Experiencing multiple seizures can impact how you live and your day-to-day activities. Certain medicines can help lower the risk of having seizures, which can help you manage your condition. Xcopri (ex-koh-pree) was approved in 2020 to manage partial-onset seizures.
How Does It Work for Partial-Onset Seizures?
A seizure happens when neurons in the brain, which are responsible for communicating chemical and electrical signals, suddenly fire too much. Neurons control how you move, think, and speak. When there is too much electrical signaling in the brain caused by the neurons, this can cause your body to do things that you cannot control.
Seizures can be triggered by many different things, such as:
- Certain medicines or missing doses of medicines
- Infections
- Using illegal drugs such as cocaine or ecstasy
- Flashing lights
- Drinking too much alcohol
- Lack of sleep
- Stress
A partial-onset seizure, also known as a focal seizure, starts in one part of the brain. This type of seizure can cause symptoms such as:
- Seeing, feeling, or hearing things that are not there
- Twitching in your arms, legs, or fingers
- Strange tastes or smells
- Gagging, smacking your lips, crying, or laughing suddenly
- Seeing flashes of light
- Uncontrolled muscle contractions
Proteins on the cells in your brain allow certain chemicals to move in and out of the cell. Xcopri works to push chloride into the cell and keep sodium outside of the cell. This lowers the amount of firing from the nerve cells in the brain and lowers the risk of having a seizure.
How Do I Take It?
Xcopri is a tablet that is taken once a day (at any time of the day) with or without food. The tablet can be taken by mouth crushed and mixed with water. The water/medicine mixture can be taken by mouth given through a nasogastric (NG) tube. An NG tube is a tube that goes from your nose to your stomach and is put in people who have trouble swallowing.
If you swallow the tablet by mouth, it is important not to crush or chew the tablet and to swallow it whole. If you are crushing the tablet and mixing it with water, follow the instructions below.
- Crush the number of tablets that you need for your dose in a cup.
- Combine the crushed tablets with 25 milliliters (about 5 teaspoons) of water.
- Swirl the mixture in the cup and drink the tablet/water mixture immediately. Do not store it for later.
- After drinking the tablet/water mixture, add another 25 milliliters of water in the cup, swirl the cup, and drink the mixture immediately to make sure there is no tablet residue left in the cup.
- If there is still tablet residue left in the cup, repeat step 4.
Talk to your health care provider if you need to give a loved one Xcopri through an NG tube. Your health care provider can teach you on how to do this.
Xcopri comes in many different doses ranging from 12.5-milligram to 200-milligram tablets. You could be prescribed a bottle of Xcopri where all the tablets have the same dose. You could be prescribed a titration blister pack that contains either the same or different doses of the medicine.
When you first start Xcopri, your health care provider may likely start you on the lowest dose of Xcopri and may increase your dose every 2 weeks until you’ve reached the 200-milligram per day dose (which is classified as the maintenance dose). This process is called titration. A maintenance dose is the dose that you stay on and take every day to help manage your symptoms. Your health care provider could increase your dose above 200 milligrams per day if you are still experiencing many seizures. The maximum dose you can take every day is 400 milligrams. If you have certain liver or kidney problems, the dose of Xcopri you take may be lower.
How Was It Studied?
Two clinical studies were done to see if Xcopri was safe and effective. People in both studies had partial-onset seizures that were not controlled on one to three seizure medicines, called antiepileptics. People were also able to take other medicines for their seizures while they participated in the study. These medicines included carbamazepine, clobazam, lamotrigine, levetiracetam, oxcarbazepine, and valproate or valproic acid. The studies looked at how often people had seizures over a 28-day period.
The first clinical study was conducted over 12 weeks in people between the ages 18 and 65. People in the study received either Xcopri 200 milligrams or a placebo containing no medicine. The average age of people in the study was 37 years old and included White, Asian, Black, and people classified as “other or unknown.”
The second clinical study was conducted over 18 weeks in people between the ages of 18 and 70. People in the study received either Xcopri at a dose of 100 milligrams, 200 milligrams, or 400 milligrams, or placebo. The average age of people in the study was 40 and included White Americans, Asian Americans, Black Americans, and those classified as “other.”
What Benefits Were Seen?
In the first study, when taking Xcopri with other medicines for seizures, Xcopri 200 milligrams reduced the amount of partial-onset seizures people experienced by 56% compared to placebo, which reduced partial-onset seizures by 22%.
