cenobamate (Rx)

Brand and Other Names:Xcopri
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet (Schedule V)

  • 12.5mg
  • 25mg
  • 50mg
  • 100mg
  • 150mg
  • 200mg

Partial-onset Seizures

Indicated for treatment of partial-onset seizures as either monotherapy or adjunctive therapy

Dose and titration schedule

  • Do not exceed recommended dosage and titration, owing to potential for serious adverse reactions
  • Weeks 1-2: 12.5 mg PO qDay initially
  • Titration dose
    • Weeks 3-4: 25 mg PO qDay
    • Weeks 5-6: 50 mg PO qDay
    • Weeks 7-8: 100 mg PO qDay
    • Weeks 9-10 150 mg PO qDay
  • Maintenance dose
    • Week 11 and thereafter: 200 mg PO qDay
  • Maximum dose
    • Based on clinical response and tolerability, dose may be increased above 200 mg by increments of 50 mg/day q2week to 400 mg PO qDay if needed

Dosage Modifications

Renal impairment

  • Mild, moderate, or severe: Caution advised; consider dosage reduction
  • End-stage renal disease: Not recommended

Hepatic impairment

  • Mild-to-moderate (Child-Pugh 5-9): Not to exceed 200 mg/day; additional dosage reduction may be necessary
  • Severe: Not recommended

<18 years: Safety and efficacy not established

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Interactions

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                • abemaciclib

                  cenobamate will decrease the level or effect of abemaciclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • abiraterone

                  cenobamate will decrease the level or effect of abiraterone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • acalabrutinib

                  cenobamate will decrease the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • acrivastine

                  cenobamate, acrivastine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ado-trastuzumab emtansine

                  cenobamate will decrease the level or effect of ado-trastuzumab emtansine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • aldesleukin

                  cenobamate, aldesleukin. Either increases effects of the other by sedation. Use Caution/Monitor.

                • alfentanil

                  cenobamate will decrease the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, alfentanil. Either increases effects of the other by sedation. Use Caution/Monitor.

                • alfuzosin

                  cenobamate will decrease the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • alpelisib

                  cenobamate will decrease the level or effect of alpelisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • alprazolam

                  cenobamate will decrease the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, alprazolam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ambrisentan

                  cenobamate will increase the level or effect of ambrisentan by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • amiodarone

                  cenobamate will decrease the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of amiodarone by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • amitriptyline

                  cenobamate, amitriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.

                • amlodipine

                  cenobamate will decrease the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • amobarbital

                  cenobamate, amobarbital. Either increases effects of the other by sedation. Use Caution/Monitor.

                • amoxapine

                  cenobamate, amoxapine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • apalutamide

                  cenobamate will decrease the level or effect of apalutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • apixaban

                  cenobamate will decrease the level or effect of apixaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • apomorphine

                  cenobamate, apomorphine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • apremilast

                  cenobamate will decrease the level or effect of apremilast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • aprepitant

                  cenobamate will decrease the level or effect of aprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • aripiprazole

                  cenobamate will decrease the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, aripiprazole. Either increases effects of the other by sedation. Use Caution/Monitor.

                • armodafinil

                  cenobamate will decrease the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • asenapine

                  cenobamate, asenapine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • atazanavir

                  cenobamate will decrease the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • atorvastatin

                  cenobamate will decrease the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • avanafil

                  cenobamate will decrease the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • avatrombopag

                  cenobamate will decrease the level or effect of avatrombopag by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • axitinib

                  cenobamate will decrease the level or effect of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • bedaquiline

                  cenobamate will decrease the level or effect of bedaquiline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • belladonna and opium

                  cenobamate, belladonna and opium. Either increases effects of the other by sedation. Use Caution/Monitor.

                • benzhydrocodone/acetaminophen

                  cenobamate will decrease the level or effect of benzhydrocodone/acetaminophen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, benzhydrocodone/acetaminophen. Either increases effects of the other by sedation. Use Caution/Monitor.

                • benzphetamine

                  cenobamate will decrease the level or effect of benzphetamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • bortezomib

                  cenobamate will decrease the level or effect of bortezomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of bortezomib by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • bosentan

                  cenobamate will decrease the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • bosutinib

                  cenobamate will decrease the level or effect of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • brentuximab vedotin

                  cenobamate will decrease the level or effect of brentuximab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • brexanolone

                  cenobamate, brexanolone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • brexpiprazole

                  cenobamate will decrease the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, brexpiprazole. Either increases effects of the other by sedation. Use Caution/Monitor.

                • brigatinib

                  cenobamate will decrease the level or effect of brigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • brivaracetam

                  cenobamate, brivaracetam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • bromocriptine

                  cenobamate will decrease the level or effect of bromocriptine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, bromocriptine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • brompheniramine

                  cenobamate, brompheniramine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • budesonide

                  cenobamate will decrease the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • buprenorphine

                  cenobamate will decrease the level or effect of buprenorphine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, buprenorphine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • buprenorphine buccal

                  cenobamate, buprenorphine buccal. Either increases effects of the other by sedation. Use Caution/Monitor.

                • buprenorphine subdermal implant

                  cenobamate will decrease the level or effect of buprenorphine subdermal implant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, buprenorphine subdermal implant. Either increases effects of the other by sedation. Use Caution/Monitor.

                • buprenorphine transdermal

                  cenobamate will decrease the level or effect of buprenorphine transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, buprenorphine transdermal. Either increases effects of the other by sedation. Use Caution/Monitor.

