Does Xeloda (capecitabine) cause side effects?

Xeloda (capecitabine) is an antineoplastic (anti-cancer) medication used to treat

  • cancer of the colon that has spread to lymph nodes in the area close to the colon (Dukes’ C stage) after surgery;
  • cancer of the colon or rectum (colorectal) that has spread to other parts of the body (metastatic);
  • breast cancer that has spread to other parts of the body (metastatic) together with another medicine called docetaxel after treatment with certain other anti-cancer medicines have not worked; and
  • breast cancer that has spread to other parts of the body and has not improved after treatment with paclitaxel and certain other anti-cancer medicines, or who cannot receive any more treatment with certain anti-cancer medicines. 

Xeloda is converted by the body to 5-fluorouracil (5-FU), a drug which has been given intravenously for many years to treat various types of cancer. 5-FU inhibits the production by the cancerous cells of both DNA and protein that are necessary for the cells to divide and the cancer to grow in size. 

Common side effects of Xeloda include

  • diarrhea,
  • nausea,
  • vomiting,
  • painful swelling of the mouth,
  • fatigue,
  • painful rash and swelling of the hands or feet,
  • low white blood cell count (which can lead to infections),
  • low blood platelet counts (which can lead to bleeding), and
  • anemia.

Serious side effects of Xeloda include

Drug interactions of Xeloda include blood thinner medicines, such as warfarin, because taking Xeloda with these medicines can cause changes in how fast your blood clots, and can cause life-threatening bleeding.

  • This can occur as soon as a few days after you start taking Xeloda, or later during treatment, and possibly even within 1 month after you stop taking Xeloda.
  • Your risk may be higher because you have cancer, and if you are over 60 years of age.
  • If you take warfarin or a similar blood thinner during treatment with Xeloda, your doctor should do blood tests often, to check how fast your blood clots during and after you stop treatment with Xeloda.
  • Your doctor may change your dose of the blood thinner medicine if needed. 

Xeloda can damage a fetus. It should not be taken by pregnant women. 

It is unknown if Xeloda is secreted into breast milk. Consult your doctor before breastfeeding

What are the important side effects of Xeloda (capecitabine)?

The most common side effects with capecitabine are:

  • diarrhea,
  • nausea,
  • vomiting,
  • painful swelling of the mouth,
  • fatigue,
  • painful rash and
  • swelling of the hands or feet,
  • low white blood cell count (which can lead to infections),
  • low blood platelet counts (which can lead to bleeding), and
  • anemia.

Other important side effects experienced by some patients include:

Xeloda (capecitabine) side effects list for healthcare professionals

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Adjuvant Colon Cancer

  • Table 4 shows the adverse reactions occurring in =5% of patients from one phase 3 trial in patients with Dukes' C colon cancer who received at least one dose of study medication and had at least one safety assessment.
  • A total of 995 patients were treated with 1250 mg/m2 twice a day of Xeloda administered for 2 weeks followed by a 1-week rest period, and 974 patients were administered 5-FU and leucovorin (20 mg/m2 leucovorin IV followed by 425 mg/m2 IV bolus 5-FU on days 1-5 every 28 days).
  • The median duration of treatment was 164 days for capecitabine-treated patients and 145 days for 5-FU/LV-treated patients.
  • A total of 112 (11%) and 73 (7%) capecitabine and 5-FU/LV-treated patients, respectively, discontinued treatment because of adverse reactions.
  • A total of 18 deaths due to all causes occurred either on study or within 28 days of receiving study drug: 8 (0.8%) patients randomized to Xeloda and 10 (1.0%) randomized to 5-FU/LV.
  • Table 5 shows grade 3/4 laboratory abnormalities occurring in =1% of patients from one phase 3 trial in patients with Dukes' C colon cancer who received at least one dose of study medication and had at least one safety assessment.

Table 4 Percent Incidence of Adverse Reactions Reported in =5% of Patients Treated With Xeloda or 5-FU/LV for Colon Cancer in the Adjuvant Setting (Safety Population)

