Capecitabine

Capecitabine is a type of chemotherapy. You pronounce it as ka-pe-site-a-been.

It is a treatment for a number of different cancer types. 

You might have capecitabine on its own or with other chemotherapy drugs. You might also have it with radiotherapy.

How does capecitabine work?

Capecitabine is a type of chemotherapy called an anti metabolite. The body changes capecitabine into a common chemotherapy drug called fluorouracil. It stops cells making and repairing DNA   Cancer cells need to make and repair DNA so they can grow and multiply.

How do you have capecitabine?

Capecitabine comes as a tablet that you swallow whole, with water and within 30 minutes of finishing a meal. You take it twice a day, morning and evening.

You might have two different strengths of tablets to make up the correct dose.

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

How often do you have capecitabine?

You might have capecitabine as a course of several cycles of treatment . Each cycle is often over 3 weeks, but this depends on the type of cancer you have.

For example, you may take capecitabine every day for 2 weeks. Then have a week with no treatment. You then start the next cycle. Or you may take capecitabine every day for a few months.

Your doctor will tell you:

• what dose of capecitabine you need to take
• when to take it
• how long to take it for

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before starting treatment with capecitabine you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from these drugs. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, pharmacist or nurse will talk to you about this.

What are the side effects of capecitabine?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

• the side effects are affecting your daily life

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include:

Tiredness and weakness (fatigue) during and after treatment

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Loss of appetite

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

You might lose weight.

Diarrhoea

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a stoma , you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Mouth sores and ulcers

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Soreness, redness and peeling on palms and soles of feet

The skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Moisturise your skin regularly. Your healthcare team will tell you what moisturiser to use.

Tummy (abdominal) pain and pain in other areas of the body 

You might get tummy pain or less commonly you may have pain in other parts of your body such as your joints, arms, legs and back.

Tell your treatment team if you have this. They can check the cause and give you medicine to help. 

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• low levels of white blood cells in your blood which can increase your risk of getting an infection. Call your advice line straight away if you think you have an infection, such as a high temperature
• low levels of red blood cells in your blood (anaemia) that can cause breathlessness and looking pale
• difficulty pooing (constipation)
• passing wind (flatulence)
• indigestion, symptoms include heartburn, bloating or burping
• headaches
• dizziness, rarely it may feel like the area around you is spinning and you may lose your balance (vertigo)
• eye problems, such as watery eyes and redness (conjunctivitis). Rarely you may have eyesight changes including double or blurred vision
• hair loss or thinning that usually grows back once your chemotherapy treatment has finished
• skin and nail problems such as skin rashes, dry skin, itching, changes in skin colour, and darkening or brittle nails
• liver changes that are usually mild and unlikely to cause symptoms. It is very rare for your liver to stop working (liver failure) symptoms might include yellowing of the skin and whites of the eyes
• low levels of fluid in the body (dehydration)
• feeling very low in mood (depression)
• difficulty sleeping (insomnia)
• fluid build up in different parts of your body causing swelling
• feeling generally unwell (malaise)
• cough or shortness of breath. This could be a sign of infection or more rarely lung problems such as asthma or a collapsed lung (pneumothorax)
• runny nose
• dry mouth
• nosebleeds, bleeding in the gut or rarely other areas of your body. This might be due to a drop in the number of platelets in the blood, which help your blood to clot
• taste changes
• numbness and tingling sensation on the skin
• pain in your tummy (abdomen), back, chest or other parts of your body
• joint pain
• an infection in your chest or throat
• cold sores

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• heart problems such as changes to your heart rate or rhythm, angina or heart attack
• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness
• changes in blood sugar levels (diabetes)
• high or low blood pressure
• low levels of a mineral in the blood called potassium – you have regular blood tests to check for any changes
• skin sensitivity to sunlight or previously treated areas of skin with radiation can become irritated and inflamed 
• loss of interest in sex
• confusion or memory changes 
• changes to your balance
• numbness or tingling in fingers and toes can make it difficult to do fiddly things such as doing up buttons
• inflammation or blockage in the bowel
• changes to how well your kidneys are working- you will have regular blood tests to check for this  
• problems with passing urine such as going very often overnight or being unable to control when you pass urine 
• flu-like symptoms such as a fever, chills and muscle aches
• very rarely you may develop a severe skin reaction that may start as tender red patches which leads to peeling or blistering of the skin. You might also feel feverish and your eyes may be more sensitive to light. This is serious and could be life threatening
• difficulty swallowing
• panic attacks this can make you feel as though your heart is pounding, sweating, feeling weak and dizzy and having trouble breathing
• fainting
• lumps under the skin (lipoma)
• high levels of a type of fat in your blood
• cold limbs
• muscle weakness and stiffness
• ear pain
• problems with your speech
• blood clots in the veins in the lung (pulmonary embolism)
• sepsis
• oral thrush symptoms can include white patches on the tongue
• tooth infection or abscess
• coughing up blood
• blood in your poo
• changes to how quickly your blood clots
• a blood disorder where your red blood cells get destroyed faster than they can be made (haemolytic anaemia)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do you need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Contraception and pregnancy

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment.

Women must not become pregnant for at least 6 months after the end of treatment. Men should not get someone pregnant for at least 3 months after treatment. 

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

Don’t breastfeed during this treatment and for 2 weeks after your final treatment. This is because the drug may come through into your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.