1. What is capecitabine (Xeloda)?
2. How does capecitabine work?
3. When is capecitabine prescribed?
4. How is capecitabine taken?
5. What happens if I miss a dose?
6. How long will I take capecitabine for?
7. What are the possible side effects of capecitabine?
8. Can I drive or use machinery while taking capecitabine?
9. Can I take capecitabine with other drugs?
10. Can I get pregnant while taking capecitabine?
11. Blood clots
12. How to find further support
Capecitabine is a type of oral chemotherapy drug, which means that it is taken as tablets.
Capecitabine is the generic (non-branded) name of the drug, but you may also hear it called Xeloda, which is its brand name.
Before starting your treatment many hospitals will arrange a chemotherapy information session. At this appointment it will be explained how and when your chemotherapy will be given and how side effects can be managed. Your appointment will usually be with a nurse. Contact numbers will also be given so you know who to phone if you have any questions or concerns.
Chemotherapy drugs such as capecitabine work by interfering with how cancer cells develop and grow.
Capecitabine is taken as tablets and absorbed into the bloodstream through the digestive system. The drug travels throughout the body, via the bloodstream, to various cells including the breast cancer cells, where it is converted into the chemotherapy drug 5 fluorouracil (also known as 5FU).
As capecitabine is converted into 5FU more efficiently in cancer cells, it means that there are fewer effects on normal cells.
Capecitabine is used to treat locally advanced breast cancer (also known as regional recurrence) or secondary (metastatic) breast cancer. It’s often given on its own, but can also be given alongside other chemotherapy drugs such as docetaxel.
Studies have shown that some people with primary breast cancer that has not spread beyond the breast or the lymph nodes under the arm) may also benefit from capecitabine. This includes people with breast cancer that is triple negative. People who have chemotherapy before surgery (neo-adjuvant chemotherapy) may be offered capecitabine after. Your specialist will discuss with you if this is an option.
Capecitabine may also be offered as part of a clinical trial.
Capecitabine is taken in cycles. Your specialist will prescribe a dose and regime that is appropriate for you.
Capecitabine is available in two different tablet strengths: 150mg or 500mg. You will be told how many of each tablet to take to make sure you get the right amount each day for your body size.
You will usually take the capecitabine tablets twice a day (in the morning and evening) for 14 days and then have a seven-day break from taking the tablets. This 21-day period is one treatment cycle.
If you are prescribed capecitabine differently to the 21-day cycle your doctors will explain why this is.
You should swallow the tablets whole with water within half an hour of eating a meal.
If you miss a dose of capecitabine, do not take an extra dose to make up for the one you missed. Keep to your usual amount and speak to someone in your treatment team.
This will vary from person to person. People with secondary breast cancer will usually keep taking capecitabine until it is no longer helping to control the cancer or they are experiencing significant side effects.
If you have primary breast cancer then your specialist will talk to you about what is best for you.
Like any drug, capecitabine can cause side effects. Most people tolerate capecitabine well as the side effects are often mild and can normally be controlled. However, everyone reacts differently to drugs and some people have more side effects than others. The side effects described here will not affect everyone.
The information below does not list all possible side effects. If you are taking other drugs at the same time as capecitabine, you may have additional side effects from these drugs. If you are concerned about any side effects, regardless of whether they are listed here, talk to your specialist.
Most side effects can be treated and your specialist can reduce or delay the dose of capecitabine you take if the side effects become too severe. Reducing the dose of capecitabine is common and the treatment can still be effective at a lower dose. Before you start capecitabine, you should receive information about its possible side effects. However, if you have any questions, talk to your specialist team.
Common side effects
Effects on the blood
Capecitabine, like most chemotherapy drugs, can temporarily affect the number of healthy blood cells in the body. Blood cells (white blood cells, red blood cells and platelets) are released by the bone marrow (the spongy material found in the hollow part of bones) to replace those that are naturally used up in the body. Chemotherapy reduces the ability of the bone marrow to make these cells.
You will have regular blood tests throughout your treatment to check your blood count. If the number of blood cells is too low your next course of treatment may be delayed or the dose of the chemotherapy reduced.
Risk of infection
When the white blood cells fall below a certain level, it’s known as neutropenia. Not having enough white blood cells can increase the risk of getting an infection. The number of white blood cells usually returns to normal before your next cycle of chemotherapy is due.
Contact your hospital immediately if:
- you have a high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your chemotherapy team has advised
- you suddenly feel unwell, even with a normal temperature
- you have any symptoms of an infection, for example, a sore throat, a cough, a need to pass urine frequently or feel cold and/or shivery
Before starting capecitabine you should be given a 24-hour contact number or told where to get emergency care by your specialist team. You may need antibiotics. Sometimes your doctor may recommend injections of drugs called growth factors to stimulate the production of white blood cells to reduce your risk of infection.
Having too few red blood cells can mean you are anaemic. If you feel particularly tired, breathless or dizzy, let your specialist team know. A blood transfusion may be necessary during your treatment if the number of red blood cells falls significantly.
Bruising and bleeding
Capecitabine can reduce the number of platelets, which help the blood to clot. You may bruise more easily, have nosebleeds or your gums can bleed when you brush your teeth. Tell your specialist team if you experience any of these symptoms.
