What Is the Capecitabine Chemotherapy Pill?

What Is Capecitabine?

Last updated: October 2026

Capecitabine is a chemotherapy drug taken orally at home that is converted to 5-FU in the body. It is used alone or with other medicines for colon, rectal, breast, stomach and pancreatic cancers. In Türkiye it is sold as Kapeda, Capetabin and Xeltabin. Correct dosing schedules, pretreatment DPD testing and early management of adverse effects are crucial for safe use.

Why Is This Important?

With intravenous chemotherapy, a team prepares and administers the medicine and monitors the patient. With oral chemotherapy, much of this responsibility passes to the patient and caregiver at home: taking the correct number of tablets at the correct times and on the correct days, recognizing adverse effects early, and knowing when to interrupt treatment. Standards from the American Society of Clinical Oncology (ASCO) and Oncology Nursing Society (ONS) require every patient starting oral chemotherapy to receive education on these issues before the first dose.

Capecitabine is one of the most widely used of these medicines. Being a pill does not mean it is a "mild treatment": it is converted to the same active substance as intravenous 5-FU and can cause the same serious adverse effects. In particular, in people with DPD enzyme deficiency, even a standard dose may cause severe toxicity. Therefore, since 2020 in Europe and Türkiye, and from 2025 in the United States, pretreatment DPD testing has been recommended.

What Is Capecitabine?

Capecitabine is an oral chemotherapy medicine in tablet form. It is itself inactive; in the liver and tumor tissue it is converted in three steps to 5-fluorouracil (5-FU), disrupting cellular DNA and RNA production. It is used for colon, rectal, breast, stomach-esophageal and pancreatic cancers. Its trade names in Türkiye are Kapeda, Capetabin and Xeltabin; Xeloda is inactive.

How Does It Work in the Body?

Capecitabine is a "prodrug". After intestinal absorption, it passes through two enzymatic steps, first in the liver and then in tissues; thymidine phosphorylase, the enzyme in the final step, is present at higher levels in many tumors than in healthy tissue. The resulting 5-FU inhibits thymidylate synthase, an enzyme needed for cell division, and stops rapidly dividing cancer cells from multiplying. Its main advantage is providing an effect similar to prolonged intravenous 5-FU infusion as a pill, without requiring a port or infusion pump.

The half-life of the medicine and 5-FU is approximately 45 minutes; it is therefore taken twice daily. Approximately %96 of the administered dose is excreted in urine, which is why kidney function matters in dose calculation. Of the resulting 5-FU, more than %80 is broken down by the DPD enzyme. Because it is converted to the same active substance, in our 5-FU article much of the information also applies to capecitabine.

For Which Cancers Is Capecitabine Used?

In the United States, the product information was updated in December 2022 under the FDA program for updating labels of older oncology medicines (Project Renewal), and new indications were added. The indications in Türkiye's summaries of product characteristics (KÜB) are narrower:

What Evidence Supports Uses Not Listed in the License?

Although the following uses appear in current guidelines, they may not appear in Türkiye's KÜBs. In that case, SGK requires a medical board report showing the treatment protocol (details in the Türkiye section).

BILCAP, in our biliary tract cancer article, and CREATE-X, in our breast cancer article , are discussed in detail.

How Is Capecitabine Used?

The dose is determined according to body surface area (m²), calculated from height and weight, and is made up using a combination of 500 mg and 150 mg tablets. The dose and schedule vary according to the cancer, accompanying medicines and kidney function:

• How to swallow: Swallow tablets whole with water within 30 minutes after a meal; do not chew, split or crush them. Tell your team if you have difficulty swallowing; crushing or splitting should be performed only by a trained healthcare professional.
• Missed dose: Do not take a missed dose later or double the next dose; continue the schedule where you left off and inform your team.
• Kidney function: For creatinine clearance of 30-50 mL/dk, the starting dose is reduced by %25. European product information states that the medicine should not be used below 30 mL/dk; the US label states that a dose has not been established in this group.
• Safe handling and storage: Capecitabine is a cytotoxic medicine. Wash your hands after touching tablets, store the medicine in its original package out of children's reach, and do not put unused tablets in household waste; return them to the pharmacy or your treatment center.
• Contraception: The medicine may harm the baby during pregnancy. Women should use effective contraception for 6 months after the last dose, and men whose partners could become pregnant for 3 months.