                • buprenorphine, long-acting injection

                  cenobamate will decrease the level or effect of buprenorphine, long-acting injection by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, buprenorphine, long-acting injection. Either increases effects of the other by sedation. Use Caution/Monitor.

                • bupropion

                  cenobamate will decrease the level or effect of bupropion by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                • buspirone

                  cenobamate will decrease the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, buspirone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • busulfan

                  cenobamate will decrease the level or effect of busulfan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • butalbital

                  cenobamate, butalbital. Either increases effects of the other by sedation. Use Caution/Monitor.

                • butorphanol

                  cenobamate, butorphanol. Either increases effects of the other by sedation. Use Caution/Monitor.

                • cabozantinib

                  cenobamate will decrease the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • calcium/magnesium/potassium/sodium oxybates

                  cenobamate, calcium/magnesium/potassium/sodium oxybates. Either increases effects of the other by sedation. Use Caution/Monitor.

                • carbamazepine

                  cenobamate will decrease the level or effect of carbamazepine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Concomitant use of carbamazepine with multiple doses of cenobamate 200 mg qDay decreased carbamazepine mean Cmax and AUC by 23%. Increase carbamazepine dosage as needed when used concomitantly with cenobamate.

                  cenobamate will decrease the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, carbamazepine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • carbinoxamine

                  cenobamate, carbinoxamine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • cariprazine

                  cenobamate, cariprazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • carisoprodol

                  cenobamate will increase the level or effect of carisoprodol by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, carisoprodol. Either increases effects of the other by sedation. Use Caution/Monitor.

                • cetirizine

                  cenobamate, cetirizine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • chloral hydrate

                  cenobamate, chloral hydrate. Either increases effects of the other by sedation. Use Caution/Monitor.

                • chlordiazepoxide

                  cenobamate, chlordiazepoxide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • chlorpheniramine

                  cenobamate will decrease the level or effect of chlorpheniramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, chlorpheniramine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • chlorpromazine

                  cenobamate, chlorpromazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • chlorzoxazone

                  cenobamate, chlorzoxazone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ciclesonide inhaled

                  cenobamate will decrease the level or effect of ciclesonide inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ciclesonide intranasal

                  cenobamate will decrease the level or effect of ciclesonide intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • cilostazol

                  cenobamate will decrease the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • citalopram

                  cenobamate will decrease the level or effect of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of citalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, citalopram. Either increases effects of the other by sedation. Use Caution/Monitor.

                • clarithromycin

                  cenobamate will decrease the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • clemastine

                  cenobamate, clemastine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • clobazam

                  cenobamate will increase the level or effect of clobazam by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Consider reducing dose of clobazam as clinically appropriate. Cenobamate may result in increased exposure to N-desmethylclobazam (active metabolite).

                  cenobamate will increase the level or effect of clobazam by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, clobazam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • clomipramine

                  cenobamate, clomipramine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • clonazepam

                  cenobamate will decrease the level or effect of clonazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, clonazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • clonidine

                  cenobamate, clonidine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • clorazepate

                  cenobamate will decrease the level or effect of clorazepate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, clorazepate. Either increases effects of the other by sedation. Use Caution/Monitor.

                • clozapine

                  cenobamate, clozapine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • cobicistat

                  cenobamate will decrease the level or effect of cobicistat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • cobimetinib

                  cenobamate will decrease the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • cocaine

                  cenobamate will decrease the level or effect of cocaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • codeine

                  cenobamate, codeine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • colchicine

                  cenobamate will decrease the level or effect of colchicine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • conivaptan

                  cenobamate will decrease the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • conjugated estrogens

                  cenobamate will decrease the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • copanlisib

                  cenobamate will decrease the level or effect of copanlisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • crizotinib

                  cenobamate will decrease the level or effect of crizotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • cyclobenzaprine

                  cenobamate, cyclobenzaprine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • cyclophosphamide

                  cenobamate will decrease the level or effect of cyclophosphamide by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of cyclophosphamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • cyclosporine

                  cenobamate will decrease the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • cyproheptadine

                  cenobamate, cyproheptadine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dabrafenib

                  cenobamate will decrease the level or effect of dabrafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • dantrolene

                  cenobamate will decrease the level or effect of dantrolene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, dantrolene. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dapsone

                  cenobamate will decrease the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • darifenacin

                  cenobamate will decrease the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • darolutamide

                  cenobamate will decrease the level or effect of darolutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • darunavir

                  cenobamate will decrease the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • dasatinib

                  cenobamate will decrease the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • deflazacort

                  cenobamate will decrease the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • desflurane

                  cenobamate, desflurane. Either increases effects of the other by sedation. Use Caution/Monitor.

                • desipramine

                  cenobamate, desipramine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • desloratadine

                  cenobamate, desloratadine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • desvenlafaxine

                  cenobamate, desvenlafaxine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • deutetrabenazine

                  cenobamate, deutetrabenazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dexamethasone

                  cenobamate will decrease the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • dexchlorpheniramine

                  cenobamate, dexchlorpheniramine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dexlansoprazole

                  cenobamate will decrease the level or effect of dexlansoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of dexlansoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • dexmedetomidine

                  cenobamate, dexmedetomidine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dextroamphetamine

                  cenobamate will decrease the level or effect of dextroamphetamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • diazepam

                  cenobamate will decrease the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of diazepam by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, diazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • diazepam intranasal

                  cenobamate will decrease the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Strong or moderate CYP3A4 inducers may increase rate of diazepam elimination; therefore, efficacy of diazepam may be decreased.

                  cenobamate will increase the level or effect of diazepam intranasal by affecting hepatic enzyme CYP2C19 metabolism. Use Caution/Monitor. Strong or moderate CYP2C19 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.

