Anti-epileptic
Cenobamate
Brand names: Ontozry
Adult dose
Dose: Initial 12.5mg OD; titrate over 11+ weeks to 200mg OD; max 400mg OD
Route: PO
Frequency: OD
Clinical pearls
- Slow titration mandatory to reduce DRESS risk
- Adjunct for focal-onset seizures in adults uncertain on ≥2 AEDs
Contraindications
- Familial short QT syndrome
- Severe hepatic impairment
Side effects
- Somnolence
- Dizziness
- Diplopia
- Fatigue
- DRESS (rare)
Interactions
- Reduces hormonal contraceptive efficacy — use additional method
- Reduces lamotrigine, carbamazepine, clobazam levels
- Increases phenytoin levels
- Avoid with fentanyl/strong CYP3A4 substrates
Monitoring
- LFTs
- Mood
- ECG (baseline if QT risk factors)
Reference: BNF; https://bnf.nice.org.uk/drugs/cenobamate/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- Revised Original International Autoimmune Hepatitis Score (IAIHG) · Autoimmune Liver Disease
- Ho Index for Predicting Response to Medical Therapy in IBD · Inflammatory Bowel Disease
- BER Score (Benign vs Epileptic vs Other Paroxysmal Events) · Headache / Epilepsy
- Rh(D) Immune Globulin Dosage for Maternal-Fetal Haemorrhage · Haematology in Pregnancy
- AREDS Classification of Age-related Macular Degeneration · Macular Degeneration
- Diabetic Macular Oedema (DMO) Classification · Diabetic Retinopathy
Pathways
- Acute Stroke / TIA Assessment · NICE NG128; RCP Stroke Guidelines 2023
- Status Epilepticus (Adults) · NICE CG137; ESEM guidelines; RCP Neurology Guidelines
- Suspected Subarachnoid Haemorrhage · NICE NG228; RCEM 2023; AHA/ASA 2023
- Adult Head Injury · NICE NG232 (2023)
- Bell's Palsy / Facial Nerve Palsy · ENT UK 2017; AAN
- Vertigo Workup · ENT UK; NICE CKS