Cenobamate – DRESS Risk and Slow Titration — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersCenobamate – DRESS Risk and Slow TitrationSCE Neurology

A 55-year-old man with drug-resistant epilepsy is started on cenobamate as adjunctive therapy. What is the key safety concern during dose titration of cenobamate that requires slow uptitration?

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Correct answer: C — DRESS syndrome — slow titration over at least 11 weeks is required to minimise the risk

Explanation lettering: E = shown as A · A = shown as B · B = shown as C · C = shown as D · D = shown as E

Cenobamate is a novel dual-mechanism AED (sodium channel modulation and positive allosteric modulation of GABA-A receptors) that has shown significant efficacy in drug-resistant focal epilepsy. However, during clinical development, cases of DRESS syndrome were observed with rapid titration. Consequently, the SmPC mandates slow uptitration over at least 11 weeks (starting at 12.5 mg/day and increasing every 2 weeks) to minimise the risk. Patients must be counselled about the signs of DRESS (rash, fever, lymphadenopathy, organ involvement). A: Hepatotoxicity is not the primary concern. C: Renal failure is not a major risk. D/E: Not the primary safety concerns.

Reference: Cenobamate SmPC; EAN Epilepsy Treatment Guidelines