Body System/
Adverse Event
Adjuvant Treatment for Colon Cancer (N=1969)
Xeloda (N=995)5-FU/LV (N=974)
All GradesGrade 3/4All GradesGrade 3/4
Gastrointestinal Disorders
  Diarrhea47126514
  Nausea342472
  Stomatitis2226014
  Vomiting152212
  Abdominal Pain143162
  Constipation9-11<1
  Upper Abdominal Pain7<17<1
  Dyspepsia6<15-
Skin and Subcutaneous Tissue Disorders
  Hand-and-Foot Syndrome60179<1
  Alopecia6-22<1
  Rash7-8-
  Erythema615<1
General Disorders and Administration Site Conditions
  Fatigue16<1161
  Pyrexia7<19<1
  Asthenia10<1101
  Lethargy10<19<1
Nervous System Disorders
  Dizziness6<16-
  Headache5<16<1
  Dysgeusia6-9-
Metabolism and Nutrition Disorders
  Anorexia9<111<1
  Eye Disorders
  Conjunctivitis5<16<1
Blood and Lymphatic System Disorders
  Neutropenia2<185
Respiratory Thoracic and Mediastinal Disorders
  Epistaxis2-5-

Table 5 Percent Incidence of Grade 3/4 Laboratory Abnormalities Reported in =1% of Patients Receiving Xeloda Monotherapy for Adjuvant Treatment of Colon Cancer (Safety Population)

Advers e EventXeloda (n=995) Grade 3/4 %IV 5-FU/LV (n=974) Grade 3/4 %
  Increased ALAT (SGPT)1.60.6
  Increased calcium1.10.7
  Decreased calcium2.32.2
  Decreased hemoglobin1.01.2
  Decreased lymphocytes13.013.0
  Decreased neutrophils*2.226.2
  Decreased neutrophils/granulocytes2.426.4
  Decreased platelets1.00.7
  Increased bilirubin206.3
*The incidence of grade 3/4 white blood cell abnormalities was 1.3% in the Xeloda arm and 4 .9% in the IV 5-FU/LV arm. It should be noted that grading was according to NCIC CTC Version 1 (May, 1994 ). In the NCIC-CTC Version 1, hyperbilirubinemia grade 3 indicates a bilirubin value of 1.5 to 3.0 x upper limit of normal (ULN) range, and grade 4 a value of > 3.0 x ULN. The NCI CTC Version 2 and above define a grade 3 bilirubin value of>3.0 to 10.0 x ULN, and grade 4 values >10.0 x ULN.

Metastatic Colorectal Cancer

Monotherapy
  • Table 6 shows the adverse reactions occurring in =5% of patients from pooling the two phase 3 trials in first-line metastatic colorectal cancer.
  • A total of 596 patients with metastatic colorectal cancer were treated with 1250 mg/m2 twice a day of Xeloda administered for 2 weeks followed by a 1-week rest period, and 593 patients were administered 5-FU and leucovorin in the Mayo regimen (20 mg/m2 leucovorin IV followed by 425 mg/m2 IV bolus 5-FU, on days 1-5, every 28 days).
  • In the pooled colorectal database the median duration of treatment was 139 days for capecitabine-treated patients and 140 days for 5-FU/LV-treated patients.
  • A total of 78 (13%) and 63 (11%) capecitabine and 5-FU/LVtreated patients, respectively, discontinued treatment because of adverse reactions/intercurrent illness.
  • A total of 82 deaths due to all causes occurred either on study or within 28 days of receiving study drug: 50 (8.4%) patients randomized to Xeloda and 32 (5.4%) randomized to 5-FU/LV.

Table 6 Pooled Phase 3 Colorectal Trials : Percent Incidence of Adverse Reactions in =5% of Patients

Adverse EventXeloda
(n=596)
5-FU/LV
(n=593)
Total
%
Grade
3%
Grade
4%
Total
%
Grade
3%
Grade
4%
Number of Patients
With > One Adverse
Event
9652994459
Body System/Adverse Event
GI
  Diarrhea5513261102
  Nausea434-513<1
  Vomiting274<1304<1
  Stomatitis252<162141
  Abdominal Pain359<1315-
  Gastrointestinal Motility
Disorder
10<1-7<1-
  Constipation141<1171-
  Oral Discomfort10--10--
  Upper GI Inflammatory
Disorders
8<1-101-
  Gastrointestinal
Hemorrhage
61<131-
  Ileus641521
Skin and Subcutaneous
  Hand-and-Foot
Syndrome
5417NA61NA
  Dermatitis271-261-
  Skin Discoloration7<1-5--
  Alopecia6--21<1-
General
  Fatigue/Weakness424-464-
  Pyrexia181-212-
  Edema151-91-
  Pain121-101-
  Chest Pain61-61<1
Neurological
  Peripheral Sensory Neuropathy10--4--
  Headache101-7--
  Dizziness*8<1-8<1-
  Insomnia7--7--
  Taste Disturbance61-11<11
Metabolism
  Appetite Decreased263<1312<1
  Dehydration72<1831
Eye
  Eye Irritation13--10<1-
  Vision Abnormal5--2--
Respiratory
  Dyspnea141-10<11
  Cough7<118--
  Pharyngeal Disorder5--5--
  Epistaxis3<1-6--
  Sore Throat2--6--
Musculoskeletal
  Back Pain102-9<1-
  Arthralgia81-61-
Vascular
  Venous Thrombosis83<162-
Psychiatric
  Mood Alteration5--6<1-
  Depression5--4<1-
Infections
  Viral5<1-5<1-
Blood and Lymphatic
  Anemia802<1791<1
  Neutropenia131246813
Hepatobiliary
  Hyperbilirubinemia481851733
–Not observed
NA = Not Applicable
*Excluding vertigo