                • dichloralphenazone

                  cenobamate, dichloralphenazone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dichlorphenamide

                  cenobamate, dichlorphenamide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dienogest/estradiol valerate

                  cenobamate will decrease the level or effect of dienogest/estradiol valerate by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Advise women to use additional or alternative non-hormonal birth control when concomitantly using cenobamate with oral contraceptives.

                • difenoxin hcl

                  cenobamate, difenoxin hcl. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dihydroergotamine inhaled

                  cenobamate will decrease the level or effect of dihydroergotamine inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • diltiazem

                  cenobamate will decrease the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • diphenhydramine

                  cenobamate, diphenhydramine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • diphenoxylate hcl

                  cenobamate, diphenoxylate hcl. Either increases effects of the other by sedation. Use Caution/Monitor.

                • disopyramide

                  cenobamate will decrease the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • divalproex sodium

                  cenobamate, divalproex sodium. Either increases effects of the other by sedation. Use Caution/Monitor.

                • docetaxel

                  cenobamate will decrease the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • doravirine

                  cenobamate will decrease the level or effect of doravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • doxepin

                  cenobamate will decrease the level or effect of doxepin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, doxepin. Either increases effects of the other by sedation. Use Caution/Monitor.

                • doxepin cream

                  cenobamate will decrease the level or effect of doxepin cream by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • doxorubicin

                  cenobamate will decrease the level or effect of doxorubicin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • doxorubicin liposomal

                  cenobamate will decrease the level or effect of doxorubicin liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • doxylamine

                  cenobamate, doxylamine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dronabinol

                  cenobamate will decrease the level or effect of dronabinol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, dronabinol. Either increases effects of the other by sedation. Use Caution/Monitor.

                • dronedarone

                  cenobamate will decrease the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • droperidol

                  cenobamate, droperidol. Either increases effects of the other by sedation. Use Caution/Monitor.

                • duloxetine

                  cenobamate, duloxetine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • duvelisib

                  cenobamate will decrease the level or effect of duvelisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • efavirenz

                  cenobamate will decrease the level or effect of efavirenz by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of efavirenz by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, efavirenz. Either increases levels of the other by sedation. Use Caution/Monitor.

                • elagolix

                  cenobamate will decrease the level or effect of elagolix by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • elbasvir/grazoprevir

                  cenobamate will decrease the level or effect of elbasvir/grazoprevir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • eletriptan

                  cenobamate will decrease the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • eliglustat

                  cenobamate will decrease the level or effect of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • elvitegravir

                  cenobamate will decrease the level or effect of elvitegravir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • encorafenib

                  cenobamate will decrease the level or effect of encorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • entrectinib

                  cenobamate will decrease the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • enzalutamide

                  cenobamate will decrease the level or effect of enzalutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • eplerenone

                  cenobamate will decrease the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ergoloid mesylates

                  cenobamate will decrease the level or effect of ergoloid mesylates by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ergotamine

                  cenobamate will decrease the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • erlotinib

                  cenobamate will decrease the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • erythromycin base

                  cenobamate will decrease the level or effect of erythromycin base by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • erythromycin ethylsuccinate

                  cenobamate will decrease the level or effect of erythromycin ethylsuccinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • erythromycin lactobionate

                  cenobamate will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • erythromycin stearate

                  cenobamate will decrease the level or effect of erythromycin stearate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • escitalopram

                  cenobamate will decrease the level or effect of escitalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of escitalopram by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, escitalopram. Either increases effects of the other by sedation. Use Caution/Monitor.

                • esketamine intranasal

                  cenobamate, esketamine intranasal. Either increases effects of the other by sedation. Use Caution/Monitor.

                • eslicarbazepine acetate

                  cenobamate, eslicarbazepine acetate. Either increases effects of the other by sedation. Use Caution/Monitor.

                • esomeprazole

                  cenobamate will decrease the level or effect of esomeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of esomeprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • estazolam

                  cenobamate, estazolam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • estradiol

                  cenobamate will decrease the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • estrogens conjugated synthetic

                  cenobamate will decrease the level or effect of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • estrogens esterified

                  cenobamate will decrease the level or effect of estrogens esterified by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • estropipate

                  cenobamate will decrease the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • eszopiclone

                  cenobamate will decrease the level or effect of eszopiclone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, eszopiclone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ethanol

                  cenobamate, ethanol. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ethinylestradiol

                  cenobamate will decrease the level or effect of ethinylestradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of ethinylestradiol by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Advise women to use additional or alternative non-hormonal birth control when concomitantly using cenobamate with oral contraceptives.

                • ethosuximide

                  cenobamate will decrease the level or effect of ethosuximide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, ethosuximide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ethotoin

                  cenobamate, ethotoin. Either increases effects of the other by sedation. Use Caution/Monitor.

                • etomidate

                  cenobamate, etomidate. Either increases effects of the other by sedation. Use Caution/Monitor.

                • etoposide

                  cenobamate will decrease the level or effect of etoposide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • etravirine

                  cenobamate will decrease the level or effect of etravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of etravirine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • everolimus

                  cenobamate will decrease the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • exemestane

                  cenobamate will decrease the level or effect of exemestane by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fedratinib

                  cenobamate will decrease the level or effect of fedratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • felbamate

                  cenobamate will decrease the level or effect of felbamate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, felbamate. Either increases effects of the other by sedation. Use Caution/Monitor.

