Side effects of capecitabine (Xeloda)
Find out about the side effects of the chemotherapy drug capecitabine for bile duct cancer.
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.
Common side effects
Each of these effects happens in more than 1 in 10 people (10%). You might have one or more of them.
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.
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.
Let your doctor or nurse know if you're eating much less than usual.
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.
Up to half of the people having this treatment have diarrhoea. It can be severe.
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.
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. Tell your doctor or nurse if you feel sick. You might need to try different anti-sickness medicines to find one that works.
Contact your doctor or nurse straight away if you’ve been sick more than once in a day.
Tips
- Avoid eating or preparing food when you feel sick.
- Avoid fried foods, fatty foods or foods with a strong smell.
- Drink plenty of liquid to stop you from getting dehydrated.
- Relaxation techniques help control sickness for some people.
- Ginger can help – try it as crystallised stem ginger, ginger tea or ginger ale.
- Fizzy drinks help some people when they are feeling sick.
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.
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.
Tell your doctor or nurse if you have this.
Occasional side effects
Each of these effects happens in more than 1 in 100 people (1%). You might have one or more of them.
Signs of an infection include headaches, aching muscles, a cough, a sore throat, pain passing urine, or feeling cold and shivery.
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.
This side effect is more common when you have capecitabine with other chemotherapy drugs.
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.
This side effect is more common when you have capecitabine with other chemotherapy drugs.
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.
Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.
You might have eye problems, including watery eyes and redness (conjunctivitis).
Let your doctor or nurse know if you have any problems with your eyes. They can give you eye drops to help.
You might have some hair loss. Capecitabine is unlikely to cause all your hair to fall out.
Hair usually begins falling out gradually about 3 to 4 weeks after treatment starts.
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.
Skin problems include a rash, dry skin and itching.
During treatment, your nails may:
- become brittle and dry
- change colour
- develop ridges
Tips
- Check with your doctor whether you need to do anything to protect your skin.
- Tell your doctor if you have any rashes or itching.
- Don't go swimming if you have a rash, the chlorine can make it worse.
- Use unperfumed moisturising cream if your skin gets dry and itchy, check with your doctor first if you have had radiotherapy to the area.
- Wear a high factor sun block if you are going out in the sun.
- Use nail oils or moisturising creams if your nails are flaking.
The changes are usually very mild and unlikely to cause symptoms. They will almost certainly go back to normal when treatment is finished.
You have regular blood tests throughout your treatment so your doctor can check this.
You may have some pain in your joints, arms and legs, or back. Tell your doctor or nurse if you have any pain. They can give medicine to help.
Tell your doctor or nurse if you’re feeling depressed. They can arrange for you to talk to someone and give treatment if necessary.
Talk to your doctor or nurse if you’re having problems sleeping. It can help to change a few things about when and where you sleep.
Tips
- Go to bed and get up at the same time each day.
- Make sure the temperature is right.
- Spend time relaxing before you go to bed - have a bath, read or listen to music.
- Do some light exercise each day to help tire yourself out.
- Avoid caffeine (coffee, tea, chocolate and cola drinks) after early afternoon.
- Have a light snack before you go to bed to stop hunger waking you up.
Rare side effects
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.
You'll 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.
This side effect is more common when you have capecitabine with other chemotherapy drugs.
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).
Don't use sunbeds or sit in the sun. Cover up or use sunscreen if you go out in the sun.
Remember to put sun cream on your head or wear a hat if you have lost hair there.
Numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons. This starts within a few days or weeks and can last for a few months. Rarely, the numbness may be permanent.
Tips
- 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 at least a couple of times a day.
- Take care when cutting your nails.
Blood clots can develop in the deep veins of your body. This is called deep vein thrombosis (DVT).
A DVT usually develops in the thigh or lower leg. A clot can block the normal flow of blood through the veins.
A blood clot can be very serious if it starts to move through your body. It can cause a blockage in your heart or lungs, although this isn’t common.
Treatment is with drugs to thin the blood.
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.
