoms). This risk is greatly reduced by starting at a very low dose (12.5 mg) and increasing slowly over weeks, which is now standard practice. Any rash, fever, or swelling in the first weeks should be reported urgently.
More common side effects include sleepiness, dizziness, and double vision. Serious liver injury, including rare liver failure needing a transplant, has been reported since approval, so liver blood tests are checked before starting. Report yellowing skin or eyes, dark urine, or unexplained nausea, vomiting or upper right belly pain right away. Cenobamate can also shorten the heart's QT interval, so it must not be used by people with a rare inherited heart rhythm condition called familial short QT syndrome. It interacts with several other medications (including other seizure drugs and birth control), so doses are adjusted carefully[2]. Like other seizure medicines, it can raise the risk of suicidal thoughts or actions, so report any new or worsening mood changes right away, and do not stop it suddenly, since that can bring on more seizures.
This is not a complete list of side effects. Talk to your doctor or pharmacist about what to expect and when to seek medical attention.
Taking Cenobamate
Taken by mouth once daily. The defining feature is a deliberately slow start, beginning at 12.5 mg and stepping up every two weeks, specifically to avoid the DRESS reaction seen when earlier studies escalated too fast. Reaching an effective dose therefore takes a couple of months[2].
Availability and cost
Only available as the brand-name product.
Help paying for Xcopri
Pick your insurance to see which help fits. Drugmaker copay cards can't be used with Medicare, Medicaid or TRICARE; charity funds are the usual route there.
- Insurance and case manager help
Checks whether your insurance covers XCOPRI and provides prior authorization information.
The official page does not say who qualifies. Ask the program. · source - Free medicine program
Patient Assistance Program may provide XCOPRI free to eligible US residents who are uninsured, functionally uninsured or have financial hardship and meet a financial threshold.
For: no insurance, underinsured · source - Copay help
Most eligible commercially insured patients may pay as little as $20 per month for refills. Eligibility requirements apply.
For: private insurance · source - Other support
One-time $0 Trial Offer for a first 28-day starter prescription (12.5/25 mg). Not valid if the prescription is billed to Medicare or Medicaid.
For: private insurance, no insurance · source - Bridge or quick-start supply
Navigator may supply XCOPRI to eligible people starting treatment or experiencing coverage delays.
The official page does not say who qualifies. Ask the program. · source
Good to know: Navigator phone 1-866-SKNAVIG (756-2844), Mon-Fri 9am-6pm ET. The trial offer is not valid in Vermont and cannot be used to cover insurance delays. Pharmacy hotline for finding XCOPRI: 1-833-742-7675.
- From a charity · The Assistance FundEpilepsy fundWaitlist
Pays for: Copays, coinsurance, deductibles and other health-related expenses.
The foundation says: “WAITLIST — Accepting Waitlist Patients. TAF is currently accepting requests to join the enrollment waitlist for this program. Waitlists a…”
Clinical trial results
The FDA approved cenobamate in November 2019 for focal (partial-onset) seizures in adults, based on placebo-controlled trials in which a notable share of patients on higher doses became seizure-free, an unusually strong result for an add-on drug in treatment-resistant epilepsy. A dedicated safety study established the slow-titration schedule now used to prevent DRESS[1][3].
Development history
Cenobamate was developed by the South Korean company SK Biopharmaceuticals and its U.S. subsidiary SK Life Science, and launched as Xcopri in 2020 following FDA approval in November 2019. It quickly drew attention as one of the most efficacious antiseizure drugs in years and is a key comparator for newer agents entering the focal-epilepsy space[1].
Explore Focal Epilepsy trials
Other Focal Epilepsy treatments
Common questions about Cenobamate
▸What is Cenobamate (Xcopri)?
One of the most effective add-on seizure drugs to reach the market in recent years, with unusually high rates of seizure freedom in trials. Its two-pronged mechanism comes with a need for very slow, careful dose build-up to avoid a serious allergic reaction.
▸How does Cenobamate work?
Cenobamate attacks seizures on two fronts at once. First, it tamps down the 'persistent' sodium current, a small, steady leak of sodium that keeps overactive neurons firing repetitively, which calms runaway electrical activity. Second, it gently boosts the brain's main calming system by acting on GABA-A receptors at a site different from benzodiazepines.
Combining an excitation-reducing action with an inhibition-boosting one is thought to explain why cenobamate produced higher seizure-freedom rates in trials than is typical for add-on drugs[3].
