WHAT CAPECITABINE IS AND WHAT IT IS USED FOR
The name of medicine is Capecitabine 150mg film-coated Tablets or Capecitabine 500mg film-coated Tablets.
Capecitabine belongs to the group of medicines called “cytostatic agents”, which stop the growth of cancer cells.
Capecitabine Tablets contain 150mg or 500mg capecitabine, which itself is not a cytostatic agent. Only after being absorbed by the body is it changed into an active anti-cancer agent (more in tumour tissue than in normal tissue).
Capecitabine is prescribed by doctors for the treatment of colon, rectal, gastric, or breast cancers.
Furthermore, capecitabine is prescribed by doctors to prevent new occurrence of colon cancer after complete removal of the tumour by surgery.
Capecitabine may be used either alone or in combination with other medicines.
WHAT YOU NEED TO KNOW BEFORE YOU TAKE CAPECITABINE
Do not take capecitabine
•if you are allergic to capecitabine or any of the other ingredients of this medicine. You must inform your doctor if you know that you have an allergy or over-reaction to capecitabine
•if you have previously had severe reactions to fluoropyrimidine therapy (a group of anticancer medicines such as fluorouracil)
•if you are pregnant or nursing
•if you have severely low levels of white cells or platelets in the blood (leucopenia, neutropenia or thrombocytopenia)
•if you have severe liver or kidney problems
•if you have a known deficiency for the enzyme dihydropyrimidine dehydrogenase (DPD) involved in the metabolism of uracil and thymine, or
•if you are being treated now or have been treated in the last 4 weeks with brivudine, sorivudine or similar classes of substance as part of herpes zoster (chickenpox or shingles) therapy.
Warnings and precautions
Talk to your doctor or pharmacist before taking capecitabine if you
•have liver or kidney diseases
•have or had heart problems (for example an irregular heartbeat or pains to the chest, jaw and back brought on by physical effort and due to problems with the blood flow to the heart)
•have brain diseases (for example cancer that has spread to the brain or nerve damage (neuropathy))
•have calcium imbalances (seen in blood tests)
•are or become dehydrated
•have imbalances of ions in your blood (electrolyte imbalances, seen in tests)
DPD deficiency is a rare condition present at birth that is not usually associated with health problems unless you receive certain medicines.
If you have an unrecognised DPD deficiency and take capecitabine, you may experience severe forms of the side effects listed under section 4 Possible side effects. Contact your doctor immediately if you are concerned about any of the side effects or if you notice any additional side effects not listed in the leaflet (see section 4 Possible side effects).
Children and adolescents
Capecitabine is not indicated in children and adolescents. Do not give capecitabine to children and adolescents.
Other medicines and capecitabine
Before starting treatment, tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This is extremely important, as taking more than one medicine at the same time can strengthen or weaken the effect of the medicines.
You need to be particularly careful if you are taking any of the following:
•gout medicines (allopurinol)
•blood-thinning medicines (coumarin, warfarin)
•certain anti-viral medicines (sorivudine and brivudine) or
•medicines for seizures or tremors (phenytoin)
•interferon alpha or
•radiotherapy and certain medicines used to treat cancer (folinic acid, oxaliplatin, bevacizumab)
Capecitabine with food, drink and alcohol
You should take capecitabine no later than 30 minutes after meals.
Pregnancy, breast-feeding and fertility
Before starting treatment, you must tell your doctor, if you are pregnant, if you think you are pregnant or if you intend to become pregnant. You must not take capecitabine if you are pregnant or think you might be. You must not breast-feed if you are taking capecitabine. Ask your doctor or pharmacist for advice before taking this medicine.
Driving and using machines
Capecitabine may make you feel dizzy, nauseous or tired. It is therefore possible that capecitabine could affect your ability to drive a car or operate machinery.
HOW TO TAKE CAPECITABINE TABLETS
Always take this medicine exactly as your doctor or pharmacist has told you.
Check with your doctor or pharmacist if you are not sure.
Capecitabine should only be prescribed by a doctor experienced in the use of anticancer medicines.
•Capecitabine tablets should be swallowed whole with water and within 30 minutes of a meal.
Your doctor will prescribe a dose and treatment regimen that is right for you.
The dose of capecitabine is based on your body surface area. This is calculated from your height and weight.
•The usual dose for adults is 1250mg/m2 of body surface area taken two times daily (morning and evening). Two examples are provided here: A person whose body weight is 64kg and height is 1.64m has a body surface area of 1.7m2 and should take 4 tablets of 500mg and 1 tablet of 150mg two times daily. A person whose body weight is 80 kg and height is 1.80m has a body surface area of 2.00m2 and should take 5 tablets of 500mg two times daily.
•Capecitabine tablets are usually taken for 14 days followed by a 7 day rest period (when no tablets are taken). This 21 day period is one treatment cycle.
•In combination with other medicinal products the usual dose for adults may be less than 1250mg/m2 of body surface area, and you may need to take the tablets over a different time period (e.g. every day, with no rest period).
•Your doctor will tell you what dose you need to take, when to take it and for how long you need to take it.
