What precautions need to be taken when handling Xeloda (capecitabine)?

From the Guidelines

When handling Xeloda (capecitabine), it is crucial to wear gloves and avoid direct skin contact to prevent absorption through the skin, as emphasized by general guidelines for handling cytotoxic medications 1. To minimize exposure, several precautions should be taken:

• Wear gloves when touching the tablets to avoid direct skin contact
• Wash hands thoroughly before and after handling the medication
• Store Xeloda at room temperature away from moisture and heat
• Keep the medication in its original container with the safety cap secured, and place it out of reach of children and pets
• Pregnant women should avoid handling crushed or broken tablets due to potential harm to the fetus
• If you need to split tablets, use a pill cutter rather than breaking them by hand to minimize dust exposure
• If powder from the tablets contacts your skin, wash the area immediately with soap and water Although the study 1 focuses on syringe hygiene and handling of medications in an anaesthesia setting, its recommendations on storage, handling, and disposal of medications can be applied to handling Xeloda, highlighting the importance of following product-specific recommendations and maintaining sterile integrity. Key considerations for handling Xeloda include recognizing it as a chemotherapy drug that can be absorbed through the skin and taking measures to prevent such absorption, which is not directly addressed in the provided study 1 but is a critical aspect of handling cytotoxic agents.

From the FDA Drug Label

PRECAUTIONS General Patients receiving therapy with XELODA should be monitored by a physician experienced in the use of cancer chemotherapeutic agents.

The precautions to be taken when handling XELODA include:

• Monitoring by a physician: Patients receiving XELODA should be monitored by a physician experienced in the use of cancer chemotherapeutic agents.
• Handling and administration: XELODA tablets should be swallowed with water within 30 minutes after a meal.
• Dose management: Doses of XELODA may need to be withheld or reduced in case of adverse events (see DOSAGE AND ADMINISTRATION).
• Combination with other drugs: Use of XELODA in combination with other drugs (e.g. irinotecan) has not been adequately studied.
• Hand-and-foot syndrome: Patients should be monitored for hand-and-foot syndrome, and doses of XELODA should be interrupted or reduced if this occurs.
• Cardiotoxicity: Patients with a prior history of coronary artery disease should be carefully monitored for cardiotoxicity.
• Dihydropyrimidine dehydrogenase deficiency: Patients with this deficiency may be at risk of severe toxicity.
• Hepatic insufficiency: Patients with mild to moderate hepatic dysfunction should be carefully monitored.
• Hyperbilirubinemia: Patients should be monitored for hyperbilirubinemia.

2

From the Research

Precautions for Handling Xeloda

When handling Xeloda (capecitabine), several precautions need to be taken to minimize exposure and prevent adverse effects.

• Personal protective equipment (PPE) should be worn, including gloves, aprons and/or gowns, and eye protection, as recommended by the United States Pharmacopeia Chapter <800> 3.
• Xeloda is a hazardous drug and should be handled according to the guidelines for handling hazardous drugs in healthcare settings 3.
• The drug should be handled in a well-ventilated area, and measures should be taken to prevent skin contact and inhalation of dust 3.
• In case of skin contact, the area should be washed immediately with soap and water 4.
• Xeloda is not a cytotoxic drug in itself, but it is converted to 5-FU, a cytotoxic drug, within the body, and therefore, handling precautions should be taken to minimize exposure 5, 6.

Safe Handling Practices

To ensure safe handling of Xeloda, the following practices should be followed:

• The drug should be stored in a secure location, away from direct sunlight and moisture 3.
• The packaging should be intact, and the drug should be handled according to the manufacturer's instructions 3.
• Spills should be cleaned up immediately, and the area should be decontaminated according to the guidelines for handling hazardous drugs 3.
• Waste disposal should be done according to the regulations for disposing of hazardous waste 3.

Education and Training

Education and training are essential for healthcare professionals who handle Xeloda, to ensure that they are aware of the precautions and safe handling practices.

• Healthcare professionals should be trained on the proper use of PPE and safe handling practices 3, 4.
• Patients should also be educated on the proper handling and disposal of Xeloda, and the precautions to be taken to minimize exposure 5, 6.