1. What is capecitabine?
Capecitabine is a drug. You may hear it called by its brand name Xeloda.
2. When is capecitabine given?
For some people with primary breast cancer
You may benefit from capecitabine if you have that is triple negative.
If you have chemotherapy before surgery you may be offered capecitabine after your surgery.
Your treatment team will discuss with you if this is an option.
When breast cancer has spread
Capecitabine is used to treat breast cancer that has come back (recurrence) after previous treatment. This could be:
As part of a clinical trial
Capecitabine may be offered as part of a clinical trial.
3. Before starting capecitabine
Before starting your treatment, a member of the treatment team will discuss how and when you’ll have chemotherapy and how side effects can be managed.
You’ll have blood tests, and your height and weight will be measured.
You may also have tests to check your heart function, such as:
- An ECG (electrocardiogram), a simple test that checks your heart rhythm
- An echocardiogram (an ultrasound scan of the heart)
You should be given a 24-hour contact number or told who to contact if you feel unwell at any time during your treatment, including overnight or at the weekends.
DPD testing
Before starting capecitabine you will be offered a blood test to check your levels of DPD.
DPD is a type of protein (enzyme) made naturally in the body. Not having enough DPD can cause capecitabine to build up in the body, resulting in severe side effects. In very rare cases this can be life-threatening.
If you have low levels of DPD, or no DPD (known as a DPD deficiency), your treatment team may offer you a reduced dose of capecitabine or a different chemotherapy drug.
For more information on DPD see the Cancer Research UK website.
4. How is capecitabine taken?
Different ways chemotherapy can be given
Chemotherapy to treat breast cancer can be given in several ways, including through a vein or as tablets or capsules. Find out more and see ...
You will take capecitabine as a tablet (orally).
Capecitabine is available in 2 different tablet strengths (150mg or 500mg). Your treatment team will tell you how many of each tablet to take to make sure you get the right amount each day for your body size.
You should swallow the tablets whole with water within half an hour of eating a meal. It’s important not to break, crush or chew the tablets. Talk to your treatment team if you find it difficult to swallow tablets.
You usually take capecitabine twice a day (once in the morning and once in the evening) for 14 days. You will then have a 7-day break. This 21-day period is often referred to as 1 treatment cycle. If you’re prescribed capecitabine differently to the 21-day cycle, your treatment team will explain why.
Capecitabine is often taken on its own, but you may have it alongside other chemotherapy drugs.
Handling and storing chemotherapy drugs
It’s important to remember the following when you’re taking capecitabine at home. You can find out more information about handling chemotherapy drugs at home on the Cancer Research UK website.
After taking your tablets
Wash your hands after taking your capecitabine tablets.
If you are sick (vomit) after taking your tablets, do not take an extra dose.
Storing your tablets
Keep the tablets in their original packaging. Store them at room temperature, away from moisture, heat and direct sunlight.
Keep the tablets out of the reach of children. Avoid having other people touch the tablets directly.
At the end of your capecitabine treatment
Do not throw away unused capecitabine tablets. Return them to your treatment team.
How long will I have to take capecitabine for?
How long you need to take capecitabine for varies from person to person.
Primary breast cancer
If you have primary breast cancer, your treatment team will talk to you about how many treatment cycles of capecitabine you will have.
Secondary breast cancer
If you have secondary breast cancer, you’ll keep taking capecitabine for as long as your treatment team feels you’re benefiting from the drug and any side effects are manageable.
5. Side effects of capecitabine
Like any treatment, capecitabine can cause side effects. Everyone reacts differently to drugs and some people have more side effects than others. These side effects can usually be managed and those described here will not affect everyone.
If you’re worried about any side effects, regardless of whether they’re listed here, talk to your chemotherapy nurse or treatment team.
Doctors can tailor the dose of a drug by reducing it to suit an individual and to help manage its side effects. For some people this can help them stay on a treatment for longer.