Diarrhoea is common during treatment, and sometimes this can be severe. Tell your chemotherapy nurse or specialist team as they can prescribe medication and may consider stopping your capecitabine for a time to help control it. Speak to them immediately if you have any of the following symptoms:
- four or more episodes of diarrhoea in 24 hours
- blood in your stools when you go to the toilet
- abdominal pain
Hand-foot (palmar-plantar) syndrome
Hand-foot syndrome, often called Palmar-plantar syndrome, is a common side effect of some chemotherapy drugs used to treat breast cancer. The palms of the hands and the soles of the feet can become red and sore. Sometimes you may also notice a tingling sensation, numbness or some swelling.
The skin on your hands and feet may also become red, dry and flaky. This should improve if the treatment is delayed or if the dose is reduced. Using a moisturising cream can also help.
If you experience skin reactions, mention this to your specialist when you see them next so that the symptoms can be managed.
Nausea and vomiting
Some people have nausea (feeling sick) during their treatment. Although most people will not actually vomit (be sick), anti-sickness drugs can help reduce or stop this happening, so take these as prescribed. Contact your specialist team or GP (local doctor) if symptoms persist.
Your mouth and gums can become sore and small ulcers may develop. This is usually worse if you are taking capecitabine at the same time as other chemotherapy drugs. Your chemotherapy nurse or specialist team will advise you about suitable mouthwashes or medicine if a mouth infection develops. Find out more about diet and breast cancer.
Loss of appetite
You can lose your appetite while taking capecitabine. Your sense of taste can also change and some foods and drink may taste different. Talk to your specialist team about this. They will give you advice and information to help, or refer you to a dietitian if needed. Find out more about diet and breast cancer.
Cancer-related fatigue is a common symptom in people being treated for breast cancer. Everyone knows what it feels like to be tired sometimes, but if you have cancer-related fatigue you may feel like you have very little energy.
Fatigue has many causes, from psychological factors such as the stress of coping with the diagnosis to physical ones such as the side effects of treatment or progression of the cancer.
Find out more about fatigue and how to manage it. We also have specific information on managing fatigue if you have secondary breast cancer.
Hair loss (alopecia)
When used on its own, capecitabine occasionally causes some temporary hair thinning. It very rarely causes complete hair loss. However, if capecitabine is taken in combination with docetaxel, most people will lose all their hair including eyebrows, eyelashes and body hair.
Rare side effects
Very occasionally allergic reactions to a drug can occur. Reactions can vary from mild to severe, although severe reactions are uncommon. If you have any swelling, wheezing, chest pain or difficulty breathing after taking capecitabine, let your specialist team or chemotherapy nurse know immediately.
DPD deficiency (very rare)
DPD (dihydropyrimidine dehydrogenase) is an enzyme (a type of protein) that help our genes function normally. It also helps to absorb capecitabine.
If you have low levels of DPD (DPD deficiency) chemotherapy will build up in your body, resulting in severe side effects. In very rare cases this can be life threatening. Tell your specialist team if you have severe side effects while taking capecitabine. If they think you have DPD deficiency it’s likely the capecitabine will be stopped.
There is more information about this on the Cancer Research UK website.
Capecitabine may make you feel dizzy, sick or tired, so could possibly affect your ability to drive or operate machinery safely. Avoid driving or using machinery if you have any symptoms that may affect your ability to do this.
Tell your specialist team about any other drugs or supplements you are taking.
If you take drugs to thin the blood (anti-coagulants), such as warfarin, capecitabine can increase your risk of bleeding. Your specialist may check more often how quickly your blood clots, adjust your dose of blood-thinning drugs or, more commonly, change you to an injection to thin the blood instead.
Find out more about vitamins and supplements during and after breast cancer treatment.
Taking capecitabine while pregnant may have a harmful effect on a developing baby. Some women can still become pregnant even if their periods are irregular or have stopped. Use a non-hormonal contraception to avoid getting pregnant such as condoms, Femidoms or a diaphragm. It may also be possible to use a coil (IUD or intrauterine device). However, you would need to discuss this with your specialist as not all types may be suitable for women with breast cancer.
People with breast cancer have a higher risk of blood clots. Their risk is higher because of the cancer itself and some treatments for breast cancer. Having capecitabine increases the risk of blood clots such as deep vein thrombosis (DVT). People with a DVT are at risk of developing a pulmonary embolism. This is when part of the blood clot breaks away and travels to the lung.
If the cancer has spread to other parts of the body (secondary breast cancer), this also increases the risk.
Blood clots can be harmful but are treatable so it’s important to report symptoms as soon as possible.
If you experience any of the following symptoms contact your local A&E department, GP or specialist team straight away.
- pain, redness/discolouration, heat and swelling of the calf, leg or thigh
- shortness of breath
- tightness in the chest
- unexplained cough (may cough up blood)
If you have any concerns about taking capecitabine, you can talk to your specialist team or GP. You may also find it helpful to talk to someone on our Helpline 0808 800 6000 for more information or use our Ask Our Nurses email service.