Capecitabine

What Is Capecitabine?

Capecitabine is a prescription chemotherapy medicine that belongs to a drug class called antimetabolites. More specifically, it is a fluoropyrimidine. It is a “prodrug,” which means the body converts it in steps into fluorouracil (5-FU), the active anti-cancer medicine. It is taken by mouth and is sold under the brand name Xeloda. Generic versions are also available.

Approved Uses

In the United States, capecitabine is FDA-approved to treat certain cancers, often alone or together with other medicines, including:

• Colon cancer: after surgery for certain stages (adjuvant treatment)
• Colorectal cancer: that has spread to other parts of the body
• Breast cancer: that has spread (metastatic), alone or with docetaxel, in certain situations
• Gastric (stomach), esophageal, and gastroesophageal junction cancers: in certain treatment plans
• Pancreatic cancer: in certain treatment settings

The exact approved use depends on the cancer type, its stage, and previous treatments. Your specialist will explain how it applies to you.

Other Prescribed Uses

Specialists sometimes prescribe capecitabine for other cancers that are not listed on the FDA label. These decisions are individual and are made by an experienced specialist. This guide does not recommend use for any condition that is not FDA-approved.

Available Formulations and Strengths

• Oral tablets (film-coated): Capecitabine 500mg

There is no approved cream, injection, or liquid form of capecitabine in the United States.

What Is the Recommended Dosage of Capecitabine?

There is no single dose that fits everyone. Your specialist decides the dose and schedule based on:

• The type and stage of cancer
• The treatment plan, including which other medicines are given with it
• Body size (body surface area)
• Kidney function: people with reduced kidney function often need lower doses
• Liver function and blood counts
• Genetic testing results. Some people have low activity of an enzyme called DPD (made by the DPYD gene), which can cause severe side effects. Testing may be recommended before treatment.
• Side effects. Doses are often lowered or paused if side effects occur.

Available Dosage Forms

Capecitabine comes only as a tablet. It is usually taken twice a day, about 12 hours apart, on a schedule in repeating cycles. A common pattern is a period of daily dosing followed by a rest period, but schedules vary. Swallow tablets whole with water, within about 30 minutes after a meal, unless your specialist gives different directions.

Follow Your Specialist’s Instructions

Doses may be changed based on lab results and side effects. Take capecitabine exactly as prescribed. Do not change the dose, skip doses, or stop the medicine on your own. Do not crush, chew, or cut tablets unless you are told to.

How Capecitabine Works

Capecitabine is designed to work in steps. After you swallow it, the body changes it in the liver and then in tissues, including many tumors, into fluorouracil. Fluorouracil blocks the building of DNA in fast-growing cells, which slows or stops their growth. Healthy fast-growing cells, such as those in the mouth, gut, skin, hair, and bone marrow, can also be affected, which explains many side effects.

Capecitabine is used to treat or control certain cancers. It does not work the same way for everyone, and it does not guarantee a cure. It is often part of a larger plan that may include surgery, radiation, or other medicines.

Is a Prescription Required to Buy Capecitabine Online?

Yes. Capecitabine is a prescription-only medicine. It should be started and monitored by a licensed medical specialist, such as:

• A medical oncologist
• A gastrointestinal, breast, or other cancer specialist who treats your type of cancer

Many oral cancer medicines are dispensed through specialty pharmacies that coordinate with your care team.

Buying Medicine Safely

• Use only licensed pharmacies that require a valid prescription.
• Be cautious of websites that sell capecitabine without a prescription. Products from these sources may be counterfeit, expired, contaminated, or the wrong strength.
• Do not use veterinary products or products from unverified sellers.
• If you are unsure whether a pharmacy is legitimate, ask your specialist, your local pharmacist, or your country’s pharmacy regulator.

Side Effects of Capecitabine

Not everyone has side effects, and many can be managed. Tell your care team about any new or worsening symptoms early.

