Kapecitabin Fresenius Kabi (Capecitabine)

Capecitabine is used in oncology to target fluoropyrimidine‑sensitive solid tumours.

• Colorectal cancer: improves disease control and survival when combined with standard chemotherapy regimens.
• Breast cancer: used in metastatic settings, often in combination with taxanes or anthracyclines, to extend progression‑free survival.
• Gastric cancer: administered as part of combination therapy to enhance response rates in advanced disease.

• Capecitabine is a prodrug that undergoes enzymatic conversion to 5‑fluorouracil (5‑FU) preferentially within tumour tissue. The resulting 5‑FU inhibits thymidylate synthase, disrupting deoxythymidine monophosphate synthesis, and incorporates into RNA and DNA, leading to impaired nucleic acid function and apoptosis of rapidly dividing cancer cells. The activation pathway involves carboxylesterase, cytidine deaminase and thymidine phosphorylase, enzymes that are often up‑regulated in malignant cells, thereby increasing selective drug exposure.

Capecitabine may cause a range of adverse reactions, varying in frequency and severity.

Common Side Effects

• Diarrhoea: mild to moderate watery stools.
• Nausea: occasional feeling of sickness.
• Hand‑foot syndrome: redness, swelling or pain on palms and soles.
• Fatigue: generalized tiredness.
• Alopecia: thinning of scalp hair.
• Stomatitis: inflammation or ulceration of the mouth lining.

Serious or Rare Side Effects

• Severe neutropenia: markedly reduced white blood cell count increasing infection risk.
• Thromboembolic events: blood clots such as deep vein thrombosis.
• Cardiotoxicity: chest pain or arrhythmias.
• Severe hand‑foot syndrome: ulceration requiring dose interruption.
• Hepatotoxicity: significant liver enzyme elevation.
• Stevens‑Johnson syndrome: severe skin reaction with blistering.

When prescribing capecitabine, clinicians should consider several precautionary measures to minimise risk.

• Baseline blood counts: obtain complete blood count before initiating therapy.
• Renal function: assess creatinine clearance, adjust if impairment is present.
• Cardiac history: evaluate for prior coronary disease or arrhythmias.
• Pregnancy potential: avoid use in pregnant or breastfeeding women unless benefits outweigh risks.
• Concomitant fluoropyrimidines: avoid overlapping use to prevent cumulative toxicity.
• Store at ambient temperature: keep tablets in original container, protect from moisture and light.

Capecitabine can interact with other medicines, altering its efficacy or safety profile.

Major Interactions (Avoid)

• Strong CYP2C9 inhibitors: may increase capecitabine exposure and toxicity.
• Anticoagulants (warfarin): heightened risk of bleeding.
• Antiepileptics inducing enzymes (e.g., carbamazepine): may reduce therapeutic effect.

Moderate Interactions (Monitor Closely)

• Antacids containing magnesium or aluminum: may affect absorption, separate dosing by at least 2 hours.
• Fluoropyrimidine‑based regimens: additive toxicity, monitor blood counts.
• Radiotherapy to the abdomen/pelvis: increased gastrointestinal toxicity.