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Capecitabine

(kape-site-uh-bean)

Trade/other name(s): Xeloda

Why would this drug be used?

Capecitabine is used to treat breast, colon, or rectal cancer. It may also be used to treat other types of cancer.

How does this drug work?

Capecitabine belongs to a group of chemotherapy drugs known as anti-metabolites. It keeps cells from making DNA and RNA, which stops cancer cells from growing. Capecitabine is converted to the drug 5-fluorouracil (5-FU) in your body, letting more of the active drug get to the tumor.

Before taking this medicine

Tell your doctor…

  • If you are allergic to anything, including medicines, dyes, additives, or foods.
  • If you have any medical conditions such as kidney disease, liver disease (including hepatitis), diabetes, gout, or infections. These conditions may require that your medicine dose, regimen, or timing be changed.
  • If you have heart disease, congestive heart failure, or any other heart problem. This drug may damage the heart, which may be worse if you already have a heart problem.
  • If you have ever been told you have a dihydropyrimidine dehydrogenase (DPD) deficiency. DPD is an enzyme the body uses to process this drug. This inborn genetic abnormality can cause extreme side effects if you use 5-FU (even on your skin) or capecitabine. DPD deficiency can be present without symptoms, so you may not know you have it until you get one of these drugs or are tested for it.
  • If you are pregnant, trying to get pregnant, or if there is any chance of pregnancy. This drug may cause birth defects if either the male or female is taking it at the time of conception or during pregnancy. Check with your doctor about what kinds of birth control can be used with this medicine.
  • If you are breast-feeding. It is not known whether this drug passes into breast milk. If it does, it could harm the baby.
  • If you think you might want to have children in the future. Some drugs can cause sterility. Talk with your doctor about the possible risk with this drug and the options that may preserve your ability to have children.
  • About any other prescription or over-the-counter medicines you are taking, including vitamins and herbs. In fact, keeping a written list of each of these medicines (including the doses of each and when you take them) with you in case of emergency may help prevent complications if you get sick.

Interactions with other drugs

The drug leucovorin can cause severe diarrhea and damage to the intestine if taken with capecitabine.

Talk with your doctor if you are taking folic acid or multiple vitamins. This may affect the way capecitabine works.

Antacids may slightly raise the amount of capecitabine your body absorbs if they are taken within an hour or two of this drug. Tell your doctor if you take antacids.

If you are taking warfarin (Coumadin) this drug can interfere with the breakdown of warfarin and increase the risk of bleeding. Your doctor will need to check your blood more often during and for some time after treatment and may need to adjust your warfarin dose.

This drug can lower platelet counts, which increases the risk of bleeding. If your platelet count is low, drugs or supplements that interfere with blood clotting can raise the risk of bleeding further. These include:

  • Vitamin E
  • Aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and many others
  • Ticlopidine (Ticlid)
  • Clopidogrel (Plavix)
  • Rivaroxaban (Xarelto)
  • Apixaban (Eliquis)
  • Dabigatran (Pradaxa)
  • Fondaparinux (Arixtra)
  • Any type of heparin injections, such as enoxaparin (Lovenox), dalteparin (Fragmin), or tinzaparin (Innohep)

Note that many cold, flu, fever, and headache remedies contain aspirin or ibuprofen. Ask your pharmacist if you aren't sure what's in the medicines you take.

This drug can increase the amount of the anti-seizure drug phenytoin (Dilantin) in your body. Drug levels must be watched closely while taking capecitabine.

Check with your doctor, nurse, or pharmacist about other medicines, vitamins, herbs, and supplements, and whether alcohol can cause problems with this medicine.

Interactions with foods

Capecitabine must be taken with food to slow down its absorption into the body. If taken without food, it reaches higher levels in the body, which may cause worsened and more dangerous side effects.

Tell all the doctors, dentists, nurses, and pharmacists you visit that you are taking this drug.

How is this drug taken or given?

This medicine is taken once in the morning and once in the evening. Take the pills with a glass of water just after a meal (within 30 minutes). Try to take the pills at the same time each day. The pills are usually given for 14 days, then no pills for 7 days. This cycle is repeated every 3 weeks if you have no serious problems.

The dose depends upon your size, your blood counts, and whether you have serious side effects. If you have certain side effects, your doctor will probably stop medicine for a while and may restart the pills at a lower dose. This does not mean the medicine will not work as well, but people may need different doses.

Take this drug exactly as your doctor tells you to. Be sure you know how much of each type of pill you are supposed to take at each dose. If your dose changes, be sure to find out exactly how to take the right amount. If you do not understand the directions, ask your doctor or nurse can explain them to you.

Store the medicine in a closed container, and protect it from light. Keep it away from children and pets.

Precautions

Do not get any immunizations (vaccines), either during or after treatment with capecitabine without your doctor's OK. Capecitabine may affect your immune system. This could make vaccinations ineffective, or could even lead to serious infections if you get a live virus vaccine during or soon after treatment. Try to avoid contact with people who have recently received a live virus vaccine, such as the oral polio vaccine or smallpox vaccine. Check with your doctor about this.