                • felodipine

                  cenobamate will decrease the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fenofibrate

                  cenobamate will decrease the level or effect of fenofibrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fenofibrate micronized

                  cenobamate will decrease the level or effect of fenofibrate micronized by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fenofibric acid

                  cenobamate will decrease the level or effect of fenofibric acid by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fentanyl

                  cenobamate will decrease the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, fentanyl. Either increases effects of the other by sedation. Use Caution/Monitor.

                • fentanyl intranasal

                  cenobamate will decrease the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, fentanyl intranasal. Either increases effects of the other by sedation. Use Caution/Monitor.

                • fentanyl transdermal

                  cenobamate will decrease the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, fentanyl transdermal. Either increases effects of the other by sedation. Use Caution/Monitor.

                • fentanyl transmucosal

                  cenobamate will decrease the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, fentanyl transmucosal. Either increases effects of the other by sedation. Use Caution/Monitor.

                • flibanserin

                  cenobamate will decrease the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of flibanserin by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • flunisolide intranasal

                  cenobamate will decrease the level or effect of flunisolide intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • flurazepam

                  cenobamate will decrease the level or effect of flurazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • flutamide

                  cenobamate will decrease the level or effect of flutamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fluticasone furoate

                  cenobamate will decrease the level or effect of fluticasone furoate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fluticasone inhaled

                  cenobamate will decrease the level or effect of fluticasone inhaled by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fluticasone topical

                  cenobamate will decrease the level or effect of fluticasone topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fosamprenavir

                  cenobamate will decrease the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • fosphenytoin

                  cenobamate will increase the level or effect of fosphenytoin by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • fostamatinib

                  cenobamate will decrease the level or effect of fostamatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • gefitinib

                  cenobamate will decrease the level or effect of gefitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • glasdegib

                  cenobamate will decrease the level or effect of glasdegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • glecaprevir/pibrentasvir

                  cenobamate will decrease the level or effect of glecaprevir/pibrentasvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • guanfacine

                  cenobamate will decrease the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • haloperidol

                  cenobamate will decrease the level or effect of haloperidol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • hydrocodone

                  cenobamate will decrease the level or effect of hydrocodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • hydroxyprogesterone caproate

                  cenobamate will decrease the level or effect of hydroxyprogesterone caproate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ibrutinib

                  cenobamate will decrease the level or effect of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • idelalisib

                  cenobamate will decrease the level or effect of idelalisib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ifosfamide

                  cenobamate will decrease the level or effect of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of ifosfamide by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • imatinib

                  cenobamate will decrease the level or effect of imatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • imipramine

                  cenobamate will increase the level or effect of imipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • indinavir

                  cenobamate will decrease the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • irinotecan

                  cenobamate will decrease the level or effect of irinotecan by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • irinotecan liposomal

                  cenobamate will decrease the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • isosorbide dinitrate

                  cenobamate will decrease the level or effect of isosorbide dinitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • isosorbide mononitrate

                  cenobamate will decrease the level or effect of isosorbide mononitrate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • isradipine

                  cenobamate will decrease the level or effect of isradipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • istradefylline

                  cenobamate will decrease the level or effect of istradefylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • itraconazole

                  cenobamate will decrease the level or effect of itraconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ivacaftor

                  cenobamate will decrease the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ivosidenib

                  cenobamate will decrease the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ixabepilone

                  cenobamate will decrease the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ixazomib

                  cenobamate will decrease the level or effect of ixazomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ketamine

                  cenobamate will decrease the level or effect of ketamine by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of ketamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • lacosamide

                  cenobamate will decrease the level or effect of lacosamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • lamotrigine

                  cenobamate will decrease the level or effect of lamotrigine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Based on population PK analyses, coadministration of lamotrigine with cenobamate may lead to a 21-52% decrease in lamotrigine concentration. Increase lamotrigine dosage as needed when used concomitantly with cenobamate.

                • lansoprazole

                  cenobamate will decrease the level or effect of lansoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of lansoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • lapatinib

                  cenobamate will decrease the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • larotrectinib

                  cenobamate will decrease the level or effect of larotrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • levomilnacipran

                  cenobamate will decrease the level or effect of levomilnacipran by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • levonorgestrel intrauterine

                  cenobamate will decrease the level or effect of levonorgestrel intrauterine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of levonorgestrel intrauterine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Advise women to use additional or alternative non-hormonal birth control when concomitantly using cenobamate with oral contraceptives.

                • levonorgestrel oral

                  cenobamate will decrease the level or effect of levonorgestrel oral by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of levonorgestrel oral by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Advise women to use additional or alternative non-hormonal birth control when concomitantly using cenobamate with oral contraceptives.

                • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

                  cenobamate will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Advise women to use additional or alternative non-hormonal birth control when concomitantly using cenobamate with oral contraceptives.

                • levonorgestrel transdermal

                  cenobamate will decrease the level or effect of levonorgestrel transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will decrease the level or effect of levonorgestrel transdermal by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Advise women to use additional or alternative non-hormonal birth control when concomitantly using cenobamate with oral contraceptives.