In the second study, when taking Xcopri with other medicines for seizures, Xcopri 400 milligrams and Xcopri 200 milligrams reduced the amount of partial-onset seizures people experienced by 55%, Xcopri 100 milligrams by 36%, and placebo by 24%.
How Can I Tell If It Is Working?
Xcopri works to lower your risk of having a seizure by stopping the nerve cells in your brain from over-firing. Based on what was seen in clinical trials, it may take a few weeks to a few months to get the full effects of Xcopri. Your health care provider has to slowly increase your dose of Xcopri every 2 weeks for at least 2 months when you first start taking the medicine, which means you may not experience the full effects of the medicine right away.
You can tell if Xcopri is working when you experience a lesser number of seizures while on the medicine compared to when you were not on the medicine. Talk to your health care provider if the number of seizures you are experiencing stays the same or if you are experiencing more seizures. Your health care provider may increase the dose of Xcopri, add on another medicine, or change you to a different medicine.
What Happens When the Drug Is Stopped?
Stopping Xcopri suddenly can cause serious problems, including experiencing more seizures or experiencing seizures that won’t stop (status epilepticus). When you first start taking Xcopri, your dose is gradually increased over time. When stopping Xcopri, your dose will have to be gradually decreased over time. It is important that you do not suddenly stop taking Xcopri without talking to your health care provider first.
What Are the Side Effects and How Can I Manage Them?
The most common side effects seen with Xcopri are drowsiness, dizziness, tiredness, double vision, and headache.
Because Xcopri can slow your thinking, affect your motor skills, cause dizziness, and affect your vision, it is important to not drive or do other dangerous activities until you know how Xcopri affects you.
If you are experiencing headaches because of Xcopri, taking over-the-counter medicines such as acetaminophen or ibuprofen can help. Talk to your health care provider if your headaches do not go away or if they are getting worse.
What Type of Drug Interactions Can Happen?
Taking certain medicines for seizures such as carbamazepine (Tegretol, Carbatrol) or lamotrigine (Lamictal) with Xcopri may cause them to not work as well. Your health care provider may increase the dose of carbamazepine and lamotrigine if you are taking them with Xcopri.
Taking clobazam (Onfi) or phenytoin (Dilantin, Phenytek), which are medicines for seizures, or taking phenobarbital, which is a for seizures, anxiety, or trouble sleeping (insomnia), with Xcopri can increase your risk of developing side effects. Your health care provider may lower the dose of clobazam, phenobarbital, or phenytoin if you are taking them with Xcopri.
Taking Xcopri with certain medicines called CYP2B6 or CYP3A substrates can cause these medicines to not work as well. CYP2B6 substrates include ketamine, methadone, and propofol. CYP3A substrates include amlodipine and lovastatin. Your health care provider may increase the dose of these medicines if you are taking them with Xcopri.
Taking Xcopri with certain medicines called CYP2C19 substrates can increase your risk of developing side effects. These medicines include omeprazole and pantoprazole. Your health care provider may lower the dose of these medicines if you are taking them with Xcopri.
Taking Xcopri with birth control can cause birth control not to work as well. Your health care provider may counsel you about backup contraception options (condoms, spermicide).
Taking Xcopri can cause changes to your heart rhythm. Taking medicines that cause changes to your heart rhythm, such as mexiletine, can worsen these effects.
Xcopri may cause you to feel drowsy. Taking Xcorpri with alcohol or other medicines that make you feel drowsy can worsen this. Do not drink alcohol while taking Xcopri without first talking to your health care provider. Do not drive or do activities that require alertness or coordination if you feel drowsy.
Tell your health care provider about all the prescription and over-the-counter medicines, vitamins, and supplements that you take.
What Are Other Unique Considerations to Be Aware Of?
Xcopri is classified as a Schedule V controlled medicine, meaning the medicine can be abused or can lead to dependence, where your body may start to rely on the medicine. Keep Xcopri in a safe place. Selling or giving Xcopri to other people may harm them and is illegal.
Is There a Cost-Savings Program?
There is a free-trial offer available from the manufacturer that may allow you to pay as little as $0 on your first prescription of Xcopri. You can find out more by visiting www.xcopri.com/epilepsy-resources/#xcopri-trial-offer or by calling 866-756-2844.