Common side effects
Effects on the blood
Capecitabine can temporarily affect the number of blood cells in the body. Blood is made up of red cells, white cells and platelets.
You’ll have regular blood tests. If these show the number of blood cells is too low, your next cycle of treatment may be delayed or the dose of chemotherapy reduced.
Risk of infection
Not having enough white blood cells can increase the risk of getting an infection.
Signs of an infection
Your treatment team may give you guidelines to follow for reporting signs of an infection. But generally you should contact your hospital advice line immediately if you experience any of the following:
- A high temperature (over 37.5°C) or low temperature (under 36°C), or whatever your treatment team has advised
- Suddenly feeling unwell, even with a normal temperature
- Symptoms of an infection, for example a sore throat, a cough, a need to pass urine frequently or feeling cold or shivery
Chemotherapy side effects
Learn about the possible side effects of chemotherapy for breast cancer - which are usually temporary - and how they can be managed or contr...
Before starting chemotherapy you should be given a 24-hour contact number or told where to get emergency care by your treatment team.
You may need treatment if you have an infection.
Sometimes your doctor may recommend injections of drugs called growth factors. This helps the body produce more white blood cells to reduce your risk of infection.
Anaemia
Having too few red blood cells is called anaemia. If you feel breathless, dizzy or particularly tired, let your treatment team know.
Bruising and bleeding
Capecitabine can reduce the number of platelets, which help the blood to clot.
You may bruise more easily, have nosebleeds or your gums may bleed when you brush your teeth.
Tell your treatment team if you have any of these symptoms.
Diarrhoea
Diarrhoea is common during treatment and can sometimes be severe.
Tell your chemotherapy team as they can prescribe medication and may consider stopping your capecitabine for a time to help control it.
Speak to them immediately if you have any of the following symptoms:
- 3 or more episodes of diarrhoea in 24 hours
- Blood in your poo when you go to the toilet
- Tummy (abdominal) pain
Skin reactions
Hand-foot syndrome (palmar-plantar erythrodysesthesia) is a common side effect of capecitabine.
The palms of the hands and the soles of the feet can become red, darkened and sore. They can also become dry and flaky.
You may also notice:
- A tingling feeling
- Numbness
- Some swelling
Find out about things you can do that may reduce the chances of developing hand-foot syndrome.
It’s important to let your treatment team know if you have any symptoms as they may prescribe emollients or creams to apply to the affected areas.
If your symptoms are severe, your treatment team may recommend delaying treatment, reducing the dose, or stopping treatment. Symptoms usually get better once treatment is reduced or stopped. Your skin should start to improve within a few weeks.
If you develop severe and ongoing hand-foot syndrome while taking capecitabine, you may lose your fingerprints. This is a rare symptom, but it may be permanent.
Feeling sick (nausea) and being sick (vomiting)
You may feel sick (nausea) or be sick (vomit), but many people will not actually be sick.
You will be given anti-sickness medication before you have chemotherapy. Your treatment team will also prescribe you anti-sickness drugs to take home to reduce or prevent nausea.
Sore mouth
Looking after your mouth, including your teeth and gums, is very important during treatment.
You may be given mouthwash to try to reduce soreness and stop mouth ulcers developing. You may be advised to use a small, soft toothbrush during this time.
See your dentist for a check-up before treatment with chemotherapy begins. Avoid dental work during chemotherapy if possible.
If you do need to have dental work during treatment, talk with your treatment team about the best time to have this.
Changes to your appetite
You can lose your appetite while you are taking capecitabine. Your sense of taste can also change, so some foods and drink may taste different.
Talk to your treatment team about this. They will give you advice and information or refer you to a dietitian if needed.
Find out more about diet during treatment.
Extreme tiredness (cancer-related fatigue)
Fatigue is extreme tiredness that does not go away with rest or sleep. It’s a very common side effect of cancer treatment.
Cancer-related fatigue is one of the most common symptoms in people with secondary breast cancer.
