Drug Action
Capecitabine is metabolised to fluorouracil.
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Drug reference
Capecitabine is metabolised to fluorouracil.
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Stage III colon cancer, adjuvant following surgery (monotherapy) ▶BY MOUTH ▶Adult: 1.25 g/m2 twice daily for 14 days, subsequent courses repeated after a 7-day interval, recommended duration of treatment is 6 months, adjust dose according to tolerability—consult product literature Stage III colon cancer, adjuvant following surgery (combination therapy) ▶BY MOUTH ▶Adult: 0.8–1 g/m2 twice daily for 14 days, subsequent courses repeated after a 7-day interval, recommended duration of treatment is 6 months, adjust dose according to tolerability—consult product literature Metastatic colorectal cancer (monotherapy) ▶BY MOUTH ▶Adult: 1.25 g/m2 twice daily for 14 days, subsequent courses repeated after a 7-day interval, adjust dose according to tolerability—consult product literature Metastatic colorectal cancer (combination therapy) ▶BY MOUTH ▶Adult: 0.8–1 g/m2 twice daily for 14 days, subsequent courses repeated after a 7-day interval, adjust dose according to tolerability—consult product literature Advanced gastric cancer (first-line treatment in combination with a platinum based regimen) ▶BY MOUTH ▶Adult: 0.8–1 g/m2 twice daily for 14 days, subsequent courses repeated after a 7-day interval, alternatively 625 mg/m2 twice daily given continuously, adjust dose according to tolerability—consult product literature Locally advanced or metastatic breast cancer (second-line treatment as monotherapy after failure of a taxane and anthracycline regimen or where further anthracycline treatment is not indicated) | Locally advanced or metastatic breast cancer (second-line treatment, in combination with docetaxel, where previous therapy included an anthracycline) ▶BY MOUTH ▶Adult: 1.25 g/m2 twice daily for 14 days, subsequent courses repeated after a 7-day interval, adjust dose according to tolerability—consult product literature
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Dihydropyrimidine dehydrogenase deficiency
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Diabetes mellitus. diarrhoea or dehydration— consult product literature for guidance on dose modification and treatment interruption. electrolyte disturbances. history of angina pectoris. history of arrhythmias. history of significant cardiovascular disease. nervous system disease
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NICE decisions ▶Bevacizumab in combination with capecitabine for the first- line treatment of metastatic breast cancer (August 2012) NICE TA263 Bevacizumab in combinations with capecitabine is not recommended within its marketing authorisation for the first-line treatment of metastatic breast cancer, that is, when treatment with other chemotherapy options including taxanes or anthracyclines is not considered appropriate, or when taxanes or anthracyclines have been used as part of adjuvant treatment in the previous 12 months. www.nice.org.uk/guidance/ta263 ▶Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine for the treatment of metastatic colorectal cancer (December 2010) NICE TA212 Bevacizumab in combination with oxaliplatin and either fluorouracil plus folinic acid or capecitabine is not recommended for the treatment of metastatic colorectal cancer. www.nice.org.uk/guidance/ta212 ▶Capecitabine for the treatment of advanced gastric cancer (July 2010) NICE TA191 Capecitabine in combination with a platinum-based regimen is recommended for the first-line treatment of inoperable advanced gastric cancer. www.nice.org.uk/guidance/ta191 ▶Capecitabine and tegafur with uracil for metastatic colorectal cancer (May 2003) NICE TA61 Capecitabine or tegafur with uracil [now discontinued] (in combination with folinic acid) is an option for the first-line treatment of metastatic colorectal cancer. www.nice.org.uk/guidance/ta61 ▶Capecitabine and oxaliplatin in the adjuvant treatment of stage III (Dukes’ C) colon cancer (April 2006) NICE TA100 Capecitabine alone or oxaliplatin combined with fluorouracil and folinic acid are options for adjuvant treatment following surgery for stage III (Dukes’ C) colon cancer. www.nice.org.uk/guidance/ta100
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RISKS OF INCORRECT DOSING OF ORAL ANTI-CANCER MEDICINES See Cytotoxic drugs p. 938.