                • linagliptin

                  cenobamate will decrease the level or effect of linagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • lomitapide

                  cenobamate will decrease the level or effect of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • lopinavir

                  cenobamate will decrease the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • lorazepam

                  cenobamate, lorazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • lorlatinib

                  cenobamate will decrease the level or effect of lorlatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • losartan

                  cenobamate will decrease the level or effect of losartan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • lovastatin

                  cenobamate will decrease the level or effect of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • lumefantrine

                  cenobamate will decrease the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • lurasidone

                  cenobamate will decrease the level or effect of lurasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • macimorelin

                  cenobamate will decrease the level or effect of macimorelin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • macitentan

                  cenobamate will decrease the level or effect of macitentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • maraviroc

                  cenobamate will decrease the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • marijuana

                  cenobamate will decrease the level or effect of marijuana by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • medroxyprogesterone

                  cenobamate will decrease the level or effect of medroxyprogesterone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • mefloquine

                  cenobamate will decrease the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • mestranol

                  cenobamate will decrease the level or effect of mestranol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • metaxalone

                  cenobamate will decrease the level or effect of metaxalone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • methadone

                  cenobamate will decrease the level or effect of methadone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • methsuximide

                  cenobamate will increase the level or effect of methsuximide by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • methylergonovine

                  cenobamate will decrease the level or effect of methylergonovine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • methylprednisolone

                  cenobamate will decrease the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • midazolam

                  cenobamate will decrease the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • midostaurin

                  cenobamate will decrease the level or effect of midostaurin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • mifepristone

                  cenobamate will decrease the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • mirtazapine

                  cenobamate will decrease the level or effect of mirtazapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • modafinil

                  cenobamate will decrease the level or effect of modafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of modafinil by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • montelukast

                  cenobamate will decrease the level or effect of montelukast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • naldemedine

                  cenobamate will decrease the level or effect of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • naloxegol

                  cenobamate will decrease the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nefazodone

                  cenobamate will decrease the level or effect of nefazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, nefazodone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • nelfinavir

                  cenobamate will decrease the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of nelfinavir by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • netupitant/palonosetron

                  cenobamate will decrease the level or effect of netupitant/palonosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nevirapine

                  cenobamate will decrease the level or effect of nevirapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nicardipine

                  cenobamate will decrease the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nifedipine

                  cenobamate will decrease the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nilotinib

                  cenobamate will decrease the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nimodipine

                  cenobamate will decrease the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nisoldipine

                  cenobamate will decrease the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nitrous oxide

                  cenobamate, nitrous oxide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • norethindrone

                  cenobamate will decrease the level or effect of norethindrone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • norethindrone acetate

                  cenobamate will decrease the level or effect of norethindrone acetate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • nortriptyline

                  cenobamate, nortriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.

                • olaparib

                  cenobamate will decrease the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ombitasvir/paritaprevir/ritonavir & dasabuvir

                  cenobamate will decrease the level or effect of ombitasvir/paritaprevir/ritonavir & dasabuvir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • omeprazole

                  cenobamate will decrease the level or effect of omeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of omeprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • ondansetron

                  cenobamate will decrease the level or effect of ondansetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • opium tincture

                  cenobamate, opium tincture. Either increases effects of the other by sedation. Use Caution/Monitor.

                • osimertinib

                  cenobamate will decrease the level or effect of osimertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ospemifene

                  cenobamate will decrease the level or effect of ospemifene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • oxazepam

                  cenobamate, oxazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • oxcarbazepine

                  cenobamate, oxcarbazepine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • oxybutynin

                  cenobamate, oxybutynin. Either increases effects of the other by sedation. Use Caution/Monitor.

                • oxycodone

                  cenobamate will decrease the level or effect of oxycodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, oxycodone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • oxymorphone

                  cenobamate, oxymorphone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • paclitaxel

                  cenobamate will decrease the level or effect of paclitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • paclitaxel protein bound

                  cenobamate will decrease the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • palbociclib

                  cenobamate will decrease the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • paliperidone

                  cenobamate, paliperidone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • panobinostat

                  cenobamate will decrease the level or effect of panobinostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • pantoprazole

                  cenobamate will increase the level or effect of pantoprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • paricalcitol

                  cenobamate will decrease the level or effect of paricalcitol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • paroxetine

                  cenobamate, paroxetine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • pazopanib

                  cenobamate will decrease the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • pentamidine

                  cenobamate will increase the level or effect of pentamidine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • pentazocine

                  cenobamate, pentazocine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • pentobarbital

                  cenobamate, pentobarbital. Either increases effects of the other by sedation. Use Caution/Monitor.

                • perampanel

                  cenobamate will decrease the level or effect of perampanel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, perampanel. Either increases effects of the other by sedation. Use Caution/Monitor.

                • perphenazine

                  cenobamate, perphenazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • pexidartinib

                  cenobamate will decrease the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • pheniramine

                  cenobamate, pheniramine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • phenobarbital

                  cenobamate will increase the level or effect of phenobarbital by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Concomitant use of phenobarbital with multiple doses of cenobamate 200 mg qDay increased carbamazepine mean Cmax and AUC by 34% and 37%. Consider a dose reduction of phenobarbital, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate will increase the level or effect of phenobarbital by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, phenobarbital. Either increases effects of the other by sedation. Use Caution/Monitor.

                • phenytoin

                  cenobamate will increase the level or effect of phenytoin by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Concomitant use of phenytoin with multiple doses of cenobamate 200 mg qDay increased phenytoin mean Cmax and AUC by 70% and 80. Gradually decrease phenytoin dosage by up to 50% when used concomitantly with cenobamate.

                  cenobamate will increase the level or effect of phenytoin by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, phenytoin. Either increases effects of the other by sedation. Use Caution/Monitor.

                • pimavanserin

                  cenobamate will decrease the level or effect of pimavanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, pimavanserin. Either increases effects of the other by sedation. Use Caution/Monitor.

