Capecitabine (Oral Route)

It interferes with cancer cell growth and slows down the spread of cancer cells to other parts of the body.

Overview:

Capecitabine (brand name Xeloda) is a prescription drug used with other drugs or alone to treat certain stomach, colon, breast, and rectal cancers. It’s made by Genentech and belongs to a category of drugs known as antimetabolites.

  • Capecitabine works by stopping or slowing down the growth of cancer cells and decreasing tumor size.
  • Capecitabine is available as a tablet and is normally taken twice a day, within half an hour after finishing your meal.
  • Capecitabine comes under the Xeloda brand name.
  • Swallow Capecitabine tablets whole. Don’t crush or cut them in half.
  • Common Capecitabine side effects include vomiting, nausea, diarrhea, as well as mouth sores.

Conditions treated:

• Colon/rectal cancer that has spread to another body part
• Metastatic breast carcinoma
• Ovarian cancer
• Stomach cancer
• Lymph node-based colon cancer

Type of medicine:

• Antineoplastic agent/Cancer medicine

Side effects:

Here are the most common Capecitabine side effects. But all the rare side effects unlikely to trouble you are not included.

You can experience some of the effects discussed, but you’re highly unlikely to experience all of them. And if you’re also taking other chemotherapy medications, you may experience other side effects not discussed here. Always report to your doctor all the effects you have.

Your doctor may prescribe medications to help manage certain side effects. It’s especially vital to take Capecitabine just as your pharmacist/nurse has instructed. This means it’ll more likely work well for you.

Your healthcare giver will show you how to control your side effects. Once you complete your treatment, your side effects will begin to improve.

Serious and potentially fatal effects

Sometimes cancer medications can bring about very serious effects, which are rarely life-threatening. Your cancer caregiver can spell out the risk of these effects to you.

Risk of infection—Capecitabine can lower your white blood cell numbers in your blood. Therefore, you’re more likely to develop an infection. When you have fewer white blood cells, it is called neutropenia.

Contact your hospital right away if:

Your temperature rises above 37.5 degrees Celsius or above 38 degrees Celsius, based on the advice provided by your chemotherapy caregivers.

You feel unwell suddenly, even with a regular temperature.

You have signs and symptoms of illness, such as shakiness, diarrhea, cough, sore throat, or urge to urinate a lot.

Your white blood cell levels usually rise steadily and normalize before your next round of treatment. You’ll need a blood exam before further chemotherapy. If you still have fewer white blood cells, your doctor can briefly delay your treatment. Sometimes your doctor can decrease your dose of treatment.

Anemia (fewer red blood cells)—Xeloda can decrease your red blood cells. Red blood cells transport oxygen around your body. If you have fewer red blood cells, you may be breathless and tired. If you feel this way, tell your nurse or doctor. If you’re seriously anemic, you may require a drip to receive additional red blood cells (i.e. a blood transfusion).

Bruising and bleeding—Capecitabine can lower your blood platelet levels. Platelets are simply cells that help with blood clotting. If you experience any unexplained bruising or bleeding, notify your doctor. This can include nosebleeds, rashes or blood spots on the skin, and bleeding gums. Some people may require a drip to get extra platelets.

Feeling sick—this can occur for a few days after your surgery. Your physician will prescribe antiemetic (anti-sickness) medications to help control or prevent sickness. Take the medications exactly as your pharmacist or nurse directed. Preventing a sickness is easier than treating it after it’s begun.

If you’re vomiting or still feel sick, contact your hospital right away. They can provide advice and switch the anti-sickness medication to one that suits you best.

Diarrhea—diarrhea can be severe sometimes. Your doctor may prescribe anti-diarrhea medicines to manage it. He/she may give you these medicines before you check out of the hospital. It’s vital to take the medicines exactly as ordered. If you have diarrhea, please drink at least 2 liters of fluids a day.

If you have diarrhea more than four to six times a day, or at night, contact your hospital right away. Your doctor may order you to stop using Capecitabine. When the symptom improves, you’ll be told when you can start using Capecitabine again. Sometimes your dose can be reduced.

Constipation –Xeloda can cause constipation and result in stomach pain. Taking at least 2 liters of fluids daily may help. Eat more fiber-rich foods, such as wholemeal bread, vegetables, and fruit. Also, try to get some gentle exercise on a regular basis.

Loss of appetite—during your treatment with Capecitabine, you can lose your appetite. Try to have small meals frequently. If you eat less for a couple of days, don’t worry. If your appetite hasn’t improved after a number of days, let your dietician or doctor know. They can advise you on how to get more protein and calories in your diet. You may be given meal replacement drinks or food supplements to try. You can get them from your pharmacist or your doctor may prescribe them.

