Xeloda

Generic Name: Capecitabine

Drug Type:

Xeloda is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  Xeloda is classified as an "antimetabolite."  (For more detail, see "How Xeloda Works" section below).

What Xeloda Is Used For: 

• Metastatic colon or rectal cancer  
• Metastatic breast cancer

Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Xeloda Is Given:

• Taken as a pill by mouth.  
• Take after food (within 30 minutes of a meal) with water. (Usually taken in a divided dose 12 hours apart).
• Tablets come in 2 sizes; 150mg and 500mg. 
• Do not crush, chew or dissolve tablets.
• The amount of Xeloda that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule.

Xeloda Side Effects:

Important things to remember about Xeloda side effects:

• Most people do not experience all of the Xeloda side effects listed.
• Xeloda side effects are often predictable in terms of their onset and duration.
• Xeloda side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent Xeloda side effects.
• There is no relationship between the presence or severity of Xeloda side effects and the effectiveness of the medication.
• The Xeloda side effects of Xeloda and their severity depend on how much of the drug is given.  In other words, high doses may produce more severe side effects.

The following Xeloda side effects are common (occurring in greater than 30%) for patients taking Xeloda:

• Low red blood cell count (anemia) 

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: N/A
Nadir: 10-14 days
Recovery: N/A

• Fatigue
• Diarrhea
• Hand -foot syndrome (Palmar-plantar erythrodysesthesia or PPE) -skin rash, swelling, redness, pain and/or peeling of the skin on the palms of hands and soles of feet.  Usually mild, has started as early as 2 weeks after start of treatment.  May require reductions in the dose of the medication.  
• Nausea and vomiting
• Dermatitis
• Elevated liver enzymes (increased bilirubin levels) (see liver problems).

These Xeloda side effects are less common side effects (occurring in about 10-29%) of patients receiving Xeloda:

• Poor appetite 
• Abdominal pain
• Low white blood cell count. (This can put you at increased risk for infection).
• Low platelet count.  (This can put you at increased risk for bleeding).
• Mouth sores
• Numbness or tingling of hands or feet
• Swelling of the feet and ankles
• Fever
• Constipation
• Eye irritation (watery eyes, inflammation of the eyelids, redness).
• Shortness of breath
• Headache 
• Chest, back, muscle, joint, bone pain  (see pain)
• Dizziness 
• Insomnia (see sleep disturbances)
• Dehydration
• Cough 
• Blood clots.  (Blood clots rarely can lead to pulmonary embolus or stroke - potentially life-threatening conditions). 
• Excessive sleepiness, confusion, very rare seizures (see central neurotoxicity). 
• Loss of balance
• Nail changes, darkening of the skin (see skin reactions)
• Taste changes

Not all Xeloda side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When To Contact Your Doctor or Health Care Provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following: 

• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• Constipation
• Extreme fatigue (unable to carry on self-care activities)
• Mouth sores (painful redness, swelling or ulcers)
• Swelling, redness and/or pain in one leg or arm and not the other
• Yellowing of the skin or eyes
• Tingling or burning, redness, swelling of the palms of the hands or soles of feet.
• Confusion, loss of balance, excessive sleepiness

Always inform your health care provider if you experience any unusual symptoms.

Xeloda Precautions: 

• Before starting Xeloda treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
• Avoid use of antacids within 2 hours of taking Xeloda. 
• If you are on warfarin (Coumadin^®) as a blood-thinner, adjustments may need to be made to your dose based on blood work. 
• Xeloda may be inadvisable if you have had a hypersensitivity (allergic) reaction to fluorouracil.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking Xeloda.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Xeloda may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking Xeloda. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking Xeloda.

Xeloda Self Care Tips:

• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.
• Prevention of hand-foot syndrome. Modification of normal activities of daily living to reduce friction and heat exposure to hands and feet, as much as possible during treatment with Xeloda. (for more information see - Managing side effects: hand foot syndrome).
• Keep palms of hands and soles of feet moist using emollients such as Aveeno^®, Udder cream, Lubriderm^® or Bag Balm^®. 
• Follow regimen of anti-diarrhea medication as prescribed by your health care professional. 
• Eat foods that may help reduce diarrhea (see managing side effects - diarrhea).
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
• You may experience drowsiness or dizziness; avoid driving or engaging in tasks that require alertness until your response to the drug is known.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
• Get plenty of rest. 
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Xeloda:

You will be checked regularly by your doctor while you are taking Xeloda, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.   

How Xeloda Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.  "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Xeloda belongs to the category of chemotherapy called antimetabolites.  Antimetabolites are very similar to normal substances within the cell.  When the cells incorporate these substances into the cellular metabolism, they are unable to divide.  Antimetabolites are cell-cycle specific.  They attack cells at very specific phases in the cycle.  Antimetabolites are classified according to the substances with which they interfere.

• Folic acid antagonist: Methotrexate.
• Pyrimidine antagonist: 5-Fluorouracil, Foxuridine, Cytarabine, Xeloda, and Gemcitabine.
• Purine antagonist: 6-Mercaptopurine and 6-Thioguanine.
• Adenosine deaminase inhibitor: Cladribine, Fludarabine and Pentostatin.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.