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Side effects of oxaliplatin and capecitabine (XELOX)

Find out about the side effects of the chemotherapy combination XELOX.

Tell your doctor or nurse if you have any side effects so they can help you manage them. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Contact your doctor or nurse immediately if any of your side effects get severe or if you have signs of infection, including a temperature above 38C.

The side effects may be different if you are having XELOX with other cancer treatments.

Common side effects

Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.

Numbness or tingling in fingers and toes can happen in most people who have a combination of oxaliplatin and capecitaine. This is due to the effect of these drugs on the nerves. The medical name for this is peripheral neuropathy.

This starts within a few days or a few weeks after treatment. It can make it difficult to do fiddly things such as doing up buttons. It might be triggered and get worse with cold temperatures: for example, cold air, cold drinks, or touching anything cold.

It's important to tell your doctor or nurse if you have any of these symptoms. They might lower the dose of oxaliplatin or stop the drug if necessary. It might be possible to re start treatment if symptoms get better.

These symptoms  usually go away altogether a few months after your treatment is finished. Unfortunately, some people have this side effect for longer and in some people it could be permanent.

Tips
  • Avoid cold when you can, including cold drinks and cold food, if you know this makes it worse.
  • Wrap up warm in the cold weather.
  • Keep your hands and feet warm.
  • Wear well fitting, protective shoes.
  • Take care when using hot water as you may not be able to feel how hot it is and could burn yourself.
  • Use oven gloves when cooking and protective gloves when gardening.
  • Moisturise your skin.

Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.

Contact your treatment centre straight away if you have any of these signs or if your temperature goes above 38C. Severe infections can be life threatening.

Chemotherapy reduces the number of white blood cells in the blood. This increases your risk of infections. White blood cells help fight infections.

When the level is very low it is called neutropenia (pronounced new-troh-pee-nee-ah).

You have antibiotics if you develop an infection. You might have them as tablets or as injections into the bloodstream (intravenously). To have them into your bloodstream you need to go into hospital.

Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away. 

You might feel very tired during your treatment. It might take 6 months to a year for your energy levels to get back to normal after the treatment ends. A low red blood cell count will also make you feel tired.

You can do things to help yourself, including some gentle exercise. It’s important not to push yourself too hard. Try to eat a well balanced diet.

Talk to your doctor or nurse if you are finding the tiredness difficult to manage.

Tiredness and weakness affects 6 out of 10 people (60%) during and after treatment. 

You might feel sick or be sick. Anti sickness injections and tablets can control it. Tell your doctor or nurse if you feel sick. You might need to try different anti sickness medicines to find one that works.

Tips 

  • Avoid eating or preparing food when you feel sick.
  • Avoid hot fried foods, fatty foods or foods with a strong smell.
  • Eat several small meals and snacks each day.
  • Relaxation techniques help control sickness for some people.
  • Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
  • Try fizzy drinks.
  • Sip high calorie drinks if you can’t eat.

This affects about 8 out of 10 people (80%). 

Diarrhoea occurs in around 1 in 2 people (50%) having this treatment and can be quite severe. 

Tell your doctor or nurse if you have diarrhoea. They can prescribe medicine to help you. 

Drink at least 2.5 litres of fluid a day. This helps to keep you hydrated.

Ask your nurse about soothing creams to apply around your back passage (rectum). The skin in that area can get very sore and even break if you have severe diarrhoea.

Contact your doctor or nurse immediately if you have diarrhoea 4 or more times a day, or any diarrhoea at night.

Your mouth might become sore about 5 to 10 days after you start treatment. It usually clears up gradually 3 to 4 weeks after your treatment ends.

Your doctor or nurse can give you mouthwashes to help prevent infection. You have to use these regularly to get the most protection.

Tell your doctor or nurse straight away if your mouth is really sore. They can help to reduce the discomfort. Some people need strong painkillers to help control mouth pain so they can eat and drink.

Tips

  • Clean your mouth and teeth gently every morning and evening and after each meal.
  • Use mouthwashes as advised by your doctor or nurse. Let them know if the mouthwash stings. They can tell you to stop using it or dilute it with water.
  • Use dental floss daily but be gentle so that you don't harm your gums, and don't floss if you have very low platelets.
  • Avoid neat spirits, tobacco, hot spices, garlic, onion, vinegar and salty food.
  • Moisten meals with gravies and sauces to make swallowing easier.
  • Avoid acidic fruits such as oranges, grapefruit or lemons.