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→Appendix 1: capecitabine
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▶Common or very common Alopecia. anaemia. appetite abnormal. asthenia. chest pain. constipation. cough. dehydration. depression. diarrhoea. dizziness. dry mouth . dyspnoea. embolism and thrombosis. eye disorders. eye inflammation. eye irritation. fever. gastrointestinal discomfort. gastrointestinal disorders. haemorrhage. headache. hyperbilirubinaemia. increased risk of infection . insomnia. joint disorders. lethargy. malaise. nail disorder. nausea. neutropenia. oedema. pain. rhinorrhoea. sensation abnormal. skin reactions. stomatitis. taste altered. vomiting. weight decreased ▶Uncommon Acute coronary syndrome. aphasia. arrhythmias. ascites. asthma. chills. confusion. diabetes mellitus. dysphagia. ear pain. facial swelling. haemolytic anaemia. hepatic disorders. hot flush. hydronephrosis. hypertension. hypertriglyceridaemia. hypokalaemia. hypotension. influenza like illness. ischaemic heart disease. leucopenia. libido decreased. lipoma. malnutrition. memory loss. movement disorders. muscle weakness. musculoskeletal stiffness. palpitations. pancytopenia. panic attack. peripheral coldness. peripheral neuropathy. photosensitivity reaction. pneumothorax. radiation recall reaction. sepsis. skin ulcer. syncope. thrombocytopenia. urinary disorders. vertigo. vision disorders ▶Rare or very rare Cutaneous lupus erythematosus. encephalopathy. QT interval prolongation. severe cutaneous adverse reactions (SCARs). vasospasm ▶Frequency not known Cardiomyopathy. heart failure. sudden death
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Contraceptive advice required, see Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Avoid (teratogenic in animal studies). See also Pregnancy and reproductive function in Cytotoxic drugs p. 938.
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Discontinue breast-feeding.
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Manufacturer advises monitor liver function in mild-to-moderate dysfunction—consult product literature for guidance on treatment interruption; avoid in severe impairment.
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Avoid if creatinine clearance less than 30 mL/minute. Dose adjustments Reduce starting dose of 1.25 g/m2 to 75% if creatinine clearance 30–50 mL/minute.
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▶Monitor plasma-calcium concentration. ▶Monitor for eye disorders (including keratitis and corneal disorders). ▶Severe skin reactions Monitor for symptoms of severe skin reactions (including Stevens-Johnson syndrome and toxic epidermal necrolysis)—permanently discontinue treatment immediately if symptoms occur. ▶Hand-foot syndrome Monitor for symptoms of hand-foot syndrome—interrupt treatment if significant syndrome occurs and refer to product literature.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 21 ▶Capecitabine (Non-proprietary) Capecitabine 150 mg Capecitabine 150mg tablets | 60 tablet P £38.90 DT = £30.00 | 60 tablet P £38.02 DT = £30.00 (Hospital only) Capecitabine 300 mg Capecitabine 300mg tablets | 60 tablet P £76.04 DT = £76.04 (Hospital only) Capecitabine 500 mg Capecitabine 500mg tablets | 120 tablet P £225.72 DT = £225.72 | 120 tablet P £240.00– £265.55 DT = £225.72 (Hospital only) ▶Xeloda (Roche Products Ltd) Capecitabine 150 mg Xeloda 150mg tablets | 60 tablet P £40.02 DT = £30.00 Capecitabine 500 mg Xeloda 500mg tablets | 120 tablet P £265.55 DT = £225.72
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1.25 g/m2 twice daily for 14 days, subsequent
First-line fragment. Read the complete Indications and Dose section above.
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0.8–1 g/m2 twice daily for 14 days, subsequent
First-line fragment. Read the complete Indications and Dose section above.
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1.25 g/m2 twice daily for 14 days, subsequent
First-line fragment. Read the complete Indications and Dose section above.
PDF page 978
0.8–1 g/m2 twice daily for 14 days, subsequent
First-line fragment. Read the complete Indications and Dose section above.
PDF page 978
0.8–1 g/m2 twice daily for 14 days, subsequent
First-line fragment. Read the complete Indications and Dose section above.
PDF page 978
1.25 g/m2 twice daily for 14 days, subsequent
First-line fragment. Read the complete Indications and Dose section above.
PDF page 978