Capecitabine is a chemotherapy drug usually given to treat cancer of the colon, rectum, breast, stomach, pancreas and gullet (oesophagus). This information should ideally be read with our general information about chemotherapy and your type of cancer.
What capecitabine looks like
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Capecitabine is available as 500mg peach-coloured tablets and 150mg light peach-coloured tablets.
Your doctor may want you to take a combination of 500mg and 150mg tablets. You need to make sure that you're taking the right dose and that you don't take too much or too little.
The tablets should be swallowed whole with a glass of water. They should be taken within half an hour of finishing a meal as capecitabine works best if it's broken down in the stomach with food. You should take them in the morning just after breakfast, and then again just after your evening meal, so that the doses are spaced at least eight hours apart or, if possible, 10–12 hours apart.
If you have trouble swallowing capecitabine tablets, they can be dissolved in a 200ml glass of warm water. The mixture should be stirred with a spoon until the tablets are completely dissolved, and then drunk immediately. You can add some blackcurrant juice just before swallowing to help disguise the taste. The glass and spoon should be washed and kept separate from your other crockery and cooking utensils.
Capecitabine tablets are usually taken twice daily for a number of days, followed by a rest period when no tablets are taken. Alternatively, they are taken twice daily (every day) with no rest period.
This may vary depending on the type of cancer you have. It's important to follow the instructions carefully and take the tablets as directed by your doctor, chemotherapy nurse or pharmacist.
You should only get the tablets from your hospital. You can't get a repeat prescription from your GP.
Before you begin your treatment your doctor will arrange for you to have blood tests. You'll usually be given anti-sickness drugs before and/or during your treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects while others may experience more. The side effects described here won't affect everyone who is given capecitabine and may be different if you're being treated with more than one type of chemotherapy drug.
We have outlined the most common side effects but haven't included those that are very rare and unlikely to affect you. If you notice any effects that are not listed here, discuss them with your doctor or nurse.
Feeling sick (nausea) and being sick (vomiting)
This is usually mild. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce, nausea and vomiting. If the sickness isn't controlled, or if it continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Sore mouth and ulcers
Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help reduce the risk of this happening. Some people may find sucking on ice soothing. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
This can be severe but can usually be controlled with medicines. It's important to drink plenty of fluids and you may be given medicine to take. Follow the instructions and take it immediately.
If you have diarrhoea more than 4-6 times a day, or if you have it at night, contact your specialist for advice immediately.
You may be advised to stop taking capecitabine. However, once the diarrhoea has eased your doctor will tell you if you can restart the treatment and may recommend a lower dose.
Abdominal pain and constipation
Capecitabine can cause pain in your tummy (abdomen) and constipation. Let your doctor know if you develop pain. It can usually be controlled with mild painkillers.
Constipation can usually be helped by drinking plenty of fluids, eating more fibre and doing some exercise. You may need to take medicine (laxatives) to help ease it. Your doctor can prescribe these or you can buy them at a pharmacy.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight.
Soreness and redness, or darkening of the palms of the hands and soles of the feet (sometimes known as palmar plantar or hand-foot syndrome) can occur. You may be prescribed vitamin B6 (pyridoxine), which can help to reduce this. A rash and dry or itchy skin may also occur. Let your specialist doctor or nurse know if you notice this.
You'll probably feel extremely tired. This is a very common side effect and it's important to get plenty of rest. Try to balance this with some gentle exercise, such as short walks, which will help. You’ll probably get tired easily and feel fairly weak for several more months after your treatment.
Pain in joints or muscles
This may be caused by capecitabine. It's important to tell your doctor about this, so that they can prescribe painkillers to help.
Less common side effects
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Risk of infection
Capecitabine can reduce the number of white blood cells, which help fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia.
Neutropenia begins seven days after treatment, and your resistance to infection is usually at its lowest 10–14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38ºC (100.4ºF)
you suddenly feel unwell, even with a normal temperature.
You'll have a blood test before having more chemotherapy to check the number of white blood cells. Occasionally, your treatment may need to be delayed if the number of your blood cells (blood count) is still low.
Bruising and bleeding
Capecitabine can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You may need to have a platelet transfusion if your platelet count is low.
Capecitabine can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
This is rare, but your hair may thin or occasionally fall out completely. If this happens, it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. This is temporary and your hair will start to grow back once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Some people find that capecitabine causes headaches. Let your doctor or nurse know. They can give you painkillers to relieve this.
Some people may feel dizzy or light-headed. Tell your doctor if you have any of these side effects.
Changes in the way your heart works
Capecitabine may affect the way your heart works. Some people may experience chest pain and tightening across the centre of the chest while taking it. Chest pain can be caused by many different things other than chemotherapy. If you develop any of these symptoms, contact your doctor immediately.
Increased production of tears
This may be caused by capecitabine and is temporary. You may also notice that your eyes become sore and inflamed (conjunctivitis). Let your doctor know so they can prescribe soothing eye drops if necessary.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Capecitabine interacts with the drugs phenytoin (Epanutin®), allopurinol (Zyloric®) and interferon (IntronA®, Roferon-A®). It may also affect the action of some medicines given to thin the blood (anti-coagulants), such as warfarin. Let your doctor know if you are taking any of these.
You should also tell your doctor if you’re taking folic acid because it might increase the side effects of capecitabine.
Some other medicines, including those you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you're taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by having this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or father a child while having capecitabine, as it may harm the developing baby. It’s important to use effective contraception while having this drug, and for at least a few months afterwards. You can discuss this with your doctor.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner, it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
There is a potential risk that chemotherapy drugs may be present in breast milk. Women are advised not to breastfeed during chemotherapy and for a few months afterwards.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you're having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
Things to remember about capecitabine tablets
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It’s important to take your tablets at the right times as directed by your doctor.
Always tell any doctors treating you for non-cancerous conditions that you're taking a course of chemotherapy tablets that should not be stopped or restarted without advice from your cancer specialist.
Keep the tablets in their original packaging, and store them at room temperature away from heat and direct sunlight.
Keep the tablets in a safe place and out of the reach of children.
If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Don't flush them down the toilet or throw them away.
If you are sick just after taking the tablets tell your doctor as you may need to take another dose. Don't take another tablet without telling your doctor first.
If you forget to take a tablet, don't take a double dose. Let your doctor know and keep to your regular dose schedule.
This section is based on our Capecitabine factsheet, which has been compiled using information from a number of reliable sources, including:
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
electronic Medicines Compendium. (accessed October 2011).
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.