Oxaliplatin and capecitabine chemotherapy
Oxaliplatin and capecitabine is a chemotherapy treatment usually used to treat bowel cancer. It’s sometimes called XELOX or CAPOX.
This information is best when read with our general information about chemotherapy and the type of cancer you have.
The drugs used in XELOXBack to top
This chemotherapy treatment uses the drugs:
You will have the treatment in the chemotherapy day unit or during a short stay in hospital. A chemotherapy nurse will give it to you. During treatment, you will usually see a cancer doctor, a chemotherapy nurse or a specialist nurse. This is who we mean when we mention doctor or nurse in this information.
Before or on the day of treatment, a nurse or person trained to take blood (phlebotomist) will take a blood sample from you. This is to check that it is okay for you to have chemotherapy.
You will also see a doctor or nurse before you have chemotherapy. They will ask you about how you have been. If your blood results are alright on the day of your treatment, the pharmacist will prepare your chemotherapy. Your nurse will tell you when your treatment is likely to be ready.
Your nurse will give you anti-sickness (anti-emetic) drugs as an injection into a vein or as tablets. They will give you the drugs and chemotherapy through one of the following (depending if you have a line in or not):
- a short thin tube that the nurse puts into a vein in your arm or hand (cannula)
- a fine tube that goes under the skin of your chest and into a vein close by (central line)
- a fine tube that is put into a vein in your arm and goes up into a vein in your chest (PICC line).
Your nurse will give you oxaliplatin as a drip (infusion) over two hours. They usually run the drip through a pump, which gives you the treatment over a set time. Capecitibine is taken as tablets. You will be given your capecitabine tablets to take at home.
When the chemotherapy is being given
Some people might have side effects while they are having the chemotherapy.
Rarely, oxaliplatin may cause an allergic reaction while it’s being given. Your nurse will check you for this. If you have a reaction, they will treat it quickly. Signs of a reaction can include:
- a rash
- feeling itchy, flushed or short of breath
- swelling of your face or lips
- feeling dizzy
- having pain in your tummy, back or chest
- feeling unwell.
Tell your nurse straight away if you have any of these symptoms.
Your course of oxaliplatin and capecitabine
You will have chemotherapy as a course of several sessions (or cycles) of treatment over a few months. Each cycle of oxaliplatin and capecitabine takes 21 days (three weeks). On the first day, you will have oxaliplatin and start taking the 14-day course of capecitabine tablets.
When you finish your capecitabine tablets, you will have a rest period with no chemotherapy for the next seven days. This completes a cycle of your chemotherapy. Each cycle lasts 21 days (three weeks).
At the end of the 21 days, you start your second cycle of oxaliplatin and capecitabine. This is exactly the same as the first cycle. You have up to four to eight cycles over three to nine months. Your doctor or nurse will tell you the number of cycles you are likely to have.
Sometimes oxaliplatin is given more often than every three weeks and capecitabine tablets may be given over one week rather than two. Your doctor or nurse will explain more about this.
Taking your chemotherapy tablets
Before you leave hospital, the nurse or pharmacist will give you chemotherapy tablets to take when you are at home. Always take your tablets exactly as explained. This is important as it will make sure they work as well as possible for you.
You take capecitabine tablets twice a day. Swallow them whole with a glass of water within half an hour of a meal. Capecitabine works best if it's broken down in the stomach with food. Take them in the morning after breakfast and then after your evening meal. The doses should be spaced 10-12 hours apart.
Tell your doctor if you find it difficult to swallow the tablets. They may suggest that you dissolve the capecitabine tablets in water. In this case, dissolve the tablets in a 200ml glass of warm water. Stir the water with a spoon until the tablets are completely dissolved and then drink it immediately. The glass and spoon should be washed and kept separate from your other crockery and cooking utensils.
If you are sick just after taking the tablets, contact the hospital. You may need to take another dose. If you forget to take a tablet, do not take a double dose. Keep to your regular schedule and let your doctor or nurse know.
Other things to remember about your tablets:
- Keep them in the original package at room temperature away from heat and direct sunlight.
- Keep them safe and out of the reach of children.
- Return any remaining tablets to the pharmacist if your treatment is stopped.
Before you go home, the nurse or pharmacist will also give you anti-sickness (anti-emetic) drugs to take. They may also give you anti-diarrhoea tablets if you need them. Take all your tablets exactly as they have explained to you.
Possible side effects of XELOXBack to top
We explain the most common side effects of XELOX here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. If you are having other chemotherapy drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have. Your doctor can prescribe drugs to help control some of these.