Common Side Effects

• Hand-foot syndrome: redness, swelling, tingling, dryness, peeling, or pain on the palms and soles
• Diarrhea
• Nausea or vomiting
• Loss of appetite
• Mouth sores
• Stomach pain
• Tiredness or weakness
• Constipation
• Skin rash or dryness
• Taste changes
• Low blood cell counts (often found on blood tests)
• Eye irritation or watery eyes
• Fever

Serious Side Effects

• Severe diarrhea or dehydration, which can affect the kidneys
• Severe hand-foot syndrome with blisters, sores, or trouble walking or using the hands
• Severe mouth sores
• Serious infections from low white blood cell counts
• Heart problems, including chest pain, irregular heartbeat, or, rarely, heart attack
• Liver problems, including raised bilirubin, which can cause yellowing of the skin or eyes
• Serious skin reactions, such as blistering or peeling
• Bleeding, particularly when taken with warfarin
• Nervous system problems, including confusion or trouble with balance
• Life-threatening reactions in people with low DPD enzyme activity
• Severe allergic reactions

When to Get Medical Help Right Away

Contact your specialist or seek emergency care if you have:

• Diarrhea with four or more loose stools a day above your normal, or diarrhea at night, or diarrhea with fever or dizziness
• Vomiting that prevents you from keeping down fluids or medicine
• Fever, chills, or signs of infection
• Painful blisters, sores, or severe redness on the hands or feet
• Mouth sores that make it hard to eat or drink
• Chest pain, a racing or irregular heartbeat, or trouble breathing
• Yellow skin or eyes, or dark urine
• Unusual bleeding, bruising, or black stools
• Confusion, severe dizziness, or trouble with speech or balance
• Swelling of the face, lips, or throat
• Very severe symptoms soon after starting treatment, which can be a sign of DPD deficiency

Your care team may tell you to pause capecitabine until you are seen. Follow those instructions exactly.

Drug Interactions

Capecitabine can interact with other medicines. Some interactions can be dangerous.

Major Interaction Categories

• Warfarin (blood thinner): Capecitabine can raise the effect of warfarin and increase bleeding risk. This has been serious and sometimes fatal. Blood clotting tests (INR) need close monitoring, and your team may consider a different blood thinner.
• Phenytoin (seizure medicine): Capecitabine may raise phenytoin levels, so levels may need monitoring.
• Leucovorin or levoleucovorin: These may raise the risk of side effects when used with fluoropyrimidines. Your care team manages this combination.
• Allopurinol: It may reduce the effect of fluorouracil and is generally avoided unless a specialist approves.
• Certain antiviral medicines such as brivudine (not sold in the United States) can cause severe, potentially fatal reactions.
• Other cancer medicines and treatments that lower blood counts, including radiation, may raise the risk of side effects.
• Live vaccines: These are generally avoided during cancer treatment. Ask before any vaccination.
• Other medicines that are processed by the same liver enzymes or that affect the kidneys or heart may need review.

Over-the-Counter Medicines

Ask a pharmacist or specialist before using OTC products, including antacids, pain relievers such as aspirin and ibuprofen (which can raise bleeding risk), and anti-diarrhea medicines. Your care team may give you specific medicines to keep on hand.

Supplements and Herbal Products

Vitamins, supplements, and herbal products may interact with capecitabine or affect the liver or bleeding risk. Folic acid supplements can change the effect of capecitabine and should be used only if your specialist approves. Do not start any product without checking first.

Share a Full Medication List

Give your licensed medical specialist a complete list of everything you take, including prescription medicines, OTC medicines, supplements, and herbal products. Update the list whenever anything changes.

Safety & Important Considerations

DPD Deficiency and Genetic Testing

Some people have little or no DPD enzyme activity. Without it, the body cannot break down fluoropyrimidines properly, and severe or fatal side effects can occur. Testing for DPYD gene variants may be recommended before treatment. An emergency medicine to counter serious fluoropyrimidine toxicity exists, but it must be given quickly and only by a healthcare team.

Warfarin Warning

Capecitabine can greatly increase the effect of warfarin. If you take warfarin, tell your oncology team and the clinic that manages your blood thinner. Frequent INR checks are needed.

Liver and Kidney Precautions

People with liver problems may need closer monitoring. Capecitabine is cleared by the kidneys, so people with reduced kidney function may need lower doses, and it may not be safe for people with severe kidney impairment.

Heart Precautions

Chest pain during treatment can be a sign of heart problems. Tell your team if you have a history of heart disease, and report chest pain right away.

Pregnancy and Breastfeeding

• Capecitabine can harm an unborn baby. Females who can become pregnant should have a pregnancy test before starting and use effective birth control during treatment and for a period afterward. Males with partners who can become pregnant should also use effective birth control during and after treatment. Your specialist will give the exact timing.
• Breastfeeding is generally not advised during treatment and for a period afterward. Discuss with your specialist.
• Tell your specialist right away if you are pregnant, planning pregnancy, or become pregnant.

