Capecitabine (also known as Xeloda) is a type of chemotherapy. You might have it as a treatment for a number of different types of cancer.
How capecitabine works
Capecitabine is a type of chemotherapy called an anti metabolite. The body changes capecitabine into a common chemotherapy drug called fluorouracil. It stops cells making and repairing DNA. Cancer cells need to make and repair DNA so they can grow and multiply.
How you have capecitabine
Capecitabine comes as a tablet that you swallow whole, with plenty of water. You take it twice a day, morning and evening. You might have two different strengths of tablets to make up the correct dose.
Take the tablets up to 30 minutes after a meal, with plenty of water.
Tell your doctor or pharmacist if you have difficulty swallowing.
Taking your tablets
Speak to your pharmacist if you have problems swallowing the tablets.
Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.
You should take the right dose, no more or less.
Talk to your specialist or advice line before you stop taking a cancer drug.
When you have capecitabine
You might have capecitabine as a course of several cycles of treatment. Each cycle is usually over 3 weeks.
For example, you may take capecitabine every day for 2 weeks. Then have a week with no treatment. You then start the next cycle. Or you may take capecitabine every day for a few months.
Your doctor will tell you:
- what dose of capecitabine you need to take
- when to take it
- how long to take it for
You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.
We haven't listed all the side effects. It is very unlikely that you will have all of these side effects, but you might have some of them at the same time.
How often and how severe the side effects are can vary from person to person. They also depend on what other treatment you are having. For example, your side effects could be worse if you are also having other drugs or radiotherapy.
When to contact your team
Your doctor or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:
- you have severe side effects
- your side effects aren’t getting any better
- your side effects are getting worse
Early treatment can help manage side effects better.
Common side effects
These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:
Tiredness and weakness (fatigue) during and after treatment
Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.
Loss of appetite
You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.
Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.
Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.
Diarrhoea can be severe.
Mouth sores and ulcers
Mouth sores and ulcers can be painful. Keep your mouth and teeth clean; drink plenty of fluids; avoid acidic foods such as oranges, lemons and grapefruits; chew gum to keep the mouth moist and tell your doctor or nurse if you have ulcers.
Feeling or being sick
Feeling or being sick can be severe. It can start a few hours after treatment and last for a few days. Anti-sickness injections and tablets can control it. Contact your doctor or nurse straight away if you’ve been sick more than once in a day.
Soreness, redness and peeling on palms and soles of feet
The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.
Moisturise your skin regularly. Your doctor or nurse will tell you what moisturiser to use.
Tummy (abdominal) pain
Tell your treatment team if you have this. They can check the cause and give you medicine to help.
Occasional side effects
These side effects happen in between 1 and 10 out of every 100 people (1 to 10%). You might have one or more of them. They include:
- low levels of white blood cells in your blood which can increase your risk of getting an infection
- low levels of red blood cells in your blood (anaemia) that can cause breathlessness and looking pale
- headaches and dizziness
- eye problems such as watery eyes and redness (conjunctivitis)
- hair loss that usually grows back once your chemotherapy treatment has finished
- skin and nail problems such as skin rashes, dry skin, itching and brittle nails
- liver changes that are usually very mild and unlikely to cause symptoms
- pain in your joints, arms, legs and back
- difficulty sleeping (insomnia)
- high temperature (fever)
- an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
Rare side effects
These side effects happen in fewer than 1 in 100 people (1%). You might have one or more of them. They include:
- a drop in the number of platelets that can cause bruising, bleeding gums or nosebleeds
- changes to how your heart works that can cause changes to your heart rhythm and swelling of your ankles
- skin sensitivity to sunlight
- numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons
- blood clots in the deep veins of your body
- a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
Coping with side effects
We have more information about side effects and tips on how to cope with them.
What else do I need to know?
Between 2 and 8 out of 100 people (2 to 8%) have low levels of an enzyme called DPD in their bodies. A lack of DPD can mean you’re more likely to have severe side effects from capecitabine or fluorouracil. It might take you a bit longer to recover from the chemotherapy. These side effects can rarely be life threatening.
Low DPD levels don’t cause symptoms so you won’t know if you have a deficiency. You should have a test before you start this treatment to check if you have a DPD deficiency.
Some people have severe side effects from capecitabine or fluorouracil even if they don't have low DPD levels. Contact your doctor or nurse if your side effects are severe.
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
This drug contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.
Contraception and pregnancy
This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
Loss of fertility
You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.
Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.
Don’t breastfeed during this treatment and for 2 weeks after your final treatment. This is because the drug may come through into your breast milk.
Treatment for other conditions
Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine (as an injection)
Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine.
If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray. This is for 2 weeks following their vaccination.
Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.
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