capecitabine: clinical use

Prescribing considerations

• Initiation and supervision should be by a clinician experienced in antineoplastic treatment.
• Test for DPD deficiency before starting; a negative test does not eliminate the possibility of severe toxicity.
• Assess renal and hepatic function, blood counts, cardiac history, neurological disease and interacting medicines.
• Interrupt treatment promptly for clinically significant toxicity and manage dehydration early.

Contraindications and cautions

• Known complete DPD deficiency or a history of severe unexpected fluoropyrimidine reactions
• Hypersensitivity to capecitabine, fluorouracil or product excipients
• Pregnancy or breastfeeding
• Severe leukopenia, neutropenia or thrombocytopenia
• Severe hepatic impairment
• Severe renal impairment
• Recent or concurrent brivudine treatment
• Any contraindication to another component of a combination regimen

Monitoring

• DPD status before initiation
• Full blood count and renal and liver function before and during treatment
• Diarrhoea, mucositis, hand-foot syndrome, hydration and nutritional intake
• Cardiac symptoms and neurological or ophthalmic complications
• INR or prothrombin time with coumarin anticoagulants; phenytoin concentration where co-administered

Clinical pharmacology

Capecitabine is an orally absorbed fluoropyrimidine carbamate converted enzymatically to fluorouracil. Fluorouracil impairs thymidylate formation and disrupts RNA and protein synthesis; DPD is the rate-limiting enzyme in its catabolism.

Formulation and product differences

• The selected product is a dark-pink, capsule-shaped film-coated tablet supplied in blisters.
• It contains lactose and is essentially sodium-free.
• The tablet must not be cut or crushed because exposure to damaged tablets may cause adverse reactions.

Tablet

Route: Oral

Strengths: 150 mg, 500 mg