Xcopri, made simple.
Xcopri is a once a day medicine that helps control focal seizures in adults. This guide explains how it works, why the dose is increased slowly over several weeks, and what to watch for, in plain language. A Mississippi pharmacist wrote it for you.
This guide is here to teach you. It is not medical advice, and it does not replace your doctor or pharmacist. Always do what your doctor tells you, and ask a pharmacist before you change how you take any medicine.
Print this guide for your fridgeWhat Xcopri is and why your doctor gave it to you
Xcopri is a medicine that helps control seizures. Its other name is cenobamate. It is taken once a day, by mouth, and it is used by adults who have focal seizures, also called partial-onset seizures.
A focal seizure is one that starts in one area of the brain. Xcopri is often used when other seizure medicines have not given enough control on their own, and it is frequently taken alongside other seizure medicines.
Epilepsy is a common medical condition, and needing medicine to manage it is ordinary, like managing any other long-term health condition. This guide is here to help you take Xcopri well and confidently.
The simple version: Xcopri is a once a day seizure medicine for adults. Its dose is raised slowly, over about 10 weeks, and that slow schedule is the most important thing to understand about it.
How Xcopri works
A seizure happens when brain cells send out a burst of overly active electrical signals.
Xcopri works in two ways at once to calm that. It quiets the overactive signals that can build into a seizure, and it strengthens the brain's own natural calming system.
Working on both sides at once is part of why Xcopri can help when other medicines have not.
Your dose, and the slow schedule that matters most
Here is the most important thing on this page. Xcopri is started at a low dose and increased very slowly, over at least 10 weeks. This slow schedule is not optional, and it must never be sped up. Early on, when Xcopri was increased too quickly, some patients developed a serious and potentially life-threatening reaction called DRESS, covered in the side effects section. The slow schedule was put in place to lower that risk. Speeding up, doubling up, or skipping ahead is genuinely dangerous.
What that means in practice: you start on a low dose, often a 14 day starter pack of the smallest tablet, supplied as a special blister pack, which is normal and intentional. Your dose then goes up in small steps, each step lasting about 2 weeks, until you reach the dose your doctor is aiming for. Take exactly the dose for the week you are on. Do not move faster, even if you feel fine, and even if you are eager for it to work.
Take Xcopri once a day, at about the same time each day, with or without food. The tablets can be swallowed whole, or, if swallowing is hard, crushed and mixed with a small amount of water and taken right away. Your doctor sets your dose and your schedule. This page will not tell you what dose to take. Every time Fairview fills your next step up, we will remind you what to watch for.
Timing, and what to do if you miss a dose
Take Xcopri once a day, at about the same time each day. It does not have to be the exact same minute, but a steady routine helps.
With seizure medicines, gaps matter, so consistency is part of the treatment.
If you miss a dose:
- If you miss a dose, take it as soon as you remember that same day.
- If it is almost time for your next dose, skip the missed one and go back to your regular schedule.
- Never take two doses in one day.
- If you miss several doses, do not try to catch up. Call your prescriber or pharmacist for guidance.
Side effects, what is normal and what is not
Serious warnings to understand.
- DRESS, the reason for the slow dose schedule. DRESS is a severe, potentially life-threatening reaction affecting both the skin and internal organs. The warning signs are a skin rash or hives, fever, swollen glands, and swelling of the face, lips, or tongue. If you develop these signs, especially more than one together, call 911 or go to the emergency room right away. Do not wait.
- Liver injury. Xcopri can affect the liver. Your prescriber will check your liver with a blood test before you start and will monitor it during treatment. Tell your doctor promptly about yellowing of the skin or eyes, dark urine, ongoing nausea or loss of appetite, pain in the upper right of your belly, or unusual tiredness.
- Heart rhythm. Xcopri can shorten a part of the heartbeat called the QT interval. For most people this is not a problem, but it is why Xcopri must not be used by anyone with a rare inherited condition called Familial Short QT syndrome. Tell your doctor about any personal or family history of heart rhythm problems or sudden death in the family.
- Mood and thoughts of self-harm. All seizure medicines, as a group, carry a warning that they can raise the risk of depression or thoughts of self-harm in a small number of people. Tell your doctor right away about new or worsening depression, anxiety, or mood changes. If you are ever in crisis, call or text 988 at any time.
Common, usually mild, often most noticeable during the dose increases.
- Drowsiness, dizziness, or tiredness.
- Double vision, or a headache.
- Nausea.
- Unsteadiness or trouble with balance.
Call your doctor if you notice:
- Any new rash or unusual skin change, even a mild one. With the risk of DRESS, a rash should always be reported promptly.
- Signs of a liver problem, listed above.
- New or worsening mood changes.
- Double vision or balance trouble that does not settle, or any side effect that gets in the way of daily life.
Go to the emergency room or call 911 if:
- You have a rash plus fever plus swollen glands or facial swelling. This can be DRESS.
- You have a sudden severe allergic reaction, with throat tightening or trouble breathing.