                • pimozide

                  cenobamate will decrease the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, pimozide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • pitolisant

                  cenobamate will decrease the level or effect of pitolisant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • polatuzumab vedotin

                  cenobamate will decrease the level or effect of polatuzumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • pomalidomide

                  cenobamate will decrease the level or effect of pomalidomide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ponatinib

                  cenobamate will decrease the level or effect of ponatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • pramipexole

                  cenobamate, pramipexole. Either increases effects of the other by sedation. Use Caution/Monitor.

                • praziquantel

                  cenobamate will decrease the level or effect of praziquantel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • pregabalin

                  cenobamate, pregabalin. Either increases effects of the other by sedation. Use Caution/Monitor.

                • primaquine

                  cenobamate will decrease the level or effect of primaquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • primidone

                  cenobamate, primidone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • prochlorperazine

                  cenobamate, prochlorperazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • progesterone intravaginal gel

                  cenobamate will increase the level or effect of progesterone intravaginal gel by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • progesterone micronized

                  cenobamate will decrease the level or effect of progesterone micronized by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of progesterone micronized by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • progesterone, natural

                  cenobamate will decrease the level or effect of progesterone, natural by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • promethazine

                  cenobamate will decrease the level or effect of promethazine by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, promethazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • propofol

                  cenobamate will decrease the level or effect of propofol by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, propofol. Either increases effects of the other by sedation. Use Caution/Monitor.

                • protriptyline

                  cenobamate, protriptyline. Either increases effects of the other by sedation. Use Caution/Monitor.

                • quazepam

                  cenobamate will decrease the level or effect of quazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, quazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • quetiapine

                  cenobamate will decrease the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, quetiapine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • quinidine

                  cenobamate will decrease the level or effect of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • quinine

                  cenobamate will decrease the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • rabeprazole

                  cenobamate will decrease the level or effect of rabeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate will increase the level or effect of rabeprazole by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • ranolazine

                  cenobamate will decrease the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • regorafenib

                  cenobamate will decrease the level or effect of regorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • remifentanil

                  cenobamate, remifentanil. Either increases effects of the other by sedation. Use Caution/Monitor.

                • repaglinide

                  cenobamate will decrease the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ribociclib

                  cenobamate will decrease the level or effect of ribociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • rifabutin

                  cenobamate will decrease the level or effect of rifabutin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • rifampin

                  cenobamate will decrease the level or effect of rifampin by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                • riociguat

                  cenobamate will decrease the level or effect of riociguat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • risperidone

                  cenobamate, risperidone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ritonavir

                  cenobamate will decrease the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • rivaroxaban

                  cenobamate will decrease the level or effect of rivaroxaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • roflumilast

                  cenobamate will decrease the level or effect of roflumilast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • rolapitant

                  cenobamate will decrease the level or effect of rolapitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • romidepsin

                  cenobamate will decrease the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ropinirole

                  cenobamate, ropinirole. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ropivacaine

                  cenobamate will decrease the level or effect of ropivacaine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • rotigotine

                  cenobamate, rotigotine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • rufinamide

                  cenobamate and rufinamide both decrease QTc interval. Use Caution/Monitor. Both drugs may shorten QT interval.

                  cenobamate, rufinamide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ruxolitinib

                  cenobamate will decrease the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • salmeterol

                  cenobamate will decrease the level or effect of salmeterol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • saquinavir

                  cenobamate will decrease the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • saxagliptin

                  cenobamate will decrease the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • scopolamine

                  cenobamate, scopolamine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • secobarbital

                  cenobamate, secobarbital. Either increases effects of the other by sedation. Use Caution/Monitor.

                • selegiline

                  cenobamate will decrease the level or effect of selegiline by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                • sertraline

                  cenobamate will increase the level or effect of sertraline by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, sertraline. Either increases effects of the other by sedation. Use Caution/Monitor.

                • sevoflurane

                  cenobamate, sevoflurane. Either increases effects of the other by sedation. Use Caution/Monitor.

                • sildenafil

                  cenobamate will decrease the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • simvastatin

                  cenobamate will decrease the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • siponimod

                  cenobamate will decrease the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • sirolimus

                  cenobamate will decrease the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • sodium oxybate

                  cenobamate, sodium oxybate. Either increases effects of the other by sedation. Use Caution/Monitor.

                • solifenacin

                  cenobamate will decrease the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • sonidegib

                  cenobamate will decrease the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • sorafenib

                  cenobamate will decrease the level or effect of sorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • stiripentol

                  cenobamate will decrease the level or effect of stiripentol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • sufentanil

                  cenobamate will decrease the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, sufentanil. Either increases effects of the other by sedation. Use Caution/Monitor.

                • sufentanil SL

                  cenobamate will decrease the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, sufentanil SL. Either increases effects of the other by sedation. Use Caution/Monitor.

                • sunitinib

                  cenobamate will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • suvorexant

                  cenobamate will decrease the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, suvorexant. Either increases effects of the other by sedation. Use Caution/Monitor.

                • tacrolimus

                  cenobamate will decrease the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • tacrolimus ointment

                  cenobamate will decrease the level or effect of tacrolimus ointment by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • tadalafil

                  cenobamate will decrease the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • tamoxifen

                  cenobamate will decrease the level or effect of tamoxifen by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • tamsulosin

                  cenobamate will decrease the level or effect of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • tapentadol

                  cenobamate, tapentadol. Either increases effects of the other by sedation. Use Caution/Monitor.

                • tasimelteon

                  cenobamate will decrease the level or effect of tasimelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, tasimelteon. Either increases effects of the other by sedation. Use Caution/Monitor.

