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Capecitabine - Learn about Capecitabine Side Effects and Precautions

Capecitabine Information

The pharmacology action of Capecitabine is that capecitabine is an oral systemic prodrug that is enzymatically converted to 5-fluorouracil (5-FU). Healthy and tumor cells metabolize 5-FU to 5-fluoro-2-deoxyuridine monophosphate (FdUMP) and 5-fluorouridine triphosphate (FUTP). These metabolites cause cell injury by 2 different mechanisms. First, they inhibit the formation of thymidine triphosphate, which is essential for the synthesis of DNA. Second, nuclear transcriptional enzymes can mistakenly incorporate FUTP during the synthesis of RNA. This metabolic error can interfere with RNA processing and protein synthesis.

Capecitabine is used in treatment of resistant metastatic breast cancer alone or in combination with docetaxel; colorectal cancer.

Interaction and Contraindication of Capecitabine

Interaction of Capecitabine - Antacids:  May increase capecitabine levels.
Cimetidine or metronidazole:  May increase serum concentrations of fluorouracil and potentially increase toxicity
Fluorouracil:  Drug interactions have been reported with fluorouracil, the principal active metabolite of capecitabine.
Leucovorin:  May enhance GI toxicity of fluorouracil.
Levamisole:  Risk of hepatotoxicity may be increased by coadministration with fluorouracil.
Phenytoin:  Levels may be elevated by capecitabine, increasing the risk of side effects.
Warfarin:  May alter warfarin's effects

Contraindication of Capecitabine - Hypersensitivity to 5-FU; severe renal impairment (Ccr below 30 mL/min); dihydropyrimidine dehydrogenase deficiency

Side Effects of Capecitabine

Here are the list of some common side effects of Capecitabine :

• Paresthesia (21%); peripheral sensory neuropathy, headache (10%); dizziness (8%); insomnia (7%); taste disturbances (6%); mood alteration, depression (5%).
• Hand-and-foot syndrome (54%); dermatitis (27%); skin discoloration, nail disorder (7%); alopecia (6%).
• Eye irritation (15%); pharyngeal disorder, abnormal vision (5%); sore throat (2%); laryngitis (1%).
• Diarrhea (55%); nausea (43%); abdominal pain (35%); vomiting (27%); decreased appetite (26%); stomatitis (25%); constipation (14%); GI motility disorder, oral discomfort (10%); upper GI inflammatory disorders, dyspepsia (8%); GI hemorrhage, ileus (6%).
• Fatigue/weakness (42%); pyrexia (18%); edema (15%); pain (12%); back pain (10%); myalgia (9%); arthralgia (8%); chest pain, pain in limb (6%); viral infections (5%).

Precaution and Warning while taking Capecitabine

The precaution and warnings of Capecitabine drug is as follows:

• Review the following cyclic dosing schedule with patient or caregiver: bid for 2 wk, rest for 1 wk, then repeat cycle.
• Advise patient to take prescribed dose in the morning and evening with a glass of water within 30 min after a meal.
• Advise patient or caregiver that if a dose is missed not to take the missed dose and do not double the next dose. Take the next dose at the regularly scheduled time.
• If patient is using a combination of different tablet strengths, ensure that patient or caregiver can correctly identify the correct dose.
• Advise patient that medication may be used in combination with other chemotherapy agents to achieve max benefit possible.
• Advise patient to discontinue therapy and notify health care provider if any of the following occur: diarrhea with 4 to 6 stools/day or diarrhea at night; nausea or sores in the mouth that interfere with eating; vomit 2 to 5 times within 24 hr; redness, swelling, and pain of the hands or feet.
• Advise patient or caregiver that OTC antidiarrheals (eg, loperamide) can be used to treat mild diarrhea.
• Advise patient to report fever, chills, or other signs of an infection to health care provider immediately.
• Caution women of childbearing potential to avoid becoming pregnant while being treated.
• Advise women to notify health care provider if pregnant, planning to become pregnant, or breastfeeding.
• Instruct patient not to take any prescription or OTC medications or dietary supplements unless advised by health care provider.

How to store Capecitabine

• Do not administer to patient with Ccr less than 30 mL/min.
• May be administered alone or in combination with other chemotherapy medications.
• Administer prescribed dose bid, morning and evening. Administer each dose with water within 30 min after a meal.
• Medication is administered in 3-wk cycles, 2 wk of bid therapy, then 1 wk rest period.
• Store tablets at controlled room temperature (59° to 86°F).