If you think you have fatigue, tell your GP or treatment team. They can assess you and offer advice on how to manage your energy levels.
Find out more about managing fatigue.
Less common side effects
Hair thinning
When used on its own, capecitabine occasionally causes some temporary hair thinning. It very rarely causes complete hair loss.
If capecitabine is taken in combination with another chemotherapy drug, most people will lose all their hair including eyebrows, eyelashes and body hair.
Find out more about hair loss.
Other less common side effects
Other less common side effects of capecitabine include:
- Joint and back pain
- Taste changes
- Headache
- Dizziness
- Difficulty sleeping
- Sore and watery eyes
Your treatment team can advise on how to manage these.
Rare side effects
Allergic reaction
Contact your hospital immediately if you notice any of the following symptoms:
- Itchy red/discoloured bumps on your skin (these may be harder to see on black or brown skin)
- Swelling in your lips, tongue or throat
- Breathlessness, wheezing, a bad cough or sudden difficulty breathing
- Tight chest or chest pain
If you have a severe reaction, treatment will be stopped immediately.
If you have a less severe reaction, you may need to take medication before future treatments to reduce the risk of further reactions.
Blood clots
People with breast cancer have a higher risk of blood clots. Having chemotherapy also increases the risk of blood clots such as a DVT (deep vein thrombosis).
If you have a DVT, there’s a risk part of the blood clot could break away and travel to the lung. This is known as a pulmonary embolism (PE).
Blood clots can be life-threatening and should be treated quickly.
Blood clot symptoms
Contact your treatment team or go to your local A&E department straight away if you have any of the following symptoms:
- Pain, redness/discolouration of the skin, heat and swelling of the arm or leg
- Swelling, redness or tenderness where a central line is inserted to give chemotherapy, for example in the arm, chest area or up into the neck
- Shortness of breath
- Pain or tightness in the chest
- Unexplained cough or coughing up blood
Find out more about blood clots.
6. Other important information
What happens if I miss a dose?
If you miss a dose of capecitabine, do not take an extra dose to make up for the one you missed. Take the next dose at the usual time and speak to your treatment team.
Driving and using machinery
Capecitabine may make you feel dizzy, sick or tired. This could affect your ability to drive or operate machinery safely.
Avoid driving or using machinery if you have any symptoms that may affect your ability to do this.
Can I take capecitabine with other drugs?
If you’re taking any other prescribed or over-the-counter medicines, let your treatment team know.
If you take drugs to thin the blood (anti-coagulants) such as warfarin, capecitabine can increase your risk of bleeding. Your treatment team may check more often how quickly your blood clots, adjust your dose of blood-thinning drugs or, more commonly, change you to an injection to thin the blood instead.
Sex, contraception and pregnancy
You can still have sex during treatment. It’s thought chemotherapy drugs cannot pass into vaginal fluids or semen, but this cannot be completely ruled out.
Most treatment teams will advise using barrier methods of contraception, such as condoms, during treatment.
You’re advised not to become pregnant while having treatment and for 6 months after taking your last dose. This is because capecitabine can harm a developing baby. If you have not been through the menopause, talk to your treatment team about the most suitable method of contraception for you. It’s still possible to become pregnant even if your periods are irregular or have stopped.
Find out more about how breast cancer and its treatment can affect sex and intimacy and read our tips on how to manage these changes.
Vaccinations
If you’re planning a holiday or need to travel overseas, check with your treatment team first.
You should not have any live vaccines while you’re having chemotherapy.
For more information about vaccines, including COVID-19 and flu vaccines, see our information on vaccines and breast cancer.
7. Further support
Your chemotherapy team and breast care nurse can help with any questions you have. You can also call our free helpline below for information and support.
If you’re having chemotherapy for primary breast cancer, our Someone Like Me service can put you in touch with someone who has had the same experience as you. Find out more about this service below.
You can find people going through treatment at the same time as you on the monthly chemotherapy threads on our online forum.
