Home Drug Guide Capecitabine

Drug Guide

Generic Name

Capecitabine

Brand Names Xeloda

Classification

Therapeutic: Antineoplastic agent (chemotherapy)

Pharmacological: Antimetabolite (pyrimidine analog)

FDA Approved Indications

  • Adjuvant treatment of breast cancer
  • Metastatic colorectal cancer
  • Metastatic breast cancer

Mechanism of Action

Capecitabine is a prodrug that is enzymatically converted into 5-fluorouracil (5-FU) within the body. 5-FU inhibits thymidylate synthase, disrupting DNA synthesis and leading to apoptotic cell death in rapidly dividing cancer cells.

Dosage and Administration

Adult: Typically 1250 mg/m² twice daily for 14 days followed by 7 days off; specific dosing varies based on indication and patient factors.

Pediatric: Not approved for pediatric use; dosing not established.

Geriatric: Use with caution; consider renal and hepatic function.

Renal Impairment: Adjust dose based on severity of impairment; generally, dose reduction is recommended in moderate to severe impairment.

Hepatic Impairment: Use with caution; monitor closely as metabolism may be affected.

Pharmacokinetics

Absorption: Well absorbed orally.

Distribution: Widely distributed in body tissues.

Metabolism: Converted enzymatically to 5-FU mainly in tumor tissue; undergoes hepatic metabolism.

Excretion: Primarily renal excretion of metabolites.

Half Life: T1/2 of capecitabine approximately 0.75 hours; active metabolite 5-FU has a half-life of approximately 10-20 minutes.

Contraindications

  • Hypersensitivity to capecitabine or fluoropyrimidines.
  • History of severe pulmonary, cerebellar, or cardiotoxic reactions.

Precautions

  • Monitor for signs of myelosuppression, hand-foot syndrome, diarrhea, and cardiotoxicity.
  • Use with caution in renal or hepatic impairment.
  • Pregnancy Category D: risk to fetus; avoid in pregnancy.

Adverse Reactions - Common

  • Hand-Foot Syndrome (palmar-plantar erythrodysesthesia) (Common)
  • Diarrhea (Common)
  • Nausea and vomiting (Common)
  • Mucositis/stomatitis (Common)
  • Myelosuppression (neutropenia, anemia, thrombocytopenia) (Common)

Adverse Reactions - Serious

  • Severe neutropenia and risk of infections (Serious)
  • Thromboembolic events (Serious)
  • Cardiotoxicity (angina, myocardial infarction) (Serious)
  • Severe diarrhea leading to dehydration (Serious)
  • Hand-foot syndrome leading to dose modification or discontinuation (Serious)

Drug-Drug Interactions

  • Warfarin (may increase bleeding)
  • Other myelosuppressive agents
  • Virustatic agents

Drug-Food Interactions

  • May influence absorption if taken with certain foods; generally administered without regard to food.

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor complete blood counts, renal and hepatic function, and for signs of hand-foot syndrome.

Diagnoses:

  • Risk for infection due to myelosuppression
  • Risk for injury due to hand-foot syndrome or diarrhea
  • Imbalanced nutrition: less than body requirements due to nausea or mucositis

Implementation: Administer with food to reduce gastrointestinal upset; educate patient about hand-foot syndrome; monitor for dehydration and electrolyte imbalances.

Evaluation: Assess for resolution or reduction of adverse effects; evaluate effectiveness in tumor size and progression.

Patient/Family Teaching

  • Advise patient to report symptoms such as severe diarrhea, hand-foot syndrome, or signs of infection immediately.
  • Use sun protection, as skin may become more sensitive.
  • Maintain hydration and nutritional intake.
  • Avoid pregnancy; use effective contraception during and for at least 6 months after treatment.

Special Considerations

Black Box Warnings:

  • Capecitabine can cause severe and sometimes fatal diarrhea, neutropenia, and hand-foot syndrome.
  • Use with caution in patients with dihydropyrimidine dehydrogenase (DPD) deficiency.
  • Cardiotoxicity risk may be increased in patients with underlying cardiac disease.

Genetic Factors: DPD deficiency can cause increased toxicity; testing may be considered.

Lab Test Interference: May cause false elevation of INR tests in patients on warfarin.

Overdose Management

Signs/Symptoms: Severe diarrhea, neutropenia, mucositis, neurotoxicity, or cardiotoxicity.

Treatment: Supportive care including hydration, blood transfusions, antibiotics for infection, and symptomatic management; no specific antidote.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable when stored properly; discard if expired or damaged.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.