[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Antiseizure medicines](https://durgical.com/en/pharmacology/classes/antiseizure-medicines/) › Cenobamate

# 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.

Updated Nov 1, 2026

## Quick facts

**Group**
[Antiseizure medicines](https://durgical.com/en/pharmacology/classes/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.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## 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 →](https://durgical.com/en/conditions/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

### Serious (rare, important)

- DRESS: fever, rash, swollen glands and organ involvement
- Shortening of the QT interval
- Liver injury
- Suicidal thoughts or behaviour

## 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)

## Memory aid

«CENObamate goes CEntimetre by centimetre»: the slow climb prevents DRESS, and the QT gets shorter, not longer.

## 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.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/cenobamate/)

[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## Connections

## Related drugs 3

- [Lacosamide](https://durgical.com/en/pharmacology/lacosamide/)
- [Lamotrigine](https://durgical.com/en/pharmacology/lamotrigine/)
- [Carbamazepine](https://durgical.com/en/pharmacology/carbamazepine/)

## Related conditions 1

- [Epilepsy and seizures](https://durgical.com/en/conditions/epilepsy-and-seizures/)

[← Back to the class: Antiseizure medicines](https://durgical.com/en/pharmacology/classes/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](https://medlineplus.gov/druginfo/meds/a620021.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=N03AX25) (WHO Collaborating Centre for Drug Statistics Methodology, 2026).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/cenobamate/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/cenobamate/