Capecitabine (Xeloda): what to expect and how to stay safe

Capecitabine is a pill version of fluorouracil (5-FU) used to treat colorectal and some breast cancers. The big advantage: you take it at home, not through an IV. That makes life easier — but it also means you must follow the rules closely to avoid serious side effects.

How to take capecitabine

Typical schedule most doctors use is 1250 mg/m² taken twice a day for 14 days, then 7 days off (a 21-day cycle). Some patients get a lower dose, so never assume your dose matches someone else’s. Take each tablet with water within 30 minutes after a meal. Swallow whole — don’t crush or break tablets.

If you miss a dose, don’t double up. If it’s only a short time since the missed dose, follow your clinician’s rule; if it’s close to your next dose, skip the missed one and continue the normal schedule. Ask your care team for exact missed-dose instructions before you start treatment.

Tell your doctor about all medicines you take, including over-the-counter drugs, herbal supplements, and blood thinners like warfarin. Capecitabine can interact with anticoagulants and some seizure medicines, changing bleeding risk or drug levels.

Common side effects and red flags

The most common problems are hand-foot syndrome (red, painful palms or soles), diarrhea, nausea, fatigue, and low blood counts. Hand-foot syndrome can start as tingling, swelling, or redness and get worse with heat, tight shoes, or friction. Use gentle moisturizers, avoid hot baths, and stop activities that rub your hands or feet. Call your clinic early — there are dose changes and treatments that help.

Diarrhea can lead to dehydration fast. If you have 4 or more loose stools a day, or can’t keep fluids down, contact your care team immediately. Fever over 38°C (100.4°F), signs of infection, severe weakness, sudden chest pain, or new severe shortness of breath are urgent — go to the ER or call your oncologist.

Some people have liver or kidney issues on capecitabine. If your creatinine clearance is low, your doctor may lower the dose or avoid the drug. Also ask about testing for DPD (dihydropyrimidine dehydrogenase) deficiency — lacking this enzyme can cause life-threatening toxicity with fluoropyrimidines.

Your care team will monitor blood counts, liver tests, and kidney function regularly. Keep all labs and appointments. Bring a complete list of your meds each visit so doctors can check for interactions.

Practical tips: store pills in a cool, dry place away from children; use a pill box only if it keeps doses separate by time; avoid pregnancy during treatment and for the recommended time after (use effective contraception). Do not breastfeed while on capecitabine.

If you have questions about dose adjustments, side effects, or how capecitabine fits into your overall treatment plan, ask your oncologist or pharmacist. They can tailor advice to your health, other meds, and lab results — and that keeps you safer while you get the benefit of oral chemo.