It is very important to take the drugs exactly as your nurse or pharmacist has explained. This means they will be more likely to work better for you.
Your nurse will give you advice about managing your side effects. After your treatment is over, the side effects will start to improve.
Serious and life-threatening side effects
Sometimes cancer drugs can result in very serious side effects, which rarely may be life-threatening. Your cancer doctor and nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. You can call them if you feel unwell or need advice any time of day or night. Save these numbers in your phone or keep them somewhere safe.
More information about this drug
We’re not able to list every side effect for this treatment here, particularly the rarer ones. For more detailed information you can visit the electronic Medicines Compendium (eMC).
Risk of infection
XELOX can reduce the number of white cells in your blood. This will make you more likely to get an infection. When they are low it’s called neutropenia.
Contact the hospital straight away on the contact number you’ve been given if:
- your temperature goes over 37.5°C (99.5°F) or over 38°C (100.4°F), depending on the advice given by your chemotherapy team
- you suddenly feel unwell, even with a normal temperature
- you have symptoms of an infection – these can include feeling shaky, a sore throat, a cough, diarrhoea or needing to pass urine a lot.
The number of white cells usually increases steadily and returns to normal before your next treatment. You will have a blood test before having more chemotherapy. If your blood cells are still low, your doctor may delay your treatment for a short time.
Bruising and bleeding
XELOX can reduce the number of platelets in your blood. Platelets are cells that help the blood to clot. Tell your doctor if you have any bruising or bleeding you can’t explain. This includes nosebleeds, bleeding gums, blood spots or rashes on the skin.
Anaemia (low red cells)
XELOX can reduce the number of red cells in your blood. These cells carry oxygen around the body. If they are low, you may be tired and breathless. Tell your doctor or nurse if you feel like this. If you are very anaemic, you may need a drip to give you extra red blood cells (blood transfusion).
Feeling very tired is a common side effect. It’s often worse towards the end of treatment and for some weeks after it’s finished. Try to pace yourself and get as much rest as you need. It helps to balance this with some gentle exercise, such as short walks. If you feel sleepy, don’t drive or operate machinery.
This may happen in the first few days after chemotherapy. Your doctor will prescribe anti-sickness (anti-emetic) drugs to help prevent or control sickness. Take the drugs exactly as your nurse or pharmacist explains to you. It’s easier to prevent sickness than to treat it after it has started.
If you still feel sick or are vomiting, contact the hospital as soon as possible. They can give you advice and change the anti-sickness drug to one that works better for you.
This can sometimes be severe. Your doctor can prescribe anti-diarrhoea drugs to control it. You may be given these before you leave hospital. It’s important to take them exactly as your nurse or pharmacist explained. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
If you have diarrhoea more than four to six times a day, or at night, contact the hospital straight away on the numbers your nurse gave you. Your doctor may ask you to stop taking capecitabine. When the diarrhoea is better, they will tell you if you can start taking it again. Sometimes they reduce the dose.
Your mouth may become sore and you may get ulcers. This can make you more likely to get an infection in your mouth. Gently clean your teeth and/or dentures morning and night and after meals. Use a soft-bristled or children’s toothbrush. Your nurse might ask you to rinse your mouth regularly or use mouthwashes. It’s important to follow any advice you are given and to drink plenty of fluids.
Tell your nurse or doctor if you have any problems with your mouth. They can prescribe medicines to prevent or treat mouth infections and reduce any soreness.
Your hair may thin, but you’re unlikely to lose all the hair from your head. The thinning usually starts after your first or second cycle of chemotherapy. It is almost always temporary and your hair will grow back after chemotherapy ends. Your nurse can give you advice about coping with hair loss.
Numb or tingling hands or feet
These symptoms are caused by the effect of oxaliplatin on the nerves. It’s called peripheral neuropathy. You may also find it hard to fasten buttons or do other fiddly tasks.
Tell your doctor if you have these symptoms. They sometimes need to lower the dose of the drug. The symptoms usually improve slowly after treatment finishes but in some people they may never go away. Talk to your doctor if you are worried about this.
XELOX may affect your skin. Your doctor or nurse can tell you what to expect. If your skin feels dry, try using an unperfumed moisturising cream every day. During treatment and for several months afterwards, you'll be more sensitive to the sun and your skin may burn more easily than usual. You can still go out in the sun, but use a suncream with a sun protection factor (SPF) of at least 30, and cover up with clothing and a hat.
Always tell your doctor or nurse about any skin changes. They can give you advice and may prescribe creams or medicines to help. Any changes to your skin are usually temporary and improve when treatment finishes.
