Capecitabine is a chemotherapy drug used to treat pancreatic cancer.
How is capecitabine used?
Capecitabine is normally given with another chemotherapy drug called gemcitabine. This is known as GemCap:
- Gem – gemcitabine
- Cap – capecitabine.
GemCap can be used in different ways:
- If you have cancer that can be removed with surgery (such as the Whipple’s procedure), you may be offered GemCap after surgery to try stop the cancer coming back.
- If you have cancer that has grown close to major blood vessels near the pancreas (borderline resectable cancer), you may have GemCap to try to shrink the cancer to make surgery possible.
- If you have locally advanced or advanced pancreatic cancer and surgery is not possible, you may be offered GemCap to try to control the growth of the cancer.
Sometimes capecitabine may be used on its own for advanced pancreatic cancer. This isn’t used often and is only given if you have already had gemcitabine.
Capecitabine and radiotherapy
If you have chemoradiotherapy, the chemotherapy drug that is normally used is capecitabine. The chemotherapy may make the cancer cells more sensitive to the radiotherapy, making it more effective.
How is capecitabine given?
Capecitabine is a tablet that you take at home. You take the tablets twice a day, 12 hours apart. They should be taken after eating a meal and should not be cut or crushed. If you find it hard to swallow tablets, or are sick just after taking them, contact your chemotherapy team for advice.
If you are having capecitabine with gemcitabine (GemCap), this is given in a four-week cycle. This means that you will have treatment for three weeks, and then have a one week break. The break allows your body to recover.
The number of GemCap cycles you have will depend on how the treatment is working and how chemotherapy affects you.
You will take the capecitabine tablets every day, twice a day, for three weeks. You will also have gemcitabine once a week, through an infusion which takes 30 minutes. You may hear an infusion called a ‘drip’.
Read more about how chemotherapy is given.
Capecitabine and radiotherapy
If you are having capecitabine with radiotherapy, you will take capecitabine tablets on the days that you have radiotherapy. For example, you may have capecitabine and radiotherapy every day during the week, and then have a break from treatment at the weekend. Speak to your doctor or nurse about your treatment.
What are the side effects of Capecitabine?
Capecitabine can cause side effects, but these can affect everyone differently, and you may not get all of the side effects mentioned here.
Your chemotherapy team should give you information about any possible side effects and how to manage them. Ask them any questions you have. You can also speak to our specialist nurses on our free Support Line. Knowing what to expect can help you deal with any side effects.
Capecitabine is broken down in the body by an enzyme called dihydropyrimidine dehydrogenase (DPD). Some people have lower amounts of the DPD enzyme, which is known as DPD-deficiency. People with DPD-deficiency can have side effects that are much worse than usual. These include infections, runny poo (diarrhoea) and feeling or being sick. You will have a blood test to check for DPD-deficiency before you start chemotherapy.
Your chemotherapy team should give you a 24 hour emergency number to call if you are unwell, have any signs of infection, or if you need information about any side effects. Your nurse will explain when to use this number. If you haven’t been given a number, ask your nurse about this.
Common side effects
Capecitabine can increase your risk of getting an infection. An infection is an emergency if you are having chemotherapy, and needs treating straight away. Signs of an infection include:
- a high temperature – your chemotherapy team will tell you what a high temperature is
- feeling shivery and cold
- sore muscles
- a cough or sore throat
- having pain or burning when you pee
- feeling generally unwell or tired.
Call the 24 hour emergency number your chemotherapy team will have given you if you have signs of an infection. You should phone if you have any of these symptoms or feel suddenly unwell, even if your temperature is normal or low.
Fatigue (extreme tiredness)
Fatigue is a common side effect of capecitabine. It isn’t the same as feeling tired. Fatigue can make you feel weak and have problems concentrating. Some people find that the fatigue starts a few hours to a few days after having chemotherapy and starts to get better after a few days. See how the chemotherapy affects you and work out how much activity you can manage. There are things that can help with fatigue. Read our tips coping with fatigue.