                • temazepam

                  cenobamate, temazepam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • temsirolimus

                  cenobamate will decrease the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • teniposide

                  cenobamate will decrease the level or effect of teniposide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • tetrabenazine

                  cenobamate, tetrabenazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • tetracycline

                  cenobamate will decrease the level or effect of tetracycline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • tezacaftor

                  cenobamate will decrease the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • thalidomide

                  cenobamate, thalidomide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • theophylline

                  cenobamate will decrease the level or effect of theophylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, theophylline. Either increases effects of the other by sedation. Use Caution/Monitor.

                • thioridazine

                  cenobamate, thioridazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • thiothixene

                  cenobamate, thiothixene. Either increases effects of the other by sedation. Use Caution/Monitor.

                • tiagabine

                  cenobamate will decrease the level or effect of tiagabine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                  cenobamate, tiagabine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ticagrelor

                  cenobamate will decrease the level or effect of ticagrelor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • ticlopidine

                  cenobamate will decrease the level or effect of ticlopidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

                • tizanidine

                  cenobamate, tizanidine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • tofacitinib

                  cenobamate will increase the level or effect of tofacitinib by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • topiramate

                  cenobamate, topiramate. Either increases effects of the other by sedation. Use Caution/Monitor.

                • tramadol

                  cenobamate, tramadol. Either increases effects of the other by sedation. Use Caution/Monitor.

                • triazolam

                  cenobamate, triazolam. Either increases effects of the other by sedation. Use Caution/Monitor.

                • trifluoperazine

                  cenobamate, trifluoperazine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • trimethobenzamide

                  cenobamate, trimethobenzamide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • trimipramine

                  cenobamate will increase the level or effect of trimipramine by affecting hepatic enzyme CYP2C19 metabolism. Modify Therapy/Monitor Closely. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                  cenobamate, trimipramine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • triprolidine

                  cenobamate, triprolidine. Either increases effects of the other by sedation. Use Caution/Monitor.

                • valerian

                  cenobamate, valerian. Either increases effects of the other by sedation. Use Caution/Monitor.

                • velpatasvir

                  cenobamate will decrease the level or effect of velpatasvir by affecting hepatic enzyme CYP2B6 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP2B6 substrate, as needed, when coadministered with cenobamate.

                • vigabatrin

                  cenobamate, vigabatrin. Either increases effects of the other by sedation. Use Caution/Monitor.

                • vilazodone

                  cenobamate, vilazodone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • zaleplon

                  cenobamate, zaleplon. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ziconotide

                  cenobamate, ziconotide. Either increases effects of the other by sedation. Use Caution/Monitor.

                • ziprasidone

                  cenobamate, ziprasidone. Either increases effects of the other by sedation. Use Caution/Monitor.

                • zolpidem

                  cenobamate, zolpidem. Either increases effects of the other by sedation. Use Caution/Monitor.

                • zonisamide

                  cenobamate, zonisamide. Either increases effects of the other by sedation. Use Caution/Monitor.

                Minor (2)

                • stiripentol

                  cenobamate will increase the level or effect of stiripentol by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

                • voriconazole

                  cenobamate will increase the level or effect of voriconazole by affecting hepatic enzyme CYP2C19 metabolism. Minor/Significance Unknown. Consider a dose reduction of CYP2C19 substrates, as clinically appropriate, when used concomitantly with cenobamate.

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                Adverse Effects

                >10%

                Somnolence (19-37%)

                Dizziness (18-33%)

                Fatigue (12-24%)

                Diplopia (6-15%)

                Headache (10-12%)

                Serum potassium increased; K+ >5 mEq/L (8.3-10.8%)

                1-10%

                Nausea (6-9%)

                Balance disorder (3-9%)

                Constipation (2-8%)

                Gait disturbance (1-8%)

                Nystagmus (3-7%)

                Dysarthria (1-7%)

                Ataxia (2-6%)

                Vertigo (1-6%)

                Vomiting (2-5%)

                Nasopharyngitis (2-5%)

                Urinary tract infection (2-5%)

                Back pain (2-5%)

                Diarrhea (1-5%)

                Appetite decreased (1-5%)

                Vision blurred (2-4%)

                ALT increased (1-4%)

                Aphasia (1-4%)

                Dyspnea (3%)

                Confusional state (2-3%)

                Asthenia (1-3%)

                AST increased (1-3%)

                Dry mouth (1-3%)

                Tremor (1-3%)

                Palpitations (2%)

                Dyspepsia (2%)

                Dysgeusia (2%)

                Migraine (2%)

                Euphoric mood (2%)

                Papular rash (2%)

                Abdominal pain (1-2%)

                Pharyngitis (1-2%)

                Head injury (1-2%)

                Weight decreased (1-2%)

                Musculoskeletal chest pain (1-2%)

                Memory impairment (1-2%)

                Sedation (1-2%)

                Irritability (1-2%)

                Suicidal ideation (1-2%)

                Dysmenorrhea (1-2%)

                Pruritus (1-2%)

                Pollakiuria (1%)

                Hiccups (1%)

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                Warnings

                Contraindications

                Hypersensitivity

                Familial short QT syndrome (SQTS)

                Cautions

                Drug reaction with eosinophilia and systemic symptoms (DRESS), also known as multiorgan hypersensitivity, reported; DRESS has occurred, including 1 fatality, when cenobamate was titrated rapidly (weekly or faster titration)

                QT shortening >20 msec (31-66%) observed in clinical trials compared with placebo (6-17%); QTc reduction <300 msec not observed; contraindicated in patients with familial SQTS

