Xcopri (cenobamate) is a brand-name oral tablet that’s prescribed for focal onset seizures in adults. Xcopri has interactions with alcohol and some other drugs. Examples include diazepam (Valium) and certain other antiseizure drugs.

An interaction occurs when one substance causes another substance to have a different effect than expected.

Before you start treatment with Xcopri, tell your doctor and pharmacist which prescription, over-the-counter (OTC), and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Xcopri interacts with supplements, herbs, or vitamins, see the “Xcopri and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Xcopri. Keep in mind that this table doesn’t include all drugs that may interact with Xcopri. Some of these interactions are described in detail just below in “Drug interactions in depth.”

Drug class or drug nameDrug examplesInteraction result with Xcopri
opioids• morphine (Mitigo, MS Contin, others)
• oxycodone (Oxycontin, Roxicodone, others)
• tramadol (Conzip, Qdolo)
may increase the risk of side effects from Xcopri and the opioid
benzodiazepines• alprazolam (Xanax)
• clonazepam (Klonopin)
• diazepam (Valium)
• midazolam
may increase the risk of side effects from Xcopri and the benzodiazepine, or certain benzodiazepines may be less effective
birth control pills• ethinyl estradiol/norgestimate (Sprintec, Tri-Sprintec, others)
• ethinyl estradiol/drospirenone (Yasmin, Yaz, others)
• ethinyl estradiol/norethindrone (Aurovela, Junel, others)
birth control pills may be less effective
sleep aids• zaleplon (Sonata)
• eszopiclone (Lunesta)
• ramelteon (Rozerem)
• zolpidem (Ambien, Edluar)
may increase the risk of side effects from Xcopri and the sleep aid
certain other antiseizure drugs• lamotrigine (Lamictal, Lamictal XR)
• carbamazepine (Carbatrol, Tegretol, others)
• phenytoin (Dilantin, Phenytek)
• rufinamide (Banzel)
• clobazam (Onfi, Sympazan)
may increase the risk of side effects from Xcopri and certain antiseizure drugs, or certain antiseizure drugs may be less effective
certain antiarrhythmics• digoxin (Lanoxin)
• lidocaine (Xylocaine)
• mexiletine
may increase the risk of QT shortening (a type of irregular heart rhythm)
bupropion (Aplenzin, Wellbutrin XL, others)bupropion may be less effective
omeprazole (Prilosec)may increase the risk of side effects from omeprazole

In some cases, factors or conditions could prevent your doctor from prescribing Xcopri due to the risk of harm. These are known as contraindications. The contraindications of Xcopri include:

Having a certain inherited heart condition

Doctors typically won’t prescribe Xcopri for people with familial short QT syndrome. This is an inherited condition that causes QT shortening (a type of irregular heart rhythm). Xcopri may cause QT shortening, which can worsen this condition.

If you have familial short QT syndrome, talk with your doctor before taking Xcopri. They’ll likely prescribe a treatment other than Xcopri for your condition.

Having had an allergic reaction to Xcopri or any of its ingredients

If you have had an allergic reaction to Xcopri or any of its ingredients, your doctor will likely not prescribe Xcopri. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Note: Before you start treatment with Xcopri, it’s important to tell your doctor if these contraindications apply to you. They can determine whether to prescribe Xcopri.

Your doctor will likely recommend that you not drink alcohol while taking Xcopri. They’ll also usually advise you not to take any prescription or OTC drugs that contain alcohol during Xcopri treatment.

This is because consuming alcohol while taking Xcopri may increase the risk of Xcopri’s side effects. Examples include difficulty thinking, difficulty walking, and sleepiness.

If you have concerns about avoiding alcohol while you’re taking Xcopri, talk with your doctor before starting treatment.

Here’s a closer look at certain drug interactions of Xcopri.

Benzodiazepines

Benzodiazepines are prescribed for anxiety and seizure disorders.

Interaction result: Taking Xcopri with benzodiazepines may increase the risk of side effects from either drug. Certain benzodiazepines may also be less effective if you take them with Xcopri.

Interaction explained: Xcopri and benzodiazepines may each cause similar side effects when you take them individually. Examples include difficulty thinking, difficulty walking, and sleepiness. Taking these medications together further increases the risk of these side effects.

Xcopri could also speed up the breakdown of certain benzodiazepines in your body. Taking them together can lower the level of the benzodiazepine, making the drug less effective.

Examples of benzodiazepine drugs: Here are some benzodiazepines that may interact with Xcopri:

  • alprazolam (Xanax)
  • clonazepam (Klonopin)
  • diazepam (Valium)
  • midazolam

Steps you or your doctor may take: Your doctor can determine whether it’s safe to combine Xcopri with a benzodiazepine.

If your doctor prescribes Xcopri with a benzodiazepine, tell them right away if you have bothersome or long lasting side effects. They may switch you from Xcopri or benzodiazepine to reduce your risk of these side effects.

To learn more about Xcopri and benzodiazepines, talk with your doctor or pharmacist.

Birth control pills

Birth control pills are prescribed to help prevent pregnancy.

Interaction result: Taking Xcopri with birth control pills can make the birth control pill less effective.

Interaction explained: Xcopri may speed up the breakdown of active ingredients in birth control pills. This can lead to low levels of the birth control drug in your system. Having low levels of this drug in your body could make birth control pills less effective.

