Capecitabine is a chemotherapy drug that is given as a treatment for many types of cancer, including advanced bowel cancer, breast cancer, stomach cancer and oesophageal cancer. This information describes capecitabine, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give more advice.

If you have any further questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

Capecitabine is available as peach-coloured tablets of 500mg, and light peach-coloured tablets of 150mg.

Your doctor may want you to take a combination of 500mg and 150mg tablets. You need to make sure that you are taking the right dose.

The tablets should be swallowed whole with a glass of water, within half an hour of the end of a meal, as capecitabine works best if it is broken down in the stomach with food. You should take them in the morning after breakfast, and then again after your evening meal, so that the doses are spaced at least eight 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 drunk immediately. The glass and spoon should be washed and kept separate from your other crockery and cooking utensils.

Capecitabine tablets are usually taken for a number of days, followed by a rest period in which no tablets are taken. This can vary depending upon the type of cancer you have. It is important to follow the instructions carefully and take the tablets as directed by your doctor, nurse or pharmacist.

You should only get the tablets from your hospital. You can't get a repeat prescription from your GP.

Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given capecitabine, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug but which are not listed in this information, please discuss them with your doctor or chemotherapy 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 is not controlled, or 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 to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe special mouthwashes and medicines, which prevent or clear any mouth infection.

Taste changes You may notice that your food tastes different. Normal taste will usually return when your treatment finishes.

Diarrhoea This can be quite severe, but can usually be controlled with medicines. If you have diarrhoea more than 4–6 times a day, contact your hospital doctor for advice immediately. You may be advised to stop taking capecitabine, but it is often possible to restart the treatment at a lower dose. It is important to drink plenty of fluids if you have diarrhoea.

Abdominal pain and constipation It may help to drink plenty of fluids, eat a high-fibre diet and take gentle exercise. Sometimes you may need to take medicines to stimulate your bowel. These can be prescribed by your doctor.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.

Skin changes Soreness and redness or darkening of the palms of the hands and soles of the feet (sometimes known as palmar plantar syndrome 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. If you notice this, let your specialist know.

Tiredness and feeling weak You may feel very tired. It is important to allow yourself plenty of time to rest.

Lowered resistance to infection Capecitabine can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, and your resistance to infection usually reaches its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily, and will usually have returned to normal levels before your next course of chemotherapy.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Capecitabine can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with capecitabine you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if you develop these symptoms.

Hair loss Hair loss is rare, but your hair may thin, or occasionally be lost completely. If this happens it usually begins about 3–4 weeks after starting treatment, although it may occur earlier. It is temporary and your hair will start to regrow once the treatment ends.

Headaches and dizziness Tell your doctor if you have headaches or feel dizzy and light-headed while taking capecitabine.

Changes in the way your heart works Capecitabine may affect the way your heart works. Some people can experience chest pain and tightening across the centre of the chest while taking capecitabine. This pain is called angina. Chest pain can be caused by many different things other than chemotherapy. If you develop any of these symptoms you should 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). Your doctor can prescribe soothing eye drops if necessary.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having 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 is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Capecitabine is known to react with the drugs phenytoin, allopurinol and interferon; you should let your doctor know if you are taking any of these. It is a good idea to tell your doctor about other medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking capecitabine, as the developing foetus may be harmed. It is necessary to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

Interaction with other drugs Capecitabine may affect the action of some medication given to thin the blood (anti-coagulants), such as warfarin. Let your doctor know if you take warfarin, as they may need to check more often how quickly your blood is clotting.

Folic acid Let your doctor know if you are taking folic acid because it might increase the side effects of capecitabine.

• It is important to take your tablets at the right times. You must take them as directed by your doctor, specialist nurse or pharmacist.
• Keep the tablets in the original packaging and store them at room temperature, away from heat and direct sunlight.
• Keep the tablets in a safe place where children cannot reach them, as capecitabine could harm them.
• If your doctor decides to stop the treatment, return any remaining tablets to the pharmacist. Do not flush them down the toilet or throw them away.
• If you are sick just after taking the tablets let your doctor know as you may need to take another dose. Do not take another tablet without first telling your doctor.
• If you forget to take a tablet, do not take a double dose. Inform your doctor 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:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Medicines.org.uk website - www.medicines.org.uk (November 2007).
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.
• Full Guidance on the Use of Capecitabine and Tegafur Uracil for Metastatic Colorectal Cancer. National Institute for Clinical Excellence, March 2003.
• Full Guidance on the Use of Capecitabine for the Treatment of Locally Advanced or Metastatic Breast Cancer. National Institute for Clinical Excellence, May 2003.

For further references, please see general bibliography.