Breast Cancer

In Combination With Docetaxel
  • The following data are shown for the combination study with Xeloda and docetaxel in patients with metastatic breast cancer in Table 7 and Table 8.
  • In the Xeloda and docetaxel combination arm the treatment was Xeloda administered orally 1250 mg/m2 twice daily as intermittent therapy (2 weeks of treatment followed by 1 week without treatment) for at least 6 weeks and docetaxel administered as a 1- hour intravenous infusion at a dose of 75 mg/m2 on the first day of each 3-week cycle for at least 6 weeks. In the monotherapy arm docetaxel was administered as a 1-hour intravenous infusion at a dose of 100 mg/m2 on the first day of each 3-week cycle for at least 6 weeks.
  • The mean duration of treatment was 129 days in the combination arm and 98 days in the monotherapy arm.
  • A total of 66 patients (26%) in the combination arm and 49 (19%) in the monotherapy arm withdrew from the study because of adverse reactions.
  • The percentage of patients requiring dose reductions due to adverse reactions was 65% in the combination arm and 36% in the monotherapy arm.
  • The percentage of patients requiring treatment interruptions due to adverse reactions in the combination arm was 79%.
  • Treatment interruptions were part of the dose modification scheme for the combination therapy arm but not for the docetaxel monotherapy-treated patients.

Table 7 Percent Incidence of Adverse Events Considered Related or Unrelated to Treatment in =5% of Patients Participating in the Xeloda and Docetaxel Combination vs Docetaxel Monotherapy Study

Adverse EventXeloda 1250
mg/m2 /bid With
Docetaxel
75 mg/m2 /3 weeks (n=251)
Docetaxel
100 mg/m2 /3 weeks (n=255)
Total
%
Grade
3%
Grade
4%
Total
%
Grade
3%
Grade
4%
Number of Patients
With at Least One
Adverse Event
9976.529.19757.631.8
Body System/Adverse Event
GI
  Diarrhea6714<1485<1
  Stomatitis6717<1435-
  Nausea457-362-
  Vomiting3541242-
  Constipation202-18--
  Abdominal Pain30<3<1242-
  Dyspepsia14--81-
  Dry Mouth6<1-5--
Skin and Subcutaneous
  Hand-and-Foot
Syndrome
6324NA81NA
  Alopecia416-427-
  Nail Disorder142-15--
  Dermatitis8--111-
  Rash Erythematous9<1-5--
  Nail Discoloration6--4<1-
  Onycholysis51-51-
  Pruritus4--5--
General
  Pyrexia282-342-
  Asthenia264<1256-
  Fatigue224-276-
  Weakness162-112-
  Pain in Limb13<1-132-
  Lethargy7--62-
  Pain7<1-51-
  Chest Pain (non-cardiac)4<1-62-
  Influenza-like Illness5--5--
Neurological
  Taste Disturbance16<1-14<1-
  Headache153-152-
  Paresthesia12<1-161-
  Dizziness12--8<1-
  Insomnia8--10<1-
  Peripheral Neuropathy6--101-
  Hypoaesthesia4<1-8<1-
Metabolism
  Anorexia131-11<1-
  Appetite Decreased10--5--
  Weight Decreased7--5--
  Dehydration102-7<1<1
Eye
  Lacrimation Increased12--7<1-
  Conjunctivitis5--4--
  Eye Irritation5--1--
Musculoskeletal
  Arthralgia152-243-
  Myalgia152-252-
  Back Pain12<1-113-
  Bone Pain8<1-102-
Cardiac
  Edema33<2-34<31
Blood
  Neutropenic Fever1631321516
Respiratory
  Dyspnea142<1162-
  Cough131-22<1-
  Sore Throat122-11<1-
  Epistaxis7<1-6--
  Rhinorrhea5--3--
  Pleural Effusion21-74-
Infections
  Oral Candidiasis7<1-8<1-
  Urinary Tract Infection6<1-4--
  Upper Respiratory Tract4--51-
Vascular
  Flushing5--5--
  Lymphoedema3<1-5--
Psychiatric
  Depression5--51-
–Not observed
NA = Not Applicable

