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Pharmacologic class: Fluoropyrimidine, antimetabolite (pyrimidine analog)
Therapeutic class: Antineoplastic
Pregnancy risk category D
FDA Box Warning
• In patients receiving concomitant oral coumarin-derivative anticoagulants (such as warfarin and phenprocoumon), monitor International Normalized Ratio (INR) or prothrombin time (PT) frequently to allow appropriate anticoagulant dosage adjustment. Altered coagulation parameters, bleeding, and death have occurred in patients taking this drug combination. Postmarketing reports show significant INR and PT increases in patients stabilized on anticoagulants when capecitabine therapy began. Age older than 60 and cancer diagnosis independently increase coagulopathy risk.
Enzymatically converts to 5-fluorouracil, which injures cells by interfering with DNA synthesis, cell division, RNA processing, and protein synthesis
Tablets: 150 mg, 500 mg
Indications and dosages
➣ Metastatic breast cancer resistant to both paclitaxel and a chemotherapy regimen that includes anthracycline; metastatic colorectal cancer when treatment with fluoropyrimidine therapy alone is preferred
Adults: Initially, 2,500 mg/m2/day P.O. in two divided doses for 2 weeks, followed by a 1-week rest period; administered in 3-week cycles
• Renal impairment
• Hepatic impairment
• Elderly patients
• Hypersensitivity to drug
• Severe renal impairment
• Pregnancy or breastfeeding
Use cautiously in:
• mild to moderate renal impairment, hepatic impairment, severe diarrhea, coronary artery disease, intestinal disease, infection, coagulopathy
• children younger than age 18.
• Give with water within 30 minutes after a meal.
• If dosage must be lowered because of toxicity, don't increase dosage later.
CNS: dizziness, fatigue, headache, insomnia, paresthesia
EENT: eye irritation
GI: nausea, vomiting, diarrhea, constipation, abdominal pain, dyspepsia, anorexia, stomatitis, intestinal obstruction
Hematologic: anemia, lymphopenia, neutropenia, thrombocytopenia
Musculoskeletal: myalgia, limb pain
Skin: dermatitis, alopecia, nail disorder, hand and foot syndrome (palmarplantar erythrodysesthesia)
Drug-drug. Antacids: increased capecitabine blood level
Leucovorin: increased cytotoxicity
Live-virus vaccines: impaired ability to mount an immune response to vaccine
Phenytoin: increased phenytoin blood level
Warfarin: increased risk of bleeding
Drug-diagnostic tests. Bilirubin: increased level
Hemoglobin, neutrophils, platelets, white blood cells: decreased levels
• Monitor patient for signs and symptoms of toxicity. Be prepared to reduce dosage or withhold drug when indicated.
• Stay alert for signs and symptoms of infection.
• Carefully assess fluid and electrolyte status if patient has severe diarrhea.
• Monitor weight, CBC, International Normalized Ratio, prothrombin time, and kidney and liver function test results.
• Evaluate closely for adverse reactions in patients older than age 80.
• Advise patient to take drug with water within 30 minutes after a meal.
➣ Instruct patient to immediately report nausea, vomiting, diarrhea, mouth ulcers, swollen joints, temperature above 100.5 °F (38 °C), and other signs or symptoms of infection.
• Tell patient to expect dosage adjustments during therapy.
• Urge patient to use reliable birth control method because drug may harm fetus if she becomes pregnant.
• Caution patient not to breastfeed during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.