Sore throat—your mouth can get sore and you can develop ulcers. Therefore, you may be more likely to develop a mouth infection. Clean your teeth/dentures after meals, in the morning, and at night. Use a children’s or soft-bristled toothbrush. You may be asked to regularly rinse your mouth or use mouthwashes. Make sure to follow all the advice given and take lots of fluids.

If you’ve got any mouth problems, let your nurse and doctor know. They can prescribe drugs to treat or prevent mouth infections and decrease any soreness.

Redness and soreness of palms and soles—this is known as hand-foot or palmar-plantar syndrome. It improves when you finish your treatment. Your healthcare giver can give you medical advice and recommend creams to ease the symptoms. It’s advisable to keep your feet and hands cool and avoid tight-fitting gloves, socks, and shoes.

Tiredness—feeling extremely exhausted is a common Xeloda side effect. It’s usually worse near the end of Xeloda treatment and for a few weeks after treatment. Try to engage in physical activity and have a break for as long you can. It’s advisable to combine this with some mild form of exercise, like short walks. Don’t operate machines or drive if you feel drowsy.

Less common Capecitabine side effects

Hair loss—your hair can thin but it’s unlikely that you’ll lose all of it from your head. Hair thinning usually begins after your first/second thermotherapy cycle. It’s nearly always short-lived and your hair grows back once you finish treatment. Your nurse can advise you on how to cope with hair loss.

Eye problems—your eyes can feel sore and become watery. Your doctor may prescribe eye drops for these symptoms. If your eyes become inflamed and red (a sign of conjunctivitis), notify your doctor. In that case, you may require antibiotic eye drops.

Headaches—Xeloda may bring about headaches. If this occurs, notify your nurse or doctor. You may be given painkillers.

Dizziness—Sometimes Xeloda may bring about dizziness. Notify your doctor as soon as you feel dizzy. Do not use machines or drive if you experience these effects.

Tummy pain—you may feel discomfort or pain in your abdomen (tummy), have wind or indigestion, or feel bloated. Your doctor may prescribe medications to ease these symptoms. Tell him/her if the pain gets worse or doesn’t improve.

Changes in heart function—Xeloda can affect how your heart functions. You may need tests to find out how your heart works before, during and occasionally after treatment. However, it’s still possible that your heart will be affected despite the tests being normal. This can very rarely result in a heart attack or heart failure. The chances of this occurring is very slim (less than 1 percent), but it’s vital to be aware of it. Notify your doctor promptly if you develop any of the symptoms below at any time while you’re being treated.

• Breathlessness
• Tightness or pain in your chest
• Change in your heartbeat

If you have any of the above symptoms, stop using Xeloda tablets until you speak to your doctor.

It’s important to immediately inform your doctor if you have very serious side effects or feel ill. This includes any side effects not mentioned above.

Dosage:

Follow the instructions found on the prescription label. Don’t take Xeloda for longer than prescribed, or in smaller or larger quantities.

During the several weeks of taking Xeloda, take this drug twice daily, one tablet in the morning and another at night, unless you’re told otherwise by your doctor. You can also be prescribed other drugs for a combination cancer therapy.

You should take Capecitabine with meals or within half an hour after having a meal.

Take Capecitabine with eight ounces of water (1 full glass of water). Swallow tablets whole.

Capecitabine is normally taken for 2 weeks followed by 7 days of rest (no taking of drugs), for a 3-week cycle. Your healthcare provider will let you know the number of treatment cycles you will need.

You may need medical tests regularly to ensure that Capecitabine isn’t causing you harmful effects. Based on your test results, your cancer therapies may be delayed. Capecitabine can have lasting effects on the body. You also may need medical tests briefly after the end of your treatment.

You must be under a doctor’s care while you’re using Xeloda.

Symptoms of a Capecitabine overdose can include nausea, vomiting, diarrhea, stomach pain, black/tarry stools, red urine, unusual bleeding/bruising, unusual weakness/tiredness, sore throat, fever, chills, or other symptoms of infection.

If you think there’s an overdose, call your emergency room or poison control agency right away at 1-800-222-1222.

Interactions:

Xeloda may interact with other herbs, vitamins, or drugs you might be using. That’s why you should let your doctor manage all your drugs carefully. For more information about how Xeloda may interact with other products you’re taking, speak to your pharmacist/doctor.

