Cenobamate
Antiseizure medicines
Antiseizure medicines
A newer oral medicine for focal seizures in adults that are hard to control. It is raised very slowly and can shorten the QT interval.
Quick facts
- Group
- Antiseizure medicines
- Target
- Voltage-gated sodium channels (persistent current) and the GABA-A receptor
- Used for
- Partial-onset
- Key effects
- Sleepiness · Double or blurred vision
- Monitor
- ECG if there is a heart rhythm risk · Skin
- ATC
- N03AX25
No doses: the clinician sets them by the current guideline.
Mechanism of action
The mechanism of cenobamate is not fully understood. It appears to enhance fast and slow inactivation of voltage-gated sodium channels and to inhibit the persistent sodium current, and it also acts as a positive allosteric modulator of the GABA-A receptor. Both effects reduce repetitive neuronal firing.
- Cenobamate inhibits the persistent sodium current
- It also strengthens GABA-A inhibition
- Repetitive neuronal firing falls
- Fewer focal seizures
Indications
- Partial-onset (focal) seizures in adults, alone or as add-on treatment Epilepsy and seizures →
Adverse effects
Common
- Sleepiness, dizziness and tiredness
- Double or blurred vision
- Poor coordination and balance
- Headache and nausea
- Difficulty reading, writing or speaking
Contraindications
- Familial short QT syndrome
- Allergy to cenobamate or any component of the product
Key interactions
- Hormonal contraceptives
- Cenobamate induces CYP3A4 and can make them less effective
- Alcohol and other sedatives
- More drowsiness and poorer coordination
What is monitored
- ECG if there is a heart rhythm risk
- Skin, fever and swollen glands in the first weeks (DRESS)
- Liver tests
- Mood and suicidal thoughts
Administration and safety
- Oral tablet once a day, with or without food
- Raised slowly over weeks; this slow titration lowers the risk of DRESS
- The tablet can be crushed and mixed with water for a nasogastric tube
- It can be habit-forming and is not stopped suddenly
Pregnancy and breastfeeding
There is little information in pregnancy; contraception and pregnancy plans are discussed with the treating team.
Nursing care
- Ask about familial short QT syndrome before starting
- Teach the signs of DRESS: fever, rash, swollen glands
- Advise another birth control method if hormonal contraception is used
- Check alertness and fall risk
Pharmacokinetics
- Absorption
- Orally bioavailable; taken once a day
- Metabolism
- In the liver by several CYPs and by glucuronidation; it induces CYP3A4
- Half-life
- Long, and it can lengthen further at higher doses (non-linear kinetics)
Test yourself
Think of the answer, then tap the question to see it.
Which inherited heart condition contraindicates cenobamate?
Familial short QT syndrome.
Why is cenobamate raised very slowly?
Slow titration lowers the risk of DRESS (drug reaction with eosinophilia and systemic symptoms).
Which two actions are proposed for cenobamate?
Inhibition of the persistent sodium current and positive allosteric modulation of the GABA-A receptor.
Connections
← Back to the class: Antiseizure medicines
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Cenobamate: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); ATCDDD - ATC/DDD Index (WHO Collaborating Centre for Drug Statistics Methodology, 2026).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.