Your doctor will likely test your blood throughout your treatment, looking for possible effects of the drug on blood counts (described below) or on other body organs. Based on the test results, you may be given medicines to help treat any effects. Your doctor may also need to reduce or delay your next dose of this drug, or even stop it completely. Keep all your appointments for lab tests and doctor visits.

Taking this drug with warfarin (Coumadin) increases the risk of serious bleeding (see “Interactions with other drugs” above).

This drug can lower your white blood cell count, especially in the weeks after the drug is given. This can increase your chance of getting an infection. Be sure to let your doctor or nurse know right away if you have any signs of infection, such as fever (100.5° or higher), chills, pain when passing urine, a new cough, or bringing up sputum.

This drug may lower your platelet count in the weeks after it is given, which can increase your risk of bleeding. Speak with your doctor before taking any drugs or supplements that might affect your body's ability to stop bleeding (see “Interactions with other drugs” above). Tell your doctor right away if you have unusual bruising, or bleeding such as nosebleeds, bleeding gums when you brush your teeth, or black, tarry stools.

This drug may lower your red blood cell count. If this occurs, it is usually a few months after starting treatment. A low red blood cell count (known as anemia) can cause shortness of breath, or make you to feel weak or tired all the time. Your doctor may give you medicines to help prevent or treat this condition, or you may need to get blood transfusions.

This drug can cause a condition known as hand-foot syndrome, in which a person may experience pain, numbness, tingling, reddening, or swelling in the hands or feet. If severe, the skin may blister and peel, and open sores may develop in these areas. Let your doctor know right away if you notice any of these symptoms.

This drug can rarely cause severe skin problems which can even be fatal. Let your doctor know if you develop a rash with blisters, skin peeling, or sores in your mouth, especially if it gets worse over time.

This drug can cause diarrhea, which is sometimes severe. Let your doctor know if you develop diarrhea with more than 4 loose bowel movements per day, have nighttime diarrhea, have bloody stools, or are unable to control your stools (have incontinence). Your doctor may need to stop this drug for a time to prevent serious problems.

Patients with problems eating and drinking, nausea, vomiting, and/or diarrhea from this drug can become dehydrated. If left untreated, this can lead to kidney failure. Let your doctor know if you are having any of these problems or if you have symptoms of dehydration, such as feeling weak, dizzy, or lightheaded. You may need treatment for these problems and dehydration before taking more capecitabine.

Patients taking this drug can develop high bilirubin levels and other abnormal blood tests that indicate possible liver problems. High bilirubin levels can lead to yellowing of the skin and the whites of the eyes and darkened urine. Your doctor will check your blood tests to see if this drug may be affecting the liver. If it is, the drug may need to be stopped for a time.

Men and women should avoid conceiving a child during and for a few months after treatment. Talk with your doctor about birth control.

Possible side effects

You will probably not have most of the following side effects, but if you have any talk to your doctor or nurse. They can help you understand the side effects and cope with them.

Common

  • Diarrhea, which is sometimes severe*
  • Nausea
  • Vomiting
  • Sores in mouth or on lips
  • Tiredness or weakness
  • Numbness, tingling, itching of hands or/and feet*
  • Skin redness, rash, dryness
  • Low red blood cell count (anemia) with increased risk of tiredness (fatigue)*
  • Skin irritation

Less common

  • Low white blood cell count with increased risk of infection*
  • Low platelet count with increased risk of bleeding*
  • Pain in the belly, back, or joints
  • Constipation
  • Poor appetite
  • Heartburn after eating
  • Fever
  • Feelings of pins and needles in hands and/or feet
  • Headache
  • Dizziness
  • Trouble sleeping
  • Cough or trouble breathing
  • Eye irritation
  • Skin color changes
  • Hair loss or thinning (including face and body hair)
  • Bleeding from the bowel
  • Abnormal blood tests which suggest that the drug is affecting the liver (Your doctor will discuss the importance of this finding, if any.)*

Rare

  • Dehydration, sometimes with kidney failure*
  • Depression
  • Bowel damage (necrotizing typhlitis)
  • Heart damage with swelling of ankles, chest pain, abnormal heartbeat
  • Hand-foot syndrome or severe skin problems*
  • Allergic reaction
  • Death due to bleeding, heart failure, heart attack, infection, skin problems, or other causes

*See "Precautions" section for more detailed information.

There are other side effects not listed above that can also occur in some patients. Tell your doctor or nurse if you develop these or any other problems.

FDA approval

Yes – first approved in 1998

Disclaimer: This information does not cover all possible uses, actions, precautions, side effects, or interactions. It is not intended as medical advice, and should not be relied upon as a substitute for talking with your doctor, who is familiar with your medical needs.


Last Medical Review: 02/01/2010
Last Revised: 10/28/2014