Feeling or being sick (nausea or vomiting)
This is a common side effect of capecitabine. You will normally be given anti-sickness medicines to manage sickness. If these medicines don’t help, speak to your chemotherapy team about changing to a different medicine.
If you find it hard to swallow the capecitabine tablets, or you are sick just after taking them, call your chemotherapy team for advice.
Sore hands and feet
Capecitabine can make the palms of your hands and the soles of your feet red and sore, and your skin may start to peel or blister. Your skin might also look shiny, feel tight and crack around the fingertips. Your doctor or nurse may give you a vitamin or creams to help with this.
The soreness normally gets better when your chemotherapy finishes. If it gets very painful or you have broken skin that looks infected, call the emergency number.
Sore mouth and mouth ulcers
Capecitabine can make your mouth sore, or cause mouth ulcers which can be painful. Tell your chemotherapy team about any problems with your mouth. They can make sure you don’t have a mouth infection, and give you a mouthwash which should help.
Loss of appetite
During your treatment you may not feel like eating, and you may start to lose weight. Try eating small meals often. If your appetite does not get better after a few days, speak to your doctor, specialist nurse or dietitian. We have tips on dealing with a loss of appetite.
Runny poo (diarrhoea)
If you have diarrhoea, try to drink as much water as you can. If you are finding it hard to drink enough fluids, contact your chemotherapy team. If you have diarrhoea more than four times a day, tell your chemotherapy team. They can give you medicines to control it. You may be told to stop taking capecitabine, or your doctor can lower the dose. We have tips on dealing with diarrhoea.
You may have some tummy pain or discomfort when you are having capecitabine. Or you may have indigestion, lots of wind, or feel bloated. You may also have constipation (when you find it harder to poo). Your doctor can give you medicines to help with these side effects.
Some people get swelling in their feet, ankles, legs, fingers or face. This is because of a build-up of fluid, which is called oedema. This normally gets better by itself. If you have swelling in your feet, it may help to have your legs up on a cushion when you are sitting down. Your doctor may also be able to give you some medicines to help.
Capecitabine can cause chest pain. It can also make you feel short of breath, dizzy, or cause an irregular heartbeat. It is important to tell your chemotherapy team straight away if you have any of these symptoms. If you have chest pain, go straight to A&E and tell them you are having chemotherapy.
Anaemia (feeling tired or dizzy)
Capecitabine can lower the number of red blood cells in your blood. This is called anaemia, and can make you feel tired, dizzy or short of breath. If any of these symptoms happen suddenly, call the emergency number.
Less common side effects
Bruising and bleeding
Capecitabine can lower the number of platelets in your blood. This is called thrombocytopenia. You may bruise more easily than normal, and you may be more likely to have nosebleeds or bleeding gums.
Joint and muscle pain
Capecitabine can cause problems with your joints, such as swelling or pain. Your muscles may also feel weak or stiff.
Sore, itchy eyes
Capecitabine can cause sore, itchy or watery eyes. Tell your doctor or nurse if this happens, as they may need to give you some eye drops.
Capecitabine can cause headaches. Tell your chemotherapy team if you have headaches. They can give you painkillers such as paracetamol or ibuprofen. Make sure that you check your temperature before taking paracetamol or ibuprofen. If you have a high temperature, call the emergency number straight away.
Risk of a blood clot in a vein
Capecitabine can increase your risk of getting a blood clot in a vein. If you have any pain or swelling in one of your arms or legs, or you feel very short of breath, call the emergency number. Or phone an ambulance and tell them you are having chemotherapy. A blood clot can be serious if it’s not treated.
Questions about side effects?
Speak to your chemotherapy team if you feel anything unusual, or if you would like more information.
You can also speak to our specialist nurses on our free Support Line about capecitabine and side effects.
Updated April 2022
Review date April 2024