Irinotecan and capecitabine (XELIRI, CAPIRI, IrCap)

Irinotecan and capecitabine is a chemotherapy combination known as XELIRI, CAPIRI and IrCap.

It is a treatment for bowel cancer that has spread to other parts of the body. When bowel cancer has spread to other parts of the body it’s called advanced or metastatic bowel cancer.

How does irinotecan and capecitabine work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

How do you have irinotecan and capecitabine?

You have irinotecan as a drip into your bloodstream (intravenously). 

Capecitabine comes as tablets that you swallow whole, with plenty of water. You usually take the tablets twice a day, about 12 hours apart. You should take them within 30 minutes of finishing a meal.

Your doctor will tell you the amount (dose) of capecitabine you need to take. You might have two different strengths of tablets to make up the correct dose. 

Taking your tablets

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.

Into the bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

How often do you have irinotecan and capecitabine?

You have irinotecan and capecitabine chemotherapy as cycles of treatment. This means you have the drugs and then a rest to allow your body to recover.

You might have a cycle that lasts either 2 weeks (14 days) or 3 weeks (21 days). You have this treatment for as long as it is working and the side effects aren’t too bad.

You usually have the 2 week cycle in the following way:

You usually have the 3 week cycle in the following way:

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 irinotecan and 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 (more than 10%). You might have one or more of them. They include:

Increased risk of getting an infection

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, headaches, feeling cold and shivery and generally unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Acute cholinergic syndrome

Irinotecan can cause some people to develop a set of side effects during or within the first 24 hours after having the drug. These side effects include diarrhoea which may be severe. Other symptoms are - sweating, stomach cramps, increased production of saliva, and watery eyes. You may have an injection of atropine before the irinotecan to reduce these side effects.

Diarrhoea

Diarrhoea means having loose, watery poo. This can happen during your treatment, or at any time between treatments.

Your healthcare team might give you medicines to take home. They will explain how and when to use them.

Tiredness and weakness (fatigue)

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.

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.

Tummy (abdominal) pain and pain in different parts of the body

You might get tummy pain or less commonly pain in different parts of the body such as your limbs, joints, chest or back.

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

Less commonly you might lose weight.

Sore mouth

It may be painful to swallow drinks or food. Painkillers and mouth washes can help to reduce the soreness and keep your mouth healthy. 

Less commonly you might have a dry mouth.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Soreness, redness and peeling on the hands and soles of the 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.

High temperature (fever)

Tell your healthcare team straightaway if you get a high temperature. Ask them if you can take paracetamol to help lower your temperature.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and10%). You might have one or more of them. They include:

• bruising, bleeding gums or nosebleeds, rarely you might notice purple spots on your skin (purpura)
• liver problems that are picked up on blood tests, rarely you might have yellowing of the skin and whites of the eyes
• skin and nail problems such as skin rashes, reddening, itching, changes in skin colour, darkening or brittle nails. Rarely your skin might blister and ulcer, it may be sensitive to sunlight.
• areas of skin previously treated with radiation can become irritated and inflamed
• difficulty pooing (constipation)
• headaches
• feeling dizzy, rarely the room around you may feel as though it is spinning or moving (vertigo)
• taste changes
• eye problems such as watery eyes or inflammation of the conjunctiva (conjunctivitis). Rarely you might have eyesight changes including blurred or double vision
• feeling generally unwell (malaise)
• changes to how well your kidneys are working- you will have regular blood tests to check for this
• difficulty sleeping (insomnia)
• feeling very low (depression)
• low levels of fluid in the body (dehydration)
• indigestion, symptoms include heartburn, bloating and burping
• passing wind (flatulence)
• bleeding in the bowel – this can make your poo look dark or you might notice blood, contact your healthcare team know if this happens
• fluid build up in the limbs and other areas of the body causing swelling
• shortness of breath and cough. This could be a sign of infection or more rarely lung problems such as asthma or a collapsed lung (pneumothorax)
• runny nose
• numbness and tingling sensation on the skin
• problems with passing urine such as burning or stinging when going, passing blood and changes to how often you go. Rarely you might be unable to control when you pass urine
• blood clots in veins near the surface of your skin (thrombophlebitis) or more rarely in deep muscles (deep vein thrombosis, DVT). DVTs can be life threatening. Signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms

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:

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life-threatening, alert your nurse or doctor if notice any of these symptoms
• high or low blood pressure
• heart problems such as changes to your heart rate or rhythm, angina or heart attack
• 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
• numbness or tingling in fingers or toes can make it difficult to do fiddly things such as doing up buttons (peripheral neuropathy)
• a blood disorder where your red blood cells get destroyed faster than they can be made (haemolytic anaemia)
• flu-like symptoms such as fever, chills and muscle aches
• inflammation of different parts of the digestive system - symptoms can include tummy pain and discomfort, loss stool (diarrhoea) that may or may not have blood in, loss of appetite and urgency to go to the toilet
• blockage in the bowel
• confusion or memory changes
• changes in blood sugar levels (diabetes)
• hot flushes
• cold limbs
• lumps under the skin (lipoma)
• low levels of a mineral known as potassium in your blood
• high levels of a type of fat in your blood
• panic attacks this can make you feel as though your heart is pounding, sweating, feeling weak and dizzy and having trouble breathing
• difficulty speaking
• problems with your balance and coordination of your movements
• fainting
• coughing up blood
• unusual bleeding from the vagina
• muscle weakness and stiffness
• lack of interest in sex
• difficulty swallowing

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

Coping with side effects

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

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Lactose intolerance 

Capecitabine contains lactose (milk sugar). If you have an intolerance to lactose, contact your doctor before taking this medicine.

Sorbitol

Irinotecan contains a type of sugar called sorbitol. If you have an intolerance to some sugars, ask your doctor if it is safe for you to take this drug. 

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant or father a child while you're having treatment and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.

Loss of fertility 

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

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.