What Is Xcopri?

Xcopri (cenobamate) is a prescription anticonvulsant FDA-approved in November 2019 for the treatment of partial-onset (focal) seizures in adults. It is manufactured by SK Life Science, a subsidiary of SK Biopharmaceuticals.

Xcopri has generated significant interest in the epilepsy community because clinical trials showed that up to 21% of patients achieved seizure freedom at the 400 mg dose — a remarkably high rate for add-on therapy in drug-resistant epilepsy. Many of these patients had previously failed multiple other anticonvulsants.

Xcopri is classified as a Schedule V controlled substance due to a small abuse potential observed in clinical studies, though this is considered minimal compared to other controlled substances.

Medfinder can help you find pharmacies with Xcopri in stock.

How does Xcopri work?

Cenobamate has a dual mechanism of action that distinguishes it from most other anticonvulsants. It works by enhancing inhibitory neurotransmission and reducing excitatory neurotransmission through two complementary pathways:

• Positive allosteric modulation of GABA-A receptors — enhances the brain's primary inhibitory signaling, particularly at non-benzodiazepine binding sites
• Inhibition of persistent sodium currents — reduces the excitatory neuronal firing that drives seizures, without significantly affecting transient sodium currents needed for normal function

This dual mechanism may explain why Xcopri shows efficacy in patients who have not responded to other anticonvulsants that work through only one of these pathways. Effects on seizure frequency are typically seen within the first few weeks of reaching therapeutic doses.

What doses are available for Xcopri?

Xcopri is available in tablets in the following strengths:

• 12.5 mg (starting dose, weeks 1–2)
• 25 mg (weeks 3–4)
• 50 mg (weeks 5–6)
• 100 mg (weeks 7–8)
• 150 mg (weeks 9–10)
• 200 mg (maintenance, week 11+)

Xcopri is taken once daily. The slow titration schedule (every 2 weeks) is critical for safety — rapid titration has been associated with DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms), a potentially fatal hypersensitivity reaction. The recommended titration should never be exceeded.

Tablets can be taken whole or crushed and mixed with water for oral administration or nasogastric tube.

How hard is it to find Xcopri in stock?

Xcopri (cenobamate) is a newer anticonvulsant for partial-onset seizures in adults, and we've assigned a findability score of 68 out of 100. While there is no FDA-listed shortage, the medication's brand-only status, high cost, and specialty distribution create meaningful access barriers.

Why It Can Be Difficult to Find

Xcopri is a brand-name only medication with no generic available — and none expected until at least 2032 based on current patent protections. The retail price exceeds $1,100/month, which means many pharmacies do not routinely stock it. Independent pharmacies in particular may need to special-order it.

Many insurance plans require prior authorization and may require patients to have tried and failed other anticonvulsants before approving Xcopri. This adds time before a patient can even attempt to fill the prescription.

The manufacturer, SK Life Science, offers a patient support program called SK Life Science Navigator that can help locate pharmacies with stock and connect patients with specialty pharmacies that offer home delivery.

What This Means for Patients

Patients are unlikely to face stockout issues once they have an established supply chain — but the initial process of getting insurance approval, finding a stocking pharmacy, and managing cost can take 1–2 weeks. Specialty pharmacies with home delivery are often the most reliable access point.

Medfinder can help you find pharmacies that carry Xcopri near you.

Who Can Prescribe Xcopri?

Xcopri is a Schedule V controlled substance. Neurologists and epileptologists are the primary prescribers. PCPs may prescribe it in some cases, though most initiate under specialist supervision due to the critical slow titration requirement and monitoring needs.

Because of prior authorization requirements from most insurers, getting started on Xcopri typically requires documentation of previous anticonvulsant failures.

Medfinder helps you find pharmacies with Xcopri in stock.

Is Xcopri a controlled substance?

Yes, Xcopri is classified as a Schedule V controlled substance, the lowest level of control. In abuse potential studies, cenobamate showed mild euphoric effects at supratherapeutic doses. In practice, this classification has minimal impact on prescribing or filling — refills are straightforward, and there are no special prescription requirements beyond standard controlled substance rules.

The more significant barrier to access is insurance prior authorization and the medication's high cost without insurance.

Common Side Effects of Xcopri

Most Common

• Somnolence (drowsiness)
• Dizziness
• Fatigue
• Diplopia (double vision)
• Headache
• Disturbance in gait and coordination

Serious Warnings

• DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) — Potentially fatal hypersensitivity reaction reported with rapid titration. The slow 2-week titration schedule is mandatory to minimize risk.
• QT shortening — Xcopri can shorten the QT interval. Contraindicated in familial Short QT syndrome.
• Suicidal behavior and ideation — Risk shared by all anticonvulsants.
• Liver injury — Liver function tests should be obtained before starting and monitored during treatment.

Alternative Medications to Xcopri

Other Newer Anticonvulsants

• Brivaracetam (Briviact) — SV2A ligand, available as generic. Good tolerability profile.
• Perampanel (Fycompa) — AMPA receptor antagonist. Once-daily dosing.
• Lacosamide (Vimpat) — Sodium channel modulator. Now available as generic.

Established Anticonvulsants (Generic Available)

• Levetiracetam (Keppra) — Most commonly prescribed AED. Very affordable generic.
• Lamotrigine (Lamictal) — Broad-spectrum, generic available. Also treats mood disorders.
• Carbamazepine (Tegretol) — Older sodium channel blocker. Inexpensive generic.
• Oxcarbazepine (Trileptal) — Related to carbamazepine with fewer drug interactions.
• Topiramate (Topamax) — Broad mechanism, generic available.

Xcopri is typically reserved for patients who have not achieved adequate seizure control with other medications. Medfinder can help find availability.

Drug Interactions with Xcopri

Important Interactions

• CYP3A4 substrates — Cenobamate is a moderate CYP3A4 inducer and can reduce levels of hormonal contraceptives, making them less effective.
• CYP2C19 substrates — Cenobamate inhibits CYP2C19, potentially increasing levels of clobazam, omeprazole, and other 2C19 substrates.
• Phenytoin and phenobarbital — Dose adjustments required when co-administered.
• Hormonal contraceptives — May be less effective. Additional or alternative contraception recommended.
• Other CNS depressants — Additive sedation with benzodiazepines, opioids, alcohol.

Final Thoughts on Xcopri

Xcopri has emerged as one of the most effective add-on anticonvulsants for drug-resistant focal epilepsy, with seizure-freedom rates that exceed those seen with most other newer AEDs. Its dual mechanism of action offers hope for patients who have not responded to other treatments.

The main barriers to access are cost (over $1,100/month without insurance), prior authorization requirements, and limited pharmacy stocking. The manufacturer's trial program offers a free 28-day titration pack, and copay assistance programs can reduce costs to $20/month for commercially insured patients.

Medfinder helps you find pharmacies with Xcopri in stock. Search for availability near you.