You can lower your risk of medication interactions by letting all your prescriptions be filled at one pharmacy. This way, your pharmacist can test for potential drug interactions.

Medications that may interact with Capecitabine

Blood thinner dugs (e.g. Warfarin)—Xeloda may interact with blood-thinning medications like Warfarin and make blood take a bit longer to clot. This may result in severe bleeding and even cause death.

Seizure drugs (e.g. Phenytoin)—Xeloda can increase Phenytoin levels in the body. This can result in more side effects. While you’re using Xeloda, your doctor may need to decrease your Phenytoin dose.

Drugs that treat Methotrexate overdose (e.g. Leucovorin)—taking these medications together with Xeloda can increase your chances of side effects, including dehydration and diarrhea. At times this can be very serious and even deadly.

Other drugs:

  • Anticoagulants
  • Angiotensin 2 receptor blockers
  • NSAIDs
  • Losartan
  • Irbesartan
  • Tamoxifen
  • Alkylating agents
  • Cyclophosphamide
  • Statins
  • Anti-estrogens
  • Diclofenac
  • Meloxicam
  • Celecoxib
  • Ibuprofen
  • Lornoxicam
  • Naproxen
  • Fluvastatin
  • Sulfonylurea
  • Glipizide
  • Glimepriride
  • Glibenclamide
  • Tolbutamide

Your doctor should monitor you closely if you use these drugs. Using them together with Xeloda may increase your chances of side effects.

This list of Xeloda interactions is not comprehensive. Xeloda can interact with other medications, including herbs, vitamin supplements, over-the-counter, and prescription medications. Not all potential interactions are listed above.

Warnings:

Capecitabine may cause dizziness and fatigue. You should be cautious when doing potentially risky activities, including operating machinery or driving, until you understand how Capecitabine affects you and you’re sure you can do these activities safely.

Chemotherapy medications including Capecitabine can lower your blood cell count. Fewer white blood cells can increase your vulnerability to illnesses; having fewer red blood cells can cause anemia and having fewer platelets can cause blood clotting issues. Therefore, you’ll need blood tests regularly to check your blood platelet levels while you’re receiving treatment with Capecitabine. Notify your doctor right away if you have one of these symptoms during treatment as they can indicate issues with blood cells: sore throat or mouth, purple spots, unexplained bruising/bleeding, fever, mouth ulcers, or other infections signs, or suddenly feeling breathless, tired, or generally unwell.

Side effects from Capecitabine can become very serious, so it’s vital that you always call your doctor promptly if you begin to experience any side effect. Your doctor may order you to lower your dose and/or stop taking Capecitabine temporarily as this may help stop a side effect getting worse. Stop taking Capecitabine right away and call your healthcare provider if you get any of these symptoms:

  • You have more than four bowel movements compared with your usual daily bowel movements, or any diarrhea at night
  • You throw up more than once within 24 hours
  • You lose appetite, and eat much less food than usual each day
  • You have redness, pain, sores, or swelling in your throat and/or mouth
  • You have swelling, redness, pain, or tingling of feet and/or hands
  • Your temperature is 38 degrees Celsius or above or you have other symptoms of infection
  • You have chest pain, especially during exercise

This medication may harm an unborn child, and therefore you should make use of effective contraception to prevent pregnancy or fathering a baby during treatment. Be sure to continue using contraception for several months after you are done with Capecitabine treatment. Please talk to your physician about this. If you’re a woman, consult your doctor promptly if you conceive during treatment.

This medicine may affect your ability to father a child or get pregnant. It is vital to talk about fertility with your physician before commencing treatment.

Capecitabine should be used cautiously by: people above the age of 60, people with decreased kidney or liver function, people with diseases affecting the nervous system or brain, people who have had heart diseases like irregular heartbeats (arrhythmias) or angina, people with diarrhea, people with diabetes mellitus, and people with issues in electrolyte levels in their blood (especially calcium).

Capecitabine must not be used by: people with allergies to fluorouracil, people who’ve had severe and unusual reactions to fluoropyrimidine treatment like fluorouracil, people with very few platelets in blood (thrombocytopenia), people with very few white blood cells (neutropenia or leucopenia), people with severely weakened kidney function, people with severely weakened liver function, pregnant women, breastfeeding women, people with rare hereditary galactose intolerance problems ( glucose-galactose malabsorption, or Lapp lactase deficiency)

Others who shouldn’t use Capecitabine include children and teenagers younger than 18, people who are allergic to Capecitabine or one of its ingredients (please tell any of your healthcare givers if you’ve previously suffered such an allergy), people who’ve been treated with sorivudine or brivudine for herpes zoster (shingles or chickenpox) in the past four weeks, and people who lack a body enzyme known as DPD (dihydropyrimidine dehydrogenase). DPD deficiency is an uncommon genetic condition that is not normally associated with medical conditions unless you take certain medications. If you’ve got an unusual DPD deficiency and use Capecitabine, you can experience very serious side effects.