The classic schedule is "14 days of medicine, 7 days off". With radiotherapy or low-dose (metronomic) use such as in SYSUCC-001, the medicine is taken every day without a break. Seeing your schedule written in your treatment calendar is the simplest way to prevent confusion.

What Are the Adverse Effects of Capecitabine?

US product information includes data from 596 patients receiving capecitabine alone for metastatic colorectal cancer. With combination treatments, the profile varies according to the accompanying medicine:

In this study, %13 of patients stopped treatment because of an adverse effect or an intercurrent illness. Hair loss and marked reductions in blood counts are less common than with intravenous chemotherapy; hand-foot syndrome and diarrhea are more prominent. Less common but important adverse effects include heart problems such as chest pain, arrhythmia and heart muscle damage; product information does not provide a frequency for these. Chest pain always requires emergency evaluation.

How Can Hand-Foot Syndrome Be Prevented?

This condition, involving redness, numbness, swelling, peeling and pain in the palms and soles, begins at a median of day 79 according to product information. With advanced (grade 2 or above) hand-foot syndrome, fingerprints may disappear, causing identification problems. Product information recommends interrupting the medicine for grade 2 or 3 hand-foot syndrome until symptoms decrease to grade 1. General care recommendations are in our hand-foot syndrome article .

• Diclofenac gel: A fingertip-sized amount of %1 gel was applied to the palms and backs of the hands 2 times daily. Details are explained in our diclofenac gel article . Consult your team before starting.
• %10 urea cream: In the German phase 3 study, when applied 3 times daily for 6 weeks, any-grade hand-foot syndrome occurred in %22,4 versus %39,5. The comparison was with another cream, not placebo, and no significant difference was found for grade 2 or higher disease.
• Vitamin B6 (pyridoxine): A meta-analysis involving 607 patients and a placebo-controlled study did not demonstrate benefit; it is not routinely recommended.
• Daily precautions: Established recommendations are to protect hands and feet from hot water, friction and pressure; wear comfortable shoes and cotton socks; and frequently use fragrance-free moisturizer.

What Should You Do If Diarrhea Occurs?

Product information grades diarrhea by the number of stools added to your usual bowel movement count: 4-6 additional bowel movements a day or nighttime bowel movements are grade 2, 7-9 additional bowel movements or incontinence are grade 3, and 10 or more are grade 4. For grade 2 or higher diarrhea, capecitabine is interrupted immediately and not restarted until diarrhea decreases to grade 1.

• Fluids: Lost fluid and salt must be replaced; water, ayran, soup and oral rehydration salt solutions are suitable. If you cannot retain fluids, feel dizzy or have reduced urination, attend the emergency department.
• Antidiarrheal medicine: Product information recommends standard antidiarrheals such as loperamide but does not specify a dose. A common schedule in the Canadian BC Cancer guideline is: initially 4 mg, then every 4 hours or after each watery stool, 2 mg, up to 16 mg daily. Use this medicine according to the written plan your team gives you.
• Dose decision: According to current US product information, after a first episode of grade 2 diarrhea, the same dose is resumed; after a second episode, %75 of the dose is resumed. For grade 3, the dose is %75; for grade 4, treatment is permanently stopped or changed to %50 of the dose. Your physician makes this decision.

What Is DPD Deficiency, and Is Testing Necessary Before Treatment?

Dihydropyrimidine dehydrogenase (DPD) is the enzyme that breaks down 5-FU. Certain variants in DPYD, the gene encoding this enzyme, reduce or eliminate its activity; in these people, standard-dose capecitabine can accumulate in the body, causing severe diarrhea, mouth sores, profound reductions in blood counts and life-threatening conditions. According to US product information, among white people, approximately %3-5 have partial and %0,2 have complete DPD deficiency. We also discuss this in our DPD deficiency article .