Children and Older Adults

• Children: Safety and effectiveness of capecitabine are not established in children.
• Older adults: They may be more sensitive to side effects, such as diarrhea, dehydration, and low blood counts, and they may need closer monitoring and dose changes.

Monitoring

Expect regular blood tests, including blood counts and liver and kidney tests. If you take warfarin, expect frequent INR checks. Your team will also ask about diarrhea, hand-foot symptoms, mouth sores, and other effects at each visit.

Skin, Hand, and Foot Care

Use gentle, fragrance-free moisturizer on hands and feet, wear soft shoes and gloves, avoid very hot water and heavy friction, and protect your skin from the sun. Ask your care team what to do if symptoms begin.

Safe Handling

Capecitabine is a hazardous drug. Caregivers should wash their hands before and after handling it, avoid touching broken tablets with bare hands, and wear disposable gloves if tablets need to be handled directly. Pregnant caregivers should ask a pharmacist about safe handling. Ask your care team how to handle body fluids, laundry, and toilet flushing after doses.

Who This Medication Is For

Capecitabine is prescribed for people who need treatment for a cancer that a specialist has decided it can help manage.

• FDA-approved indications: Certain colon, colorectal, breast, gastric, esophageal, gastroesophageal junction, and pancreatic cancers, depending on the stage and treatment plan.
• Other uses: Some specialists prescribe it for other cancers based on clinical judgment.

Whether it is right for a particular person depends on their diagnosis, kidney and liver health, heart health, genetic test results, other medicines, and other treatments.

Who Should Not Take Capecitabine

Tell your specialist before starting if any of the following apply.

• Allergy: You have had a serious allergic reaction to capecitabine, fluorouracil, or any ingredient in the medicine.
• Known DPD deficiency or a history of severe fluoropyrimidine reactions: It may not be safe, or a different treatment or a much lower dose may be needed.
• Severe kidney problems: It may not be safe, and dose changes are needed for moderate kidney problems.
• Pregnancy: Capecitabine can cause harm to an unborn baby.
• Taking warfarin or phenytoin: Interactions may require changes or close monitoring.
• Heart disease, including a history of chest pain or heart attack: Extra caution is needed.
• Severe infection, very low blood counts, or dehydration: These may need to be addressed first.
• Recent or planned live vaccines: Discuss timing with your specialist.

Your specialist will review the full list of precautions in the current FDA labeling for your product.

What to Do If You Miss a Dose

• If you miss a dose, do not take the missed dose. Take your next dose at the usual time.
• Never take a double dose or extra tablets to make up for a missed one.
• Tell your care team about any missed doses so they can guide your schedule.
• If you are unsure what to do, contact your licensed medical specialist or pharmacist for guidance.
• Use a pill organizer, phone alarm, or dose log to help stay on schedule, including your “rest” days between cycles.

Related medications to Capecitabine

The right alternative depends on the cancer being treated. Examples of options that may be used in similar situations include:

• Other fluoropyrimidines: Fluorouracil given by vein (often with leucovorin), and trifluridine/tipiracil (an oral medicine) for certain cancers.
• For colorectal cancer: Combination chemotherapy with medicines such as oxaliplatin or irinotecan, as well as targeted and immune therapies, depending on the tumor type.
• For breast cancer: Other chemotherapy medicines, hormone therapy, and targeted therapies, depending on the tumor type.
• For stomach, esophageal, and pancreatic cancers: Other chemotherapy combinations, and targeted or immune therapies, depending on the tumor type.

These options differ in how they work, their side effects, and their monitoring needs. Do not switch or stop treatment on your own. Any change should be made only after talking with your licensed medical specialist.

Storage Instructions

• Temperature: Store tablets at room temperature, generally between 68°F and 77°F (20°C to 25°C), unless the label says otherwise.
• Moisture and light: Keep tablets in the original tightly closed container, away from moisture (avoid bathrooms) and direct light and heat.
• Child safety: Keep all medicines locked or out of reach and sight of children and pets. Use child-resistant caps.
• Disposal: Do not throw away unused medicine in household trash unless instructed. Ask your pharmacist about safe disposal for hazardous drugs.

Disclaimer:

This page is for educational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Patients must consult a licensed medical specialist, such as an oncologist, before starting, changing, or stopping treatment. Treatment decisions must be based on a full clinical evaluation by a qualified specialist. If you think you are having a medical emergency, call your local emergency number right away.