Tell your physician if you use a blood thinner like Coumadin (Warfarin). This is vitally important as Capecitabine may worsen the effect of blood thinners. If you’re taking Capecitabine and blood thinners, your doctor should check how quick your blood clots more often and adjust your blood thinner dose if necessary.

If you think you’ve had an allergy to this medication, stop taking it right away and let your pharmacist and doctor know immediately.

Drink at least 2-3 quarts of liquid every day, unless your doctor instructs you otherwise.

You could be susceptible to infection, so avoid people with colds and crowds, and immediately tell your healthcare provider if you notice fever or other symptoms of infection.

To help prevent or treat mouth sores, make use of a soft toothbrush. Rinse thrice a day with a teaspoon of salt dissolved in a glass of water and/or a teaspoon full of baking soda.

Avoid activities or sports that might lead to injury.

To minimize bleeding, make use of soft a toothbrush and an electric razor.

To relieve nausea, take nausea medicines as instructed by your healthcare provider, and have small meals frequently.

To reduce diarrhea, eat foods that can help with that. You should also take the anti-diarrhea medications prescribed by your doctor.

In general, you should minimize your intake of alcoholic drinks or avoid them altogether. Be sure to talk about this with your healthcare professional.

If you experience Capecitabine side effects or symptoms, make sure to talk about them with all your healthcare professionals. They may prescribe medicines and/or provide recommendations that are effective for dealing with such problems.

Storage:

  • Keep Capecitabine in its original container, tightly sealed, and beyond the reach of kids.
  • Keep Capecitabine at room temperature.
  • Keep Capecitabine away from too much moisture (not in your bathroom) and heat.
  • Throw away any unused medication, one that’s no longer needed, or outdated.
  • Discuss proper disposal of Capecitabine with your pharmacist.

Summary:

Capecitabine is in the group of drugs known as antineoplastics (cancer medications). It helps stop cancer cells from growing, and the cells are eventually killed by the body. As this medication may also affect the growth of regular cells, other side effects can also occur. Some may be potentially serious and you must report them to your doctor.

This medication is only available with a medical doctor’s prescription.

Don’t use Capecitabine without letting your doctor know if you’re breastfeeding a child or you’re pregnant. Use effective contraception while you’re using Capecitabine, no matter your gender. If a pregnancy happens during treatment, notify your doctor.

You should not use Capecitabine if you’re allergic to it or to Adrucil (fluorouracil), or you have very serious kidney failure or a metabolic medical condition known as DPD deficiency (dihydropyrimidine dehydrogenase deficiency).

Before you use Capecitabine, let your healthcare professional know if you have kidney disease or liver disease, or have had artery disease before, or if you’re also using folic acid (present in many mineral and vitamin supplements), a blood thinner such as Coumadin (Warfarin), Phenytoin (Dilantin), or Leucovorin (Wellcovorin).

Capecitabine can leave lasting effects on the body. You may require medical tests on a regular basis while you’re taking Capecitabine and for a brief period after the end of your treatment.

Capecitabine may affect your fertility (i.e. your ability to father a child or get pregnant). If you’re concerned about this, be sure to discuss it with your doctor before you start receiving treatment.

Your doctor will suggest that you don’t father a child or become pregnant during your treatment. This is because Capecitabine can put an unborn baby at risk. It is very important to use efficient birth control methods during chemotherapy and for several months after that. You can discuss this with your nurse or doctor.

Some medicines may affect chemotherapy or harm you when you’re receiving chemotherapy. This can include medicines you buy in a pharmacy or shop. Capecitabine can affect how drugs like Warfarin (Coumadin) work. Capecitabine side effects may increase with the use of folinic acid. Tell your nurse or doctor about any drugs you’re taking now, like over-the-counter drugs, prescription drugs, herbal drugs, and complementary treatments.

Call your physician straight away if you experience any of the following serious Capecitabine side effects: severe diarrhea or vomiting, flu or fever symptoms, redness or pain in your feet or hands, yellowing of your eyes or skin (jaundice), fainting, chest pain, or sudden weakness or numbness.