Table 8 Percent of Patients With Laboratory Abnormalities Participating in the Xeloda and Docetaxel Combination vs Docetaxel Monotherapy Study

Adverse EventXeloda 1250 mg/m2 /bid With
Docetaxel 75 mg/m2 /3 weeks
(n=251)
Docetaxel 100 mg/m2 /3 weeks
(n=255)
Body System/
Adverse Event
Total
%
Grade 3
%
Grade 4
%
Total
%
Grade 3
%
Grade 4
%
Hematologic
  Leukopenia913724884233
  Neutropenia/ Granulocytopenia862049871066
  Thrombocytopenia41212312
  Anemia8073835<1
  Lymphocytopenia994841984440
Hepatobiliary
  Hyperbilirubinemia2072622

Monotherapy
  • The following data are shown for the study in stage IV breast cancer patients who received a dose of 1250 mg/m2 administered twice daily for 2 weeks followed by a 1-week rest period.
  • The mean duration of treatment was 114 days.
  • A total of 13 out of 162 patients (8%) discontinued treatment because of adverse reactions/intercurrent illness.

Table 9 Percent Incidence of Adverse Reactions Considered Remotely, Possibly or Probably Related to Treatment in =5% of Patients Participating in the Single Arm Trial in Stage IV Breast Cancer

Adverse EventPhase 2 Trial in Stage IV Breast
Cancer (n=162)
Body System/ Adverse EventTotal
%
Grade 3
%
Grade 4
%
GI
Diarrhea57123
Nausea534-
Vomiting374-
Stomatitis247-
Abdominal Pain204-
Constipation151-
Dyspepsia8--
Skin and Subcutaneous
Hand-and-Foot Syndrome5711NA
Dermatitis371-
Nail Disorder7--
General
Fatigue418-
Pyrexia121-
Pain in Limb61-
Neurological
Paresthesia211-
Headache91-
Dizziness8--
Insomnia8--
Metabolism
Anorexia233-
Dehydration741
Eye
Eye Irritation15--
Musculoskeletal
Myalgia9--
Cardiac
Edema91-
Blood
Neutropenia2622
Thrombocytopenia2431
Anemia7231
Lymphopenia944415
Hepatobiliary
Hyperbilirubinemia2292
– Not observed
NA = Not Applicable

Clinically Relevant Adverse Events In <5% Of Patients

  • Clinically relevant adverse events reported in <5% of patients treated with Xeloda either as monotherapy or in combination with docetaxel that were considered at least remotely related to treatment are shown below; occurrences of each grade 3 and 4 adverse event are provided in parentheses.
Monotherapy (Metastatic Colorectal Cancer, Adjuvant Colorectal Cancer, Metastatic Breast Cancer)

Gastrointestinal:abdominal distension, dysphagia, proctalgia, ascites (0.1%), gastric ulcer (0.1%), ileus (0.3%), toxic dilation of intestine, gastroenteritis (0.1%)
Skin & Subcutan.:nail disorder (0.1%), sweating increased (0.1%), photosensitivity reaction (0.1%), skin ulceration, pruritus, radiation recall syndrome (0.2%)
General:chest pain (0.2%), influenza-like illness, hot flushes, pain (0.1%), hoarseness, irritability, difficulty in walking, thirst, chest mass, collapse, fibrosis (0.1%), hemorrhage, edema, sedation
Neurological:insomnia, ataxia (0.5%), tremor, dysphasia, encephalopathy (0.1%), abnormal coordination, dysarthria, loss of consciousness (0.2%), impaired balance
Metabolism:increased weight, cachexia (0.4%), hypertriglyceridemia (0.1%), hypokalemia, hypomagnesemia
Eye:conjunctivitis
Respiratory:cough (0.1%), epistaxis (0.1%), asthma (0.2%), hemoptysis, respiratory distress (0.1%), dyspnea
Cardiac:tachycardia (0.1%), bradycardia, atrial fibrillation, ventricular extrasystoles, extrasystoles, myocarditis (0.1%), pericardial effusion
Infections:laryngitis (1.0%), bronchitis (0.2%), pneumonia (0.2%), bronchopneumonia (0.2%), keratoconjunctivitis, sepsis (0.3%), fungal
infections (including candidiasis) (0.2%)
Musculoskeletal:myalgia, bone pain (0.1%), arthritis (0.1%), muscle weakness
Blood & Lymphatic:leukopenia (0.2%), coagulation disorder (0.1%), bone marrow depression (0.1%), idiopathic thrombocytopenia purpura (1.0%), pancytopenia (0.1%)
Vascular:hypotension (0.2%), hypertension (0.1%), lymphoedema (0.1%), pulmonary embolism (0.2%), cerebrovascular accident (0.1%)
Psychiatric:depression, confusion (0.1%)
Renal:renal impairment (0.6%)
Ear:vertigo
Hepatobiliary:hepatic fibrosis (0.1%), hepatitis (0.1%), cholestatic hepatitis (0.1%), abnormal liver function tests
Immune System:drug hypersensitivity (0.1%)
Postmarketing:hepatic failure, lacrimal duct stenosis, acute renal failure secondary to dehydration including fatal outcome [see WARNINGS AND PRECAUTIONS], cutaneous lupus erythematosus, corneal disorders including keratitis, toxic leukoencephalopathy, severe skin reactions such as Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (TEN) [see WARNINGS AND PRECAUTIONS]

