Capecitabine is a tablet form of fluorouracil (5-FU). It is usually given together with gemcitabine (GemCap) to treat pancreatic cancer. Occasionally it may be used on its own as a second-line treatment for people with locally advanced or advanced pancreatic cancer who have already had gemcitabine as a first-line treatment. Capecitabine may also be used in chemoradiotherapy for treating locally advanced and borderline resectable pancreatic cancer.
How is capecitabine given?
Capecitabine is a tablet which is taken twice a day, 12 hours apart, at home. You will need to swallow the tablets with lots of water within 30 minutes of eating a meal.
If you have problems swallowing the tablets you can crush them and dissolve them in water. Some people are sick just after taking them. If this happens contact your doctor or nurse as anti-sickness medication may help with this.
If you are having GemCap chemotherapy, then capecitabine is taken on a four-week cycle. This means that you will take the tablets for three weeks, then have a break for one week.
GemCap chemotherapy cycle
If you are having capecitabine on its own, you will take it in a three-week cycle. You will take the tablets for two weeks, and then have a break for a week.
If you are having capecitabine combined with radiotherapy you will take it for the course of the radiotherapy treatment. This is usually only on the days that you have your radiotherapy.
The number of cycles of capecitabine you have will depend on your treatment plan and how well you respond to treatment. Ask your nurse or doctor for more details on this.
What are the side effects of capecitabine?
Capecitabine can cause side effects but these can affect everyone differently. Your doctor or nurse should give you information about side effects. Make sure you read this, and ask them any questions you may have about the possible side effects, and how to manage them. Knowing what to expect can help you to deal with any side effects.
The side effects explained below are more likely to happen if capecitabine is given with gemcitabine.
Common side effects
- Increased risk of infection. Capecitabine can increase your risk of getting an infection, because it can cause a drop in the number of your white blood cells. This means your body is less able to fight infection. Signs of an infection include a high temperature, headaches, aching muscles, a cough, sore throat, or feeling shivery and cold.
- Sore mouth and mouth ulcers. This can be mild or severe, making eating and drinking difficult. Try to drink lots of fluids, clean your teeth regularly with a soft toothbrush and avoid spicy or citrus foods that might sting your mouth. Your doctor or nurse can give you an anti-bacterial mouthwash which should help. Using painkillers such as paracetamol or ibuprofen can also help.
- Sore hands and feet. Capecitabine can cause soreness, redness and peeling on the palms of your hands and soles of your feet. Or your skin might look shiny, feel tight and crack around the fingertips. Your doctor or nurse may prescribe a vitamin or creams before starting chemotherapy to help with this. Keeping your hands and feet cool can also help. The soreness usually gets better after your chemotherapy ends.
- Loose watery poo (diarrhoea). If you have diarrhoea, make sure you drink plenty of fluids. If you have diarrhoea more than four times a day, tell your doctor or nurse. They will be able to give you advice, and you may be told to stop taking the capecitabine tablets. Or you may be given medication to control the diarrhoea, or reduce the GemCap dose in future cycles.
- Feeling or being sick (nausea or vomiting). This is a common side effect of capecitabine but can be controlled with anti-sickness medication. You will usually be given medication before your chemotherapy starts to help control or prevent sickness. If it doesn’t work, tell your doctor or nurse – you should be able to change the medication. Read more about coping with feeling and being sick.
- Loss of appetite. During your treatment you may not feel like eating. Try eating small meals often. If your appetite doesn’t improve after a few days, let your doctor or dietitian know. Read more about loss of appetite.
- Fatigue (extreme tiredness). Fatigue is a common side effect of capecitabine. People can feel tired or exhausted for much of the time during treatment. There are ways to deal with fatigue. You might want to keep a fatigue diary, so you can see when you have more energy to do things. This may help you to plan activities on the days that you are feeling better, and rest on days when you’re more tired.
- Tummy (abdominal) pain. You may feel some pain or discomfort in your tummy. Or you may have indigestion, wind or feel bloated. Your doctor can prescribe medication to help with these symptoms.
Less common side effects
- Hair loss. Capecitabine may cause your hair to thin or you may lose it altogether. It should grow back gradually once treatment stops. Talk to your nurse about dealing with hair loss.
- Heart problems. Capecitabine can cause chest pain, breathlessness, palpitations or a fluttering heart. If you have any of these symptoms let the medical team know immediately by calling the emergency number you should have been given. They may prescribe medication. These symptoms usually end after treatment.
- Eye problems. Capecitabine may cause sore or watery eyes. Tell your nurse or doctor if this happens, as you may need antibiotic eye drops.
- Headaches. Capecitabine may cause headaches. Tell your doctor or nurse who can give you painkillers or medicines to improve this. You can also take painkillers such as paracetamol or ibuprofen, but make sure that you check your temperature first. If you have a high temperature tell your medical team before taking any painkillers.
- Risk of a blood clot. Capecitabine can increase the risk of a blood clot forming in a vein (thrombosis), although this is not very common. If you have pain or swelling in one of your legs or arms, or become suddenly very short of breath, phone an ambulance or the emergency contact number that you will have been given immediately. A blood clot needs to be treated straight away.
- Allergic reactions. Capecitabine may cause a severe allergic reaction while you are taking it, but this is very rare. Signs of this can include a rash, feeling dizzy, or swelling of the face and hands. If this happens tell your nurse or doctor immediately as an allergic reaction needs to be treated straight away.
We haven’t listed every possible side effect of capecitabine. Speak to your doctor or nurse for more information if you experience anything unusual. If you are unable to contact your doctor or nurse, contact the medical team on the emergency number that you should have been given.
If you have any questions about capecitabine or side effects, you can also call our specialist nurses free on our Support Line.
More chemotherapy information
- Read more about how chemotherapy is given.
- Read more about managing the side effects of chemotherapy.
Published May 2017