A sore mouth occurs in up to 4 out of 10 people (40%). 

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can all put you off food and drinks.

Tips

  • Eating several small meals and snacks throughout the day can be easier to manage.
  • Ask your doctor or nurse to recommend high calorie drinks to sip between treatments, if you are worried about losing weight.
  • You can make up calories between treatments for the days when you really don’t feel like eating.
  • Drink plenty of fluids even if you can't eat.
  • Don't fill your stomach with a large amount of liquid before eating.
  • Try to eat high calorie foods to keep your weight up.

Loss of appetite affects 3 out of 10 people (30%). 

The skin on your hands and feet can become sore, red, and peel. You might also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Tell your doctor or nurse straight away if you have pain, swelling, redness or tingling of your hands or feet.

Tips

  • Take medicines that your doctor or nurse can prescribe.
  • Keep your hands and feet cool.
  • Avoid very hot water.
  • Don’t wear tight fitting gloves or socks.
  • Moisturise your skin with non perfumed creams.

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking.

Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Constipation affects 2 out of 10 people (20%). 

Occasional side effects

Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.

You could lose all your hair. This includes your eyelashes, eyebrows, underarm, leg and sometimes pubic hair. It usually starts gradually within 2 to 3 weeks after treatment begins.

Your hair will grow back once your chemotherapy treatment has finished. This can take several months and your hair is likely to be softer. It can also grow back a different colour or be curlier than before.

Tips

  • Ask about getting a wig before you start treatment so you can match the colour and texture of your real hair.
  • You could choose a wig for a whole new look.
  • Think about having your hair cut short before your treatment starts.
  • Some people shave their hair off completely so they don't have to cope with their hair falling out.
  • Wear a hairnet at night so you won't wake up with hair all over your pillow.

Let your doctor or nurse know if you have headaches. They can give you painkillers. 

Don’t drive or operate heavy machinery if you feel dizzy.

Watery eyes is also called excessive tearing or epiphora (pronounced ep-if-or-ah). It may be due to a blockage in the drainage system of the eye, caused by swelling of the nearby tissues. Or your eyes may make too many tears.

Tell your doctor or nurse if this is a problem. They can prescribe medicines to help reduce swelling.

Some irritants can make the watering worse. These can include dust, pollen or animal hairs. Try to avoid them or wear protective goggles.

Your eyes may be sore because the drugs cause a reaction on the inside of your eyelids. Or you may not be making enough tears. Your eyes can feel sore and gritty and might be red.

Tell your doctor or nurse if you have dry eyes. They can prescribe eye drops, ointments or artificial tears for you.

Warm compresses can help your eye to drain if you have an infection.

Tell your doctor or nurse if you have this.

You might have high levels of bilirubin in your blood. You will have regular blood tests to check the bilirubin levels. 

Kidney changes occur in about 3 out of every 100 people (3%) having oxaliplatin. This is usually mild but you will have regular blood tests to check how well your kidneys are working.

This can be triggered by cold air in the first 5 days after having oxaliplatin. This usually clears up on its own.

Tell your doctor or nurse if you have this and avoid cold drinks or ice cubes for the first few days after treatment.

Women might stop having periods (amenorrhoea) but this may be temporary.

Rare side effects

Each of these effects happens in fewer than 1 in 100 people (1%). You might have one or more of them.

You might notice a ringing sound in your ears (tinnitus). This often gets better on its own once the treatment ends.

This affects about 1 in 100 people (1%). 

Heart problems include changes to how your heart works. This can cause changes to your heart rhythm and your ankles can swell.

Tell your doctor or nurse straight away if you have any chest pain.

Your doctor might ask you to have tests to check your heart, such as an electrocardiogram (ECG).

An allergic reaction can happen during or shortly after your treatment. 

A mild allergic reaction causes a rash, itching or a red face.

Some people can have a more severe reaction. You might have steroids and other medicine before your treatment to try to stop this happening. Let your nurse or doctor know straight away if you have:

  • a sudden skin rash
  • itching
  • breathlessness
  • swelling of the lips, face or throat

Your chemotherapy nurse will keep a close eye on you and give treatment straight away if this happens.

About XELOX

More information about this treatment

We haven't listed all the very rare side effects of this treatment. For further information see the electronic Medicines Compendium (eMC) website.

You can report any side effect you have that isn’t listed here to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help

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