Soreness and redness of palms of hands and soles of feet
This is called palmar-plantar or hand-foot syndrome. It gets better when treatment ends. Your doctor or nurse may prescribe creams to improve the symptoms. It can help to keep your hands and feet cool and to avoid tight-fitting socks, shoes and gloves.
Your eyes may become watery, or feel sore and dry. Your doctor can prescribe eye drops to help with this. If your eyes get red and inflamed (conjunctivitis) tell your doctor. This is because you may need antibiotic eye drops.
Rarely, the drugs may cause blurry vision and/or eye pain. Always tell your doctor or nurse if you have eye pain or notice any change in your vision.
If you have headaches, tell your doctor or nurse. They can give you painkillers to help.
Muscle and joint pain
You may get pain in your joints or muscles for a few days after chemotherapy. Tell your doctor if this happens so they can prescribe painkillers. Let them know if the pain does not get better. Try to get plenty of rest. Having regular warm baths may help.
You may get pain or discomfort in your tummy (abdomen), feel bloated or have indigestion or wind. Your doctor can prescribe drugs to help improve these symptoms. Tell them if the pain doesn’t improve or gets worse.
Changes in the way the liver works
XELOX may affect how your liver works. This is usually mild and goes back to normal after treatment. You will have blood tests to check how well your liver is working.
Less common side effects of XELOXBack to top
Breathing and swallowing
Oxaliplatin can affect the area around the voicebox (larynx). This can make you feel as if it’s difficult to swallow or to breathe. It can feel very frightening but only lasts a short while. Try taking long deep breaths through your nose to help your breathing get back to normal. The symptoms can be made worse by cold temperatures, so avoid having cold drinks or ice cubes for a few days after treatment.
It’s important to tell your doctor or nurse if you have this side effect. They may be able to give you medicine to help. They can give you the oxaliplatin over a longer time (four to six hours) to reduce the chance of this happening.
Some people may have pain or ringing in their ears (tinnitus). Rarely, oxaliplatin may cause some hearing loss. Tell your doctor if you notice any changes to your hearing.
Effects on the nervous system
XELOX can affect the nervous system. You may feel dizzy and unsteady on your feet. Tell your doctor or nurse straight away if you notice any of these symptoms. It’s important not to drive or operate machinery if you notice these effects.
Changes in the way the heart works
Capecitabine can affect the way the heart works, but this isn’t common. If you have pain or tightness in your chest or feel breathless or notice changes to your heartbeat at any time during or after treatment, tell a doctor straight away. These symptoms can be caused by other conditions, but it’s important to get them checked by a doctor.
It’s important to tell your doctor or nurse straight away if you feel ill or have severe side effects. This includes any we don’t mention here.
Other information about XELOXBack to top
Blood clot risk
Cancer increases the chance of a blood clot (thrombosis) and chemotherapy can add to this. A clot can cause symptoms such as pain, redness and swelling in a leg, breathlessness and chest pain. Contact your doctor straight away if you have any of these symptoms. A blood clot is serious but your doctor can treat it with drugs that thin the blood. Your doctor or nurse can give you more information.
Oxaliplatin and capecitabine may interact with different drugs or affect the way blood thinning drugs, such as warfarin, work. The vitamin folic acid can increase the side effects of capecitabine.
Some other medicines, including the ones you can buy in a shop or chemist, may also be harmful when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
XELOX may affect your fertility (being able to get pregnant or father a child). If you are worried about this, you can talk to your doctor or nurse before treatment starts.
Your doctor will advise you not to become pregnant or to father a child during treatment. This is because the drugs may harm a developing baby. It’s important to use effective contraception during and for a few months after chemotherapy. You can talk to your doctor or nurse about this.
If you have sex within the first couple of days of having chemotherapy, you need to use a condom. This is to protect your partner in case there is any chemotherapy in your semen or vaginal fluid
Changes to your periods
XELOX can sometimes stop the ovaries working. You might not get a period every month and they may eventually stop. In some women this is temporary, but for others it is permanent and they start the menopause.
Women are advised not to breastfeed during treatment and for a few months after. This is in case there is chemotherapy in their breast milk.
Medical and dental treatment
If you need to go into hospital for any reason other than cancer, always tell the doctors and nurses that you are having chemotherapy. Explain you are taking chemotherapy tablets that no one should stop or restart without advice from your cancer doctor. Give them the contact details for your cancer doctor.
Talk to your cancer doctor or nurse if you think you need dental treatment. Always tell your dentist you are having chemotherapy.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a medical professional.
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