Xeloda In Combination With Docetaxel (Metastatic Breast Cancer)

Gastrointestinal:ileus (0.4%), necrotizing enterocolitis (0.4%), esophageal ulcer (0.4%), hemorrhagic diarrhea (0.8%)
Neurological:ataxia (0.4%), syncope (1.2%), taste loss (0.8%), polyneuropathy (0.4%), migraine (0.4%)
Cardiac:supraventricular tachycardia (0.4%)
Infection:neutropenic sepsis (2.4%), sepsis (0.4%), bronchopneumonia (0.4%)
Blood & Lymphatic:agranulocytosis (0.4%), prothrombin decreased (0.4%)
Vascular:hypotension (1.2%), venous phlebitis and thrombophlebitis (0.4%), postural hypotension (0.8%)
Renal:renal failure (0.4%)
Hepatobiliary:jaundice (0.4%), abnormal liver function tests (0.4%), hepatic failure (0.4%), hepatic coma (0.4%), hepatotoxicity (0.4%)
Immune System:hypersensitivity (1.2%)

What drugs interact with Xeloda (capecitabine)?

Drug-Drug Interactions

Anticoagulants
  • Altered coagulation parameters and/or bleeding have been reported in patients taking Xeloda concomitantly with coumarin-derivative anticoagulants such as warfarin and phenprocoumon.
  • These events occurred within several days and up to several months after initiating Xeloda therapy and, in a few cases, within 1 month after stopping Xeloda.
  • These events occurred in patients with and without liver metastases.
  • In a drug interaction study with single-dose warfarin administration, there was a significant increase in the mean AUC of S-warfarin.
  • The maximum observed INR value increased by 91%.
  • This interaction is probably due to an inhibition of cytochrome P450 2C9 by capecitabine and/or its metabolites.
Phenytoin
  • The level of phenytoin should be carefully monitored in patients taking Xeloda and phenytoin dose may need to be reduced.
  • Postmarketing reports indicate that some patients receiving Xeloda and phenytoin had toxicity associated with elevated phenytoin levels.
  • Formal drug-drug interaction studies with phenytoin have not been conducted, but the mechanism of interaction is presumed to be inhibition of the CYP2C9 isoenzyme by capecitabine and/or its metabolites.
Leucovorin
  • The concentration of 5-fluorouracil is increased and its toxicity may be enhanced by leucovorin.
  • Deaths from severe enterocolitis, diarrhea, and dehydration have been reported in elderly patients receiving weekly leucovorin and fluorouracil.
CYP2C9 Substrates
  • Other than warfarin, no formal drug-drug interaction studies between Xeloda and other CYP2C9 substrates have been conducted.
  • Care should be exercised when Xeloda is coadministered with CYP2C9 substrates.

Drug-Food Interaction

  • Food was shown to reduce both the rate and extent of absorption of capecitabine. In all clinical trials, patients were instructed to administer Xeloda within 30 minutes after a meal. It is recommended that Xeloda be administered with food.

Summary

Xeloda (capecitabine) is an antineoplastic (anti-cancer) medication used to treat breast cancer and cancer of the colon or rectum (colorectal). Common side effects of Xeloda include diarrhea, nausea, vomiting, painful swelling of the mouth, fatigue, painful rash and swelling of the hands or feet, low white blood cell count (which can lead to infections), low blood platelet counts (which can lead to bleeding), and anemia. Xeloda can damage a fetus. It should not be taken by pregnant women. It is unknown if Xeloda is secreted into breast milk.

Treatment & Diagnosis

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Medically Reviewed on 1/20/2021
References
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Professional side effects and drug interactions sections courtesy of the U.S. Food and Drug Administration.