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AED Sedation – Driving — SCE Neurology MCQ

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HardEpilepsy & Seizure DisordersAED Sedation – DrivingSCE Neurology

During cenobamate titration, a patient taking stable phenytoin develops nystagmus, diplopia and gait ataxia without new structural disease. Which pharmacokinetic action is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Measure phenytoin concentrations and reduce phenytoin as clinically indicated while continuing cautious cenobamate titration

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

C is correct: cenobamate can increase phenytoin exposure substantially—reported AUC increase about 84%—so compatible toxicity should prompt concentration monitoring and phenytoin reduction. A gives the interaction in the wrong direction. B is unnecessarily absolute. D worsens neurotoxicity. E adds another drug whose exposure can also rise with cenobamate. The same clinical signs can be mistaken for seizure or cerebellar disease, so interaction review is essential.

Reference: Ontozry 12.5 mg tablets SmPC: https://www.medicines.org.uk/emc/product/14636/smpc