Oral fluoropyrimidine prodrug (specialist)
Capecitabine
Brand names: Xeloda
Adult dose
Dose: 1250mg/m² PO BD days 1–14 q21d (per protocol)
Route: Oral
Frequency: BD with food
Clinical pearls
- MHRA Drug Safety Update 2020: DPYD pre-treatment genotyping mandatory in UK
- NICE TAs across colorectal, gastric, breast cancer
- ESMO / NCCP — switch to bolus 5-FU not appropriate (same DPYD risk)
Contraindications
- DPYD deficiency (test before initiation — MHRA mandatory)
- Severe renal/hepatic impairment
- Severe myelosuppression
- Pregnancy
- Hypersensitivity to 5-FU
Side effects
- Hand-foot syndrome (very common, dose-limiting)
- Diarrhoea
- Stomatitis
- Myelosuppression
- Cardiotoxicity (vasospasm/ischaemia)
- Hyperbilirubinaemia
- DPD-deficiency severe toxicity
Interactions
- Warfarin (significant INR elevation)
- Phenytoin
- Allopurinol
- Folate-containing supplements
- Live vaccines
Monitoring
- DPYD genotype baseline
- FBC
- LFTs
- Renal
- Hand-foot syndrome
- INR if on warfarin
Reference: BNF; MHRA Drug Safety Update; NICE TAs; ESMO; SmPC; https://bnf.nice.org.uk/drugs/capecitabine-specialist-drug/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators