Capecitabine
Indications
Capecitabine is a cancer medicine taken by mouth. It is used for:
- Colon cancer after surgery, and advanced colon or rectal (colorectal) cancer, alone or with other medicines.
- Rectal cancer together with radiotherapy.
- Advanced breast cancer, alone or with Docetaxel.
- Advanced stomach and food pipe (oesophageal) cancer, together with other cancer medicines.
It is prescribed and monitored by a cancer specialist (oncologist).
How It Works
Capecitabine is a "prodrug", which means it is inactive when swallowed and is changed in the body into Fluorouracil, mostly inside tumour tissue. Fluorouracil stops cancer cells from making DNA, so they cannot grow and divide.
Dosage and Administration
Take exactly as prescribed. The dose is worked out from your body size (body surface area), kidney function and the other treatments you are having.
- Usually taken twice a day, about 12 hours apart, often for 14 days followed by a 7-day break (a 21-day cycle). With radiotherapy it may be taken every day without a break.
- Take within 30 minutes after a meal, swallowed whole with water.
- If you miss a dose, do not take an extra dose; take the next dose at the usual time.
- The doctor may lower or pause the dose if side effects occur.
Interactions
- Brivudine (an antiviral for shingles) must never be taken with capecitabine or within 4 weeks of it, as the combination can be fatal.
- Warfarin: bleeding risk rises; blood clotting tests (INR) need close checking.
- Phenytoin: its level can rise; levels may need checking.
- Folinic acid can increase both the effect and the side effects.
- Allopurinol may reduce its effect and is usually avoided.
Contraindications
- Allergy to capecitabine or Fluorouracil.
- Known complete lack of the enzyme DPD (dihydropyrimidine dehydrogenase), which breaks the medicine down.
- Severe kidney impairment.
- Treatment with Brivudine in the last 4 weeks.
- Severe low blood counts, severe liver problems, pregnancy and breastfeeding.
Side Effects
Common: diarrhoea, nausea, vomiting, mouth sores, tiredness, poor appetite, stomach pain, and hand-foot syndrome (redness, swelling, pain or peeling of the palms and soles). It can lower blood counts, which raises the risk of infection and bleeding.
Stop taking it and contact your doctor straight away, or get urgent medical help, if you have:
- Diarrhoea 4 or more extra times a day, or at night.
- Vomiting more than once in 24 hours.
- Fever of 38°C or more, chills or other signs of infection.
- Mouth sores so painful you cannot eat or drink.
- Painful swelling or blistering of the hands or feet.
- Chest pain, unusual bleeding or bruising, or yellow skin or eyes.
Pregnancy and Lactation
Capecitabine can harm an unborn baby. Women should use effective contraception during treatment and for 6 months after the last dose; men with a partner who could become pregnant should use contraception during treatment and for 3 months after. Do not breastfeed during treatment and for 2 weeks after the last dose.
Precautions and Warnings
- A test for DPD deficiency may be done before starting, as people with low DPD can have severe side effects.
- Kidney function, blood counts and liver tests are checked regularly.
- Extra care in older people and in those with heart disease or kidney or liver problems.
- Drink plenty of fluids if you have diarrhoea or vomiting to avoid dehydration.
Overdose
Overdose can cause severe nausea, vomiting, diarrhoea, mouth sores, bleeding and dangerously low blood counts. Go to the nearest hospital emergency department straight away and take the pack with you.
Therapeutic Class
Anticancer medicine; antimetabolite (fluoropyrimidine).
Storage
Store below 30°C in a dry place, away from light and out of the reach of children. Keep in the original pack.
Prepared by the Oshud Alo team from standard drug references. For information only; always follow your doctor's advice.
All brands of Capecitabine