Spanish consensus on the management of concomitantantiseizure medications when using cenobamate in adultswith drug-resistant focal seizures
Mar Carreño | Antonio Gil-Nagel | José M. Serratosa | Manuel Toledo |Juan Jesus Rodriguez- Uranga | Vicente Villanueva
Abstract
Objective: Cenobamate is an antiseizure medication (ASM) associated withhigh rates of seizure freedom and acceptable tolerability in patients with focalseizures. To achieve the optimal cenobamate dose for maximal potential effec-tiveness while avoiding or minimizing drug-related adverse events (AEs), theadministration of cenobamate with other ASMs must be managed through con-comitant ASM load reduction. A panel of Spanish epilepsy experts aimed to pro-vide a Spanish consensus on how to adjust the dose of concomitant ASMs inpatients with drug-resistant epilepsy (DRE) in order to improve the effectivenessand tolerability of adjunctive cenobamate.
Methods:
A three-stage modified Delphi consensus process was undertaken,including six Spanish epileptologists with extensive experience using cenoba-mate. Based on current literature and their own expert opinion, the expert panelreached a consensus on when and how to adjust the dosage of concomitant ASMsduring cenobamate titration.
Results:
The expert panel agreed that tailored titration and close follow-up are re-quired to achieve the best efficacy and tolerability when initiating cenobamate inpatients receiving concomitant ASMs. When concomitant clobazam, phenytoin,phenobarbital, and sodium channel blockers are taken at high dosages, or whenthe patient is receiving two or more sodium channel blockers, dosages should beproactively lowered during the cenobamate titration period. Other concomitantASMs should be reduced only if the patient reports a moderate/severe AE at anystage of the titration period.
Significance:
Cenobamate is an effective ASM with a dose-dependent effect.To maximize effectiveness while maintaining the best tolerability profile, co-medication management is needed. The recommendations included herein pro-vide practical guidance for proactive and reactive management of co-medicationin cenobamate-treated patients with DRE and a high drug load.