▸What are the side effects of Cenobamate?
The most serious risk is a rare but potentially life-threatening allergic reaction called DRESS (drug reaction with eosinophilia and systemic symptoms). This risk is greatly reduced by starting at a very low dose (12.5 mg) and increasing slowly over weeks, which is now standard practice. Any rash, fever, or swelling in the first weeks should be reported urgently.
More common side effects include sleepiness, dizziness, and double vision. Serious liver injury, including rare liver failure needing a transplant, has been reported since approval, so liver blood tests are checked before starting. Report yellowing skin or eyes, dark urine, or unexplained nausea, vomiting or upper right belly pain right away. Cenobamate can also shorten the heart's QT interval, so it must not be used by people with a rare inherited heart rhythm condition called familial short QT syndrome. It interacts with several other medications (including other seizure drugs and birth control), so doses are adjusted carefully[2]. Like other seizure medicines, it can raise the risk of suicidal thoughts or actions, so report any new or worsening mood changes right away, and do not stop it suddenly, since that can bring on more seizures.
▸How is Cenobamate taken?
Taken by mouth once daily. The defining feature is a deliberately slow start, beginning at 12.5 mg and stepping up every two weeks, specifically to avoid the DRESS reaction seen when earlier studies escalated too fast. Reaching an effective dose therefore takes a couple of months[2].
▸Is Cenobamate FDA approved?
Yes, Cenobamate (Xcopri) is FDA approved (2019) for the treatment of Focal Epilepsy.
▸What is cenobamate (Xcopri) used for?
The FDA approved cenobamate (Xcopri) in November 2019 for focal (partial-onset) seizures in adults, based on placebo-controlled trials in which a notable share of patients on higher doses became seizure-free, an unusually strong result for an add-on drug in treatment-resistant epilepsy. It was developed by SK Biopharmaceuticals and its U.S. subsidiary SK Life Science and launched in 2020. Cenobamate is considered one of the most effective add-on seizure drugs to reach the market in recent years. [1][3]
▸How does cenobamate work?
Cenobamate attacks seizures on 2 fronts at once. First, it tamps down the persistent sodium current, a small, steady leak of sodium that keeps overactive neurons firing repetitively; second, it gently boosts the brain's main calming system by acting on GABA-A receptors at a site different from benzodiazepines. Combining an excitation-reducing action with an inhibition-boosting one is thought to explain why cenobamate produced higher seizure-freedom rates in trials than is typical for add-on drugs. [3]
▸What are the side effects of cenobamate?
The most serious risk of cenobamate is a rare but potentially life-threatening allergic reaction called DRESS, which is greatly reduced by starting at 12.5 mg and increasing slowly, so any rash, fever or swelling in the first weeks should be reported urgently. More common side effects include sleepiness, dizziness and double vision. Serious liver injury, including rare liver failure needing a transplant, has been reported since approval, so liver blood tests are checked before starting, and cenobamate must not be used by people with familial short QT syndrome because it can shorten the heart's QT interval. It interacts with several other medications, including other seizure drugs and birth control, can raise the risk of suicidal thoughts, and should not be stopped suddenly. [2]
▸How is cenobamate taken?
Cenobamate is taken by mouth once daily. Its defining feature is a deliberately slow start, beginning at 12.5 mg and stepping up every 2 weeks, specifically to avoid the DRESS reaction seen when earlier studies escalated too fast. Reaching an effective dose therefore takes a couple of months, and a dedicated safety study established this slow-titration schedule. [2][3]
Sources and references
Every factual claim on this page is drawn from the public sources listed below. Click any reference to open the original document.
- SK Life Science (PR Newswire). FDA Approves XCOPRI (cenobamate tablets), an Anti-Epileptic Drug from SK Biopharmaceuticals and SK Life Science. https://www.prnewswire.com/news-releases/fda-approves-xcopri-cenobamate-tablets-an-anti-epileptic-drug-aed-from-sk-biopharmaceuticals-co-ltd-and-us-subsidiary-sk-life-science-inc-300963478.html
- Epilepsy Foundation. FDA News: Cenobamate (XCOPRI) for Focal Epilepsy In Adults. https://www.epilepsy.com/stories/fda-news-cenobamate-xcoprir-focal-epilepsy-adults
- PMC. Cenobamate (YKP3089) and Drug-Resistant Epilepsy: A Review of the Literature. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456719/