•Your doctor may want you to take a combination of 150mg and 500mg tablets for each dose.
•Take the tablets in the morning and evening as prescribed by your doctor.
•Take the tablets within 30 minutes after the end of a meal (breakfast and dinner).
•It is important that you take all your medicine as prescribed by your doctor.
If you take more capecitabine than you should
•If you take more capecitabine than you should, contact your doctor as soon as possible before taking the next dose.
•You might get the following side effects if you take a lot more capecitabine than you should: feeling or being sick, diarrhoea, inflammation or ulceration of the gut or mouth, pain or bleeding from the intestine or stomach, or bone marrow depression (reduction in certain kinds of blood cells). Tell your doctor immediately if you experience any of these symptoms.
If you forget to take capecitabine
•Do not take the missed dose at all and do not double the next one. Instead, continue your regular dosing schedule and check with your doctor.
If you stop taking capecitabine
•There are no side-effects caused by stopping treatment with capecitabine. In case you are using coumarin anticoagulants (containing e.g. phenprocoumon), stopping capecitabine might require that your doctor adjusts your anticoagulant dose.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.
POSSIBLE SIDE EFFECTS
Like all medicines, this medicine can cause side effects, although not everybody gets them.
STOP taking capecitabine immediately and contact your doctor if any of these symptoms occur:
•Diarrhoea: if you have an increase of 4 or more bowel movements compared to your normal bowel movements each day or any diarrhoea at night.
•Vomiting: if you vomit more than once in a 24-hour time period.
•Nausea: if you lose your appetite, and the amount of food you eat each day is much less than usual.
•Stomatitis: if you have pain, redness, swelling or sores in your mouth and/or throat.
•Hand-and-foot skin-reaction: if you have pain, swelling, redness or tingling of hands and/or feet
•Fever:if you have a temperature of 38°C or greater
•Infection: if you experience signs of infection caused by bacteria or virus, or other organisms
•Chest pain: if you experience pain localised to the centre of the chest, especially if it occurs during exercise.
If caught early, these side effects usually improve within 2 to 3 days after treatment discontinuation. If these side effects continue, however, contact your doctor immediately. Your doctor may instruct you to restart treatment at a lower dose.
In addition to the above, when capecitabine is used alone, very common side-effects which may affect more than 1 in 10 people are:
•rash, dry or itchy skin
•loss of appetite (anorexia)
These side effects can become severe: therefore, it is important that you always contact your doctor immediately when you start to experience a side effect. Your doctor may instruct you to decrease the dose and/or temporarily discontinue treatment with capecitabine. This will help reduce the likelihood that the side effect continues or becomes severe.
Other side effects are:
Common side-effects (may affect up to 1 in 10 people) include:
•decreases in the number of white blood cells or red blood cells (seen in tests)
•dehydration, weight loss
•sleeplessness (insomnia), depression
•headache, sleepiness, dizziness, abnormal sensation in the skin (numbness or tingling sensation), taste changes
•eye irritation, increased tears, eye redness (conjunctivitis)
•inflammation of the veins (thrombophlebitis)
Uncommon side effects (may affect up to 1 in 100 people) include:
•blood infection, urinary tract infection, infection of the skin, infections in the nose and throat, fungal infections (including those of the mouth), influenza, gastroenteritis, tooth abscess
•lumps under the skin (lipoma)
•decreases in blood cells including platelets, thinning of blood (seen in tests)
•diabetes, decrease in blood potassium, malnutrition, increased blood triglycerides,
•confusional state, panic attacks, depressed mood, decreased libido
•difficulty speaking, impaired memory, loss of movement coordination,
balance disorder, fainting, nerve damage (neuropathy) and problems with sensation
•blurred or double vision
Some of these side effects are more common when capecitabine is used with other medicines for the treatment of cancer. Other side-effects seen in this setting are the following:
Common side effects (may affect up 1 in 10 people) include:
•decrease in blood sodium, magnesium or calcium, increase in blood sugar
•ringing or buzzing in the ears (tinnitus), loss of hearing
•hiccups, change in voice
•pain or altered/abnormal sensation in the mouth, pain in the jaw
•sweating, night sweats
•difficulty in urination, blood or protein in the urine
•bruising or reaction at the injection site (caused by medicines given by injection at the same time)
Very rare side effects (may affect up to 1 in 10,000 people) include:
•narrowing or blockage of tear duct (lacrimal duct stenosis)
•inflammation leading to dysfunction or obstruction in bile secretion (cholestatic hepatitis)
•specific changes in the electrocardiogram (QT prolongation)
•certain types of arrhythmia (including ventricular fibrillation, torsade de pointes, and bradycardia)
If you are concerned about these or any other unexpected effect(s), talk to your doctor.
HOW TO STORE CAPECITABINE
•Keep this medicine out of the sight and reach of children.
•Do not store above 30°C.
•Do not use this medicine after the expiry date which is stated on the carton after
•Any unused medicinal product or waste material should be disposed of in accordance with local requirements for cytotoxic agents.
•Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.