Capecitabine (XELODA)

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Indication

Breast cancer, colon cancer

Dose

Breast cancer, colon cancer

Oral: Many dosing regimens, please refer to specific chemotherapy protocol.
Given as monotherapy or in combination with other chemotherapy agents or radiation

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Supplied

Available as 150 mg and 500 mg film-coated tablets. Tablets contain lactose. Tablets should NOT be crushed or broken. Store at room temperature.

Pharmacological Category

Antimetabolite (Pyrimidine Analog)

Administration

Take with food (within 30 minutes following the end of a meal)

Missed Dose

If a dose is missed, patients should be instructed not to take the missed dose but to resume with the next scheduled dose.

Adverse Effects

Common: Diarrhea, Nausea, Vomiting, Stomatitis, Hand-foot skin reaction.

Less Common: Cardiotoxicity, Neutropenia, Thrombocytopenia, Hyperbilirubinemia.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Monitoring Parameters

Baseline before treatment: CBC & differential, platelets, creatinine, ALT, alkaline phosphatase, bilirubin, albumin, GGT, BUN, LDH, consider DPYD testing.

‍During treatment: CBC & differential, platelets, creatinine.

If clinically indicated: ALT, alkaline phosphatase, bilirubin, albumin, GGT, BUN.

Drug Interactions

Proton pump inhibitors may reduce pharmacological effect of capecitabine. Consider avoiding PPIs if possible, and a cautious approach would be to switch patient to an antacid regimen.
This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
Current drug interaction databases should be consulted for more information.

Clinical Pearls

Avoid in pregnancy and lactation.
Hand-foot skin reaction is common with this drug. Prevention tactics can include avoidance of tight fitting clothes and regular application of lanolin-containing creams.
Diarrhea and stomatitis are both common with this drug. Patients should be educated on prevention tactics, and early management is important.
Loss of fingerprints has been observed in some patients treated with capecitabine.
Capecitabine is a prodrug of fluorouracil, an IV chemotherapy agent.
Dihydropyrimidine dehydrogenase (DPD) deficiency may result in severe and unexpected toxicity, including stomatitis, diarrhea, neutropenia, neurotoxicity, which can be life threatening or fatal. This is due to reduced drug metabolism.

References

BC Cancer. BC Cancer Drug Manual. Capecitabine. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Capecitabine_monograph.pdf. Updated June 1, 2023. Accessed January 22, 2024.

Lexicomp. Capecitabine Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online.lexi.com/lco/action/doc/retrieve/docid/patch_f/6519?cesid=6kyQGBQ9rxG&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dcapecitabine%26t%3Dname%26acs%3Dfalse%26acq%3Dcapecitabine. Updated January 27, 2024. Accessed January 31, 2024.

Cancer Care Ontario. Capecitabine Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at:https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44046 . Updated April 2023. Accessed January 22, 2024.Hoffman-La Roche. XELODA® Product Monograph. Mississauga, Ontario. Updated April 4, 2022.