                Antiepileptic drugs (AEDs), including cenobamate, increase risk of suicidal thoughts or behavior in patients taking these drugs for any indication; monitor for emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior

                Similar to most AEDs, discontinue cenobamate gradually, owing to risk of increased seizure frequency and status epilepticus; may consider rapid discontinuation because of a serious adverse event

                Neurological adverse reactions

                • Dose-dependent increases in somnolence and fatigue-related adverse reactions (somnolence, fatigue, asthenia, malaise, hypersomnia, sedation, and lethargy) observed in approximately one third of patients during clinical trials
                • Dose-dependent adverse reactions related to dizziness and disturbance in gait and coordination (dizziness, vertigo, balance disorder, ataxia, nystagmus, gait disturbance, abnormal coordination) observed in up to ~50% of patients observed in clinical trials
                • Cognitive dysfunction (ie, memory impairment, disturbance in attention, amnesia, confusional state, aphasia, speech disorders, slowness of thought, disorientation, psychomotor retardation) observed
                • Visual changes (eg, diplopia, blurred vision, and impaired vision) observed
                • Warn patients against engaging in hazardous activities requiring mental alertness until the effects of cenobamate are known

                Drug interaction overview

                • Effect of cenobamate on other drugs
                  • Lamotrigine or carbamazepine: Plasma levels decreased; potential for reduced efficacy of these drugs; increase dosage of lamotrigine or carbamazepine, as needed
                  • Phenytoin: Plasma levels increased; owing to potential 2-fold increase in phenytoin levels, gradually decrease phenytoin dosage by up to 50% as cenobamate is being titrated
                  • Phenobarbital, clobazam (ie, desmethyl-clobazam active metabolite): Plasma levels increased; potential for increased adverse reactions from these drugs; consider dose reduction of phenobarbital or clobazam, as clinically appropriate
                  • CYP2B6 or CYP3A substrates: Plasma levels decreased; potential for reduced efficacy of these drugs; increase dosage of CYP2B6 or CYP3A4 substrates, as needed
                  • Oral contraceptives: Plasma levels decreased; potential for reduced efficacy of oral contraceptives; women should use additional contraceptive or a nonhormonal birth control method while taking cenobamate
                  • CYP2C19 substrates: Plasma levels increased; potential for increased risk of adverse reactions from these drugs; consider dosage reduction of CYP2C19 substrates, as clinically appropriate
                • Drugs that shorten QT interval
                  • Cenobamate can shorten QT interval; therefore, caution when administering with other drugs that shorten QT interval (eg, rufinamide)
                • CNS depressants and alcohol
                  • Coadministration with other CNS depressants, including alcohol, may increase risk of neurological adverse reactions, including sedation and somnolence
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                Pregnancy & Lactation

                Pregnancy

                Data are unavailable on the developmental risk associated with use of cenobamate in pregnant women

                Encourage women to enroll in the North American Antiepileptic Drug (NAAED) pregnancy registry 1-888-233-2334 or http://www.aedpregnancyregistry.org

                Animal studies

                • Administration during pregnancy or throughout pregnancy and lactation resulted in adverse effects on development (increased embryofetal mortality, decreased fetal and offspring body weights, neurobehavioral and reproductive impairment in offspring) at clinically relevant drug exposures

                Contraception

                • Cenobamate may decrease plasma concentrations of oral contraceptives
                • Women of reproductive potential concomitantly using oral contraceptives should use additional or alternative nonhormonal birth control

                Lactation

                Data are unavailable on the presence in human milk, effects on breastfed infants, or effects on milk production

                Pregnancy Categories

                A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

                B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

                C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

                D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

                X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

                NA: Information not available.

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                Pharmacology

                Mechanism of Action

                Exact mechanism of action unknown

                It is thought to work by reducing repetitive neuronal firing by inhibiting voltage-gated sodium currents; it is also a positive allosteric modulator of the GABA ion channel

                Absorption

                Bioavailability: 88%

                Peak plasma time: 1-4 hr

                Distribution

                Protein bound: 60%; primarily to albumin

                Vd: 40-50 L

                Metabolism

                Extensively metabolized; primarily by glucuronidation via UGT2B7 and to a lesser extent by UGT2B4, and by oxidation via CYP2E1, CYP2A6, CYP2B6, and to a lesser extent by CYP2C19 and CYP3A4/5

                Elimination

                Half-life: 50-60 hr

                Oral clearance: 0.45-9.63 L/hr

                Excretion: Urine 87.8%; feces 5.2%

                Pharmacogenomics

                Short QT syndrome

                • Genotype-phenotype correlations of congenital SQTS are presently not well characterized
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                Administration

                Oral Administration

                Administer at any time with or without food

                Swallow tablet whole with liquid; do not crush or chew

                Discontinuation

                • If discontinued, gradually reduce dose over at least 2 weeks, unless safety concerns require abrupt withdrawal
                • Abrupt withdrawal associated with increased seizure frequency and status epilepticus

                Storage

                Store at controlled room temperature of 20-25ºC (68-77ºF); excursions permitted to 15-30ºC (59-86ºF)

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                Images

                No images available for this drug.
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                Patient Handout

                A Patient Handout is not currently available for this monograph.
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                Formulary

                FormularyPatient Discounts

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                The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

                Tier Description
                1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
                2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
                3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
                4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
                NC NOT COVERED – Drugs that are not covered by the plan.
                Code Definition
                PA Prior Authorization
                Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
                QL Quantity Limits
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                ST Step Therapy
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                Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.