- You have a seizure that will not stop, or seizures one after another without recovering in between.
What to be careful with
Xcopri interacts with a number of other medicines, and this works in both directions. If you take other seizure medicines, such as phenytoin, clobazam, or phenobarbital, their levels can change when Xcopri is added or increased. Your neurologist will often adjust those other medicines on purpose as your Xcopri goes up, even before you feel any side effect. That is expected and is good care.
Avoid alcohol while on Xcopri. It adds to the drowsiness, dizziness, and coordination problems, which are already most noticeable while your dose is being increased. For the same reason, do not drive or operate heavy machinery until you know how Xcopri affects you.
Xcopri is a controlled medicine, Schedule V. That simply means a few extra rules apply to how it is refilled, for example it may not go through an automatic refill system. It is not a reflection on you. Fairview will help you stay ahead of your refills so you never run short of a seizure medicine.
The simple rule: tell your pharmacist and prescriber every medicine and supplement you take, including over the counter products, when you start Xcopri and at every dose increase. At Fairview, we check every new prescription against your list.
What it costs
The cost is different for every person, because every insurance plan is different.
Here is the honest way to find your price. If you pay cash, call Fairview and we will give you a price for your situation. If you have private insurance, there may be a coupon or a savings program from the maker of the drug that helps lower your cost, and we will check if one is available for you. The best step is to let a pharmacist look at your plan. We do this for every patient.
Do not let cost make you skip doses. Call us first. There is almost always something we can do.
There is also a generic version of many medicines. The generic is the same medicine. Ask your pharmacist if a generic is a good fit for you.
What should be checked
Xcopri treatment includes a few regular checks that keep you safe and confirm the medicine is helping.
Your doctor should check:
- Your liver, with a blood test before you start and during treatment.
- How well your seizures are controlled as your dose goes up.
- How you are tolerating the medicine.
- Your mood, especially in the early months.
Your pharmacist should:
- Remind you what to watch for at every step up in your dose.
- Check every new medicine and supplement against Xcopri.
- Keep you ahead of your refills so you never run short.
- Keep your information private, always.
At Fairview, every dose increase is a checkpoint on your side. We remind you what to watch for, especially the DRESS warning signs, and we keep your refills on track. Your care is handled calmly and without judgment.
Special situations
Never stop Xcopri suddenly.
Do not stop Xcopri abruptly, and do not stop it on your own. Stopping a seizure medicine suddenly can trigger seizures, including a dangerous prolonged one. If you and your doctor decide to stop Xcopri, the dose is lowered gradually, over at least 2 weeks, under your doctor's guidance. If a side effect ever makes you feel you need to stop, call your prescriber right away rather than just stopping.
Birth control.
Xcopri makes hormonal birth control less effective, including the pill, the patch, the implant, the shot, and the vaginal ring. If you could become pregnant and do not want to be, you need to use a barrier method, such as condoms, in addition to or instead of hormonal birth control, while on Xcopri and for 4 weeks after your last dose. If you are planning a pregnancy or think you may be pregnant, tell your prescriber so your epilepsy care can be planned safely.
Driving and falls.
Drowsiness, dizziness, and unsteadiness are most noticeable while your dose is being increased. Do not drive or use heavy machinery until you know how Xcopri affects you. If you are an older adult, take extra care during the dose increases, since the unsteadiness can raise the risk of a fall.
Surgery and dental work.
Tell your surgeon, anesthesiologist, and dentist that you take Xcopri. Do not stop it on your own before a procedure. Your prescriber will plan how to manage it, and it should be restarted as soon as you can take medicines by mouth again.
Cost should never be the reason you stop.
Xcopri is brand only, with no generic available, so the help is worth using. The maker has a support program for benefits, prior authorization, and financial assistance, plus a starter trial offer for eligible patients. Xcopri almost always needs a prior authorization, and Fairview can help with that paperwork. Never let cost cause you to skip or stretch a seizure medicine. Call us first.
How Fairview helps Xcopri patients
When you fill Xcopri at Fairview, here is what you get. This is normal care for us, and it is always private.
When you start:
- We make sure you understand the slow schedule and why it must not be rushed.
- We check Xcopri against everything else you take.
- We help with the manufacturer support program, the trial offer, and the prior authorization.
At every dose increase:
- We remind you what to watch for, especially the DRESS warning signs.
- We recheck your medicine list, since other seizure medicines may be adjusting too.
- We answer any new questions, calmly and without judgment.
On our own, without being asked:
- We keep you ahead of your refills so you never run short of a seizure medicine.
- If we see a medicine that does not mix with Xcopri, we call your doctor.
- We check your cost to keep it as low as possible.
Questions people ask about Xcopri
It is a once a day medicine that helps control focal seizures, also called partial-onset seizures, in adults. It is often used when other seizure medicines have not given enough control.
Have a question about your Xcopri? Ask a pharmacist you can trust.
The slow dose schedule is the heart of taking Xcopri safely, and you do not have to manage it alone. If you have any question, at any step, ask us. Fairview is here, calmly and without judgment.