Examples of birth control pills: Here are some birth control pills that may interact with Xcopri:

  • ethinyl estradiol/norgestimate (Sprintec, Tri-Sprintec, others)
  • ethinyl estradiol/drospirenone (Yasmin, Yaz, others)
  • ethinyl estradiol/norethindrone (Aurovela, Junel, others)

Steps you or your doctor may take: Before taking Xcopri, talk with your doctor about your birth control needs.

If you take birth control pills, your doctor can advise whether it’s safe to take them with Xcopri. They may recommend a different form of birth control that’s less likely to be affected by Xcopri. Examples include barrier methods such as condoms or diaphragms.

To learn more about Xcopri and birth control pills, talk with your doctor or pharmacist.

Certain other antiseizure drugs

As with Xcopri, other antiseizure drugs are prescribed to treat seizure disorders.

Interaction result: Taking Xcopri with certain antiseizure drugs could increase the risk of side effects from either drug. Xcopri may also cause other antiseizure drugs to be less effective.

Interaction explained: Xcopri could slow the breakdown of certain other antiseizure drugs. Taking them with Xcopri could raise the level of the other antiseizure drug in your body. This may increase your risk of side effects from the other antiseizure drug.

In addition, Xcopri and certain antiseizure drugs may cause QT shortening (a type of irregular heart rhythm) when you take them individually. Taking these medications together further increases the risk of this side effect.

Xcopri could also speed up the breakdown of certain other antiseizure drugs. Taking them together can lower the level of the other antiseizure drug in your system and make the drug less effective.

Examples of antiseizure drugs: Here are some antiseizure drugs that may interact with Xcopri:

  • lamotrigine (Lamictal, Lamictal XR)
  • carbamazepine (Carbatrol, Tegretol, others)
  • phenytoin (Dilantin, Phenytek)
  • rufinamide (Banzel)
  • clobazam (Onfi, Sympazan)

Steps you or your doctor may take: Your doctor can recommend whether it’s safe to combine Xcopri with a specific antiseizure drug.

If your doctor prescribes Xcopri with an antiseizure drug it interacts with, they may adjust the dosage of the other drug. This can help reduce the risk of side effects or help the other antiseizure drug be more effective when combined with Xcopri.

To learn more about Xcopri and other antiseizure drugs, talk with your doctor or pharmacist.

Xcopri may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Xcopri.

Xcopri and supplements

It’s possible for drugs to interact with supplements such as vitamins and herbs.

Xcopri and herbs

There are no specific reports of herbs interacting with Xcopri. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Xcopri treatment.

Xcopri and vitamins

There are no specific reports of vitamins interacting with Xcopri. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Xcopri.

Xcopri and food

There were no reports of food interactions with Xcopri. If you’d like to learn more about eating certain foods during treatment with Xcopri, talk with your doctor.

Xcopri and vaccines

There aren’t any known interactions between Xcopri and vaccines. Talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Xcopri and lab tests

Xcopri isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

XCOPRI AND CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Xcopri.

However, Xcopri and cannabis products may cause similar side effects. Examples include difficulty thinking, difficulty walking, and sleepiness. Taking Xcopri with cannabis products may increase the risk of these side effects.

As with any drug or supplement, talk with your doctor before using cannabis in combination with Xcopri. The impact of cannabis may also affect how well you stick to your Xcopri treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Xcopri. Before you take this drug, be sure to talk with your doctor about your health history. Xcopri may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Xcopri include:

  • Liver or kidney problems: If you have a liver or kidney problem, talk with your doctor before starting Xcopri treatment. Examples of these problems include liver failure and kidney failure. If you have a liver or kidney problem, your body may not break down Xcopri properly. This can lead to high levels of the drug in your system, raising your risk of side effects. Your doctor may give you a lower Xcopri dosage to reduce this risk.
  • Mental health conditions: In rare cases, taking Xcopri may lead to suicidal thoughts or behaviors. Your risk may be higher if you have a mental health condition, such as depression. Your doctor can determine whether Xcopri is right for you.
  • Familial short QT syndrome: Doctors typically won’t prescribe Xcopri for people with familial short QT syndrome. To learn more, see the “When to avoid Xcopri” section above.
  • Allergic reaction: If you’ve had an allergic reaction to Xcopri or any of its ingredients, your doctor will likely not prescribe Xcopri. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.
  • Breastfeeding: It’s not known whether it’s safe to use Xcopri while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Xcopri may have on a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before using Xcopri. They can talk with you about treatment options and ways to feed your child.
  • Pregnancy: There haven’t been enough clinical trials to determine whether Xcopri is safe to use while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth defects) or pregnancy loss. However, it’s important to note that animal studies don’t always indicate what may happen in humans. If you’re pregnant or planning to become pregnant, tell your doctor before starting Xcopri. They can advise you on the right treatment plan for you.

Suicide prevention

If you know someone at immediate risk of self-harm, suicide, or hurting another person:

  • Ask the tough question: “Are you considering suicide?”
  • Listen to the person without judgment.
  • Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
  • Stay with the person until professional help arrives.
  • Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.

If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Find more links and local resources.

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You can take certain steps to help prevent interactions with Xcopri. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

  • Let them know if you drink alcohol or use cannabis.
  • Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
  • Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Xcopri label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. The paperwork sometimes called the medication guide or patient package insert, may contain details about interactions.

If Xcopri doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Xcopri by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.