Carrier frequencies are from European product information; the risk increase, in a meta-analysis examining 7.365 patients, is the adjusted relative risk for grade 3 or higher adverse effects (Meulendijks et al., 2015).

What Do Regulatory Agencies Say?

• EMA (2020): Recommended testing by DPYD genotyping or blood uracil measurement before starting 5-FU, capecitabine and tegafur; these medicines are not used with complete deficiency, and a reduced starting dose is considered with partial deficiency.
• TİTCK (3 September 2020): Communicated the same recommendations to physicians in Türkiye in a "Dear Doctor" letter: genotyping four DPYD variants or measuring uracil (16-150 ng/mL partial deficiency, 150 ng/mL or above complete deficiency).
• FDA (2025-2026): In January 2025, reminded physicians to consider testing. In October 2025, a boxed warning entitled "serious adverse effects or death with complete DPD deficiency" was added to the capecitabine label; testing for DPYD variants before starting was required unless urgent treatment was necessary. In February 2026, the same warning was announced for 5-FU.

Some laboratories in Türkiye offer DPYD testing, but some examine only the DPYD*2A variant. When requesting a test, ask whether a panel examining all four variants or uracil measurement is performed. We could not find an SUT provision allowing us to verify whether SGK covers the test.

In severe 5-FU or capecitabine toxicity, when started within 96 hours after the last dose, uridine triacetate (Vistogard) is an antidote. The FDA approved it in 2015; in registered studies, %97 of those with overdose and %89 of those with early severe adverse effects were alive on day 30. The medicine is not licensed in Türkiye; our uridine triacetate article has details.

Which Medicines Interact with Capecitabine?

Current Situation Regarding Stomach Protectants: In an additional analysis of the TRIO-013 study in advanced stomach cancer, patients using PPIs while receiving capecitabine and oxaliplatin had a shorter time to disease progression (4,2 versus 5,7 months) and survival (9,2 versus 11,3 months). In contrast, analysis of the PRODIGE 23 study in rectal cancer found no significant difference; two studies examining drug levels also reported that rabeprazole and esomeprazole did not affect capecitabine levels. Product information does not list PPIs among interactions. In practice, avoiding unnecessary PPI use when there is no genuine need, and deciding with your physician when it is needed, is a reasonable approach. Always inform your team about herbal products and supplements too.

What Monitoring Is Performed During Treatment?

• Before each cycle: Complete blood count, liver tests (especially bilirubin) and kidney function.
• For patients taking warfarin: Frequent INR measurements throughout treatment.
• If diarrhea or vomiting occurs: Electrolyte balance (sodium, potassium) and kidney function.
• At every visit: Examination of hands and feet, inspection of the mouth, and review of remaining tablet count and medication diary.

Capecitabine in Türkiye: Which Products Are Available, and Does SGK Cover It?

Frequently Asked Questions

Can Capecitabine Be Taken on an Empty Stomach?

No. Product information recommends swallowing tablets whole with water within 30 minutes after a meal. Morning and evening doses are taken approximately 12 hours apart.

What Should I Do If I Forget a Dose?

Do not take the missed dose later or double the next dose. Continue your schedule with the next dose, note this in your medication diary and inform your team.

Are Capecitabine and 5-FU the Same Medicine?

Capecitabine is a prodrug converted to 5-FU in the body. Their effects and adverse effects are similar, but it is taken as a pill at home and does not require a port or infusion pump. The DPD deficiency warning applies to both.

When Should I Contact a Doctor Immediately?

For fever of 38 °C or above, chills, chest pain, or vomiting or diarrhea severe enough to prevent fluid retention, seek help without delay. For 4 or more additional bowel movements daily, painful redness of the hands and feet or mouth sores preventing eating, stop the medicine and call your team the same day.

Glossary

Prodrug

A medicine converted to its active form by enzymes after entering the body.

DPD / DPYD

DPD is the enzyme that breaks down 5-FU; DPYD is the gene encoding this enzyme.

Hand-foot syndrome

Redness, swelling, peeling and pain in the palms and soles; the medical name is palmar-plantar erythrodysesthesia.

Adjuvant treatment

Protective treatment given after surgery to reduce the risk of disease recurrence.