Kapecitabin Sandoz (Capecitabine)

Kapecitabin Sandoz (capecitabine) is employed in the treatment of solid tumours that are responsive to antimetabolite chemotherapy.

• Colorectal cancer: used as part of combination regimens to inhibit tumour growth and improve survival.
• Breast cancer: administered to patients with advanced or metastatic disease to slow disease progression.
• Gastric cancer: incorporated into first‑line therapy to enhance response rates in eligible adults.

• Capecitabine is a prodrug that is enzymatically converted to 5‑fluorouracil (5‑FU) preferentially within tumour tissue. The resulting 5‑FU inhibits thymidylate synthase, disrupting DNA synthesis, and is incorporated into RNA and DNA, leading to impaired nucleic acid function and cancer cell death.

Capecitabine may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Nausea and vomiting: mild to moderate gastrointestinal upset.
• Diarrhoea: watery stools that may require hydration.
• Hand‑foot syndrome: redness, swelling or pain on palms and soles.
• Fatigue: persistent tiredness affecting daily activities.
• Alopecia: thinning or loss of hair.

Serious or Rare Side Effects

• Severe neutropenia: markedly reduced white blood cells increasing infection risk.
• Thromboembolic events: blood clots that can affect lungs or deep veins.
• Cardiotoxicity: chest pain or arrhythmias requiring immediate attention.
• Severe mucositis: painful inflammation of the mouth and gastrointestinal lining.

Before initiating therapy with Kapecitabin Sandoz, several safety considerations should be reviewed.

• Pregnancy: avoid use; classified as Category D due to fetal risk.
• Breastfeeding: discontinue if nursing, as drug may be excreted in milk.
• Renal impairment: dose adjustment may be required; monitor kidney function.
• Hepatic dysfunction: assess liver enzymes and consider dose modification.
• Concomitant anticoagulants: increased risk of bleeding; monitor coagulation parameters.
• Store at ambient temperature: keep below 25 °C, in the original container, protected from moisture and light.

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

Major Interactions (Avoid)

• Strong CYP2C9 inhibitors (e.g., fluconazole): may increase capecitabine exposure.
• Warfarin: heightened anticoagulant effect, raising bleeding risk.

Moderate Interactions (Monitor Closely)

• Antacids containing magnesium or aluminum: may reduce absorption; separate dosing by at least 2 hours.
• 5‑FU‑based regimens: additive toxicity, especially myelosuppression.
• Herbal supplements (e.g., St. John’s wort): potential induction of metabolic pathways, lowering drug levels.