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Cenobamate: Guidance for Clinical Practice
Explore guides and expert insights to integrate cenobamate into your practice.
Add-on cenobamate: It may offer a possibility to simplify the treatment by effectively managing concomitant ASMs.1
People with drug-resistant epilepsy (DRE) may require treatment with a combination of ASMs to achieve optimum efficacy. At the same time it is important to avoid excessive drug load, which is associated with an increased risk of toxicity, side effects, drug interaction, poor adherence and treatment discontinuation.2,3
Reducing the number of ASMs can help to minimise adverse events, which may enhance treatment adherence, reduce costs and improve quality of life
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Post-hoc analysis of C021, a large, multicenter cenobamate phase 3 safety study with over 1300 patients showed that concomitant ASM drug load can be reduced in many patients after starting cenobamate therapy regardless of ASM drug class without compromising efficacy.1
A structured approach to managing concomitant medications when introducing a new treatment for epilepsy patients can help to improve clinical outcomes.4 Simplifying the medication regimen by reducing the number of drugs can lead to better adherence. Patients are more likely to consistently take their medications as prescribed if the regimen is less complex and has fewer side effects.3
Cenobamate Dosing and Titration: A Practical Guide
Managing co-medications with cenobamate requires careful patient evaluation. Dose adjustments should therefore be made on a case-by-case basis, bearing in mind the concomitant ASM doses, seizure type and frequency, tolerability to ASMs, and comorbidities.5
International epilepsy experts state in expert opinion for cenobamate initiation that some patients may be able to have concomitant ASM doses lowered or discontinued after clinical efficacy with adjunctive ONTOZRY® is established to reduce their overall drug burden and reduce the risk of adverse events.6
In some patients, the doses of concomitant ASMs may be proactively reduced to prevent adverse events.6
We have compiled a couple of practical resources to assist you in your daily clinical practice and to help to maximize the benefits when introducing cenobamate.
On the first link, you can download a simple material that provides practical guidance on dosing and titrating cenobamate for adults with focal-onset seizures. It outlines recommended starting doses, titration schedules, and key considerations for co-medication management to optimize patient outcomes and minimize adverse events:
An introduction to Cenobamate
Watch Dr. Patrick House (Epileptologicum Hamburg) give an insightful overview of the introduction of cenobamate, focusing on its integration with existing medications and strategies for managing interactions with other antiseizure drugs to enhance patient outcomes.
- Aboumatar S, Ferrari L, Stern S et al. Reductions in concomitant antiseizure medication drug load during adjunctive cenobamate therapy: Post-hoc analysis of a subset of patients from a phase 3, multicenter, open-label study. Epilepsy Res. 2024;200:107306.
- Smith MC, Klein P, Krauss G et al. Dose Adjustment of Concomitant Antiseizure Medications During Cenobamate Treatment: Expert Opinion Consensus Recommendations. Neurol Ther. 2022 Dec;11(4):1705-1720
- Faught, E. 2012. Adherence to antiepilepsy drug therapy. Epilepsy & Behavior, 25(3), 297-302
- Perucca, E., & Tomson, T. 2011. The pharmacological treatment of epilepsy in adults. The Lancet Neurology, 10(5), 446-45
- Steinhoff B, Ben-Menachem E, Klein P et al. Therapeutic strategies during cenobamate treatment initiation: Delphi panel recommendations. Ther Adv Neurol Disord 2024, Vol. 17: 1–10
- Steinhoff BJ, Rosenfeld BJ, Serratosa JM et al. Practical guidance for the management of adults receiving adjunctive cenobamate for the treatment of focal epilepsy—expert opinion. Epilepsy Behav. 2021 Oct;123:108270.
MAT-DK-0092-P 17.8.2026