Cenobamate and pregnancy: A-single level 4 epilepsy center experience

Data on Cenobamate (CNB) use in females of childbearing age with epilepsy (FCAWE) and during pregnancy is limited. We report four patients who became pregnant on CNB and its pharmacokinetic profile during pregnancy.

Single-center retrospective chart review of FCAWE receiving CNB between 2020 and 2024. Data on contraceptive use, pregnancy outcomes, and medication levels were analyzed.

147 out of 215 adult female patients received CNB were FCAWE. Thirty-three patients had documented use of contraceptive methods. Four unintended pregnancies occurred. Contraceptive methods included condoms (n = 1), hormonal contraceptive (n = 2), and no contraception (n = 1). One had a live early-term birth, two had elective terminations due to medical comorbidities, and one had spontaneous miscarriage. The child born had no reported congenital malformations or developmental delays up to 5 months of age. One patient had ASM levels measured throughout pregnancy and post-partum period, displaying a trend towards decreased concentration-to-dose ratio (CDR) during pregnancy compared to baseline and similar levels in the one-month post-partum period.

While our report remains anecdotal and preliminary given the very small sample size, we underscore the importance of pre-conceptual counseling in FCAWE to prevent unintended pregnancies and undesired outcomes, particularly when using ASM with limited data regarding teratogenicity. We also shed light on drug level monitoring during pregnancy.