From the Guidelines
Xeloda (capecitabine) can cause several severe side effects, including hand-foot syndrome, diarrhea, and neutropenia, which can significantly impact a patient's quality of life and increase the risk of morbidity and mortality. The most common side effects of Xeloda include:
- Hand-foot syndrome, which affects up to 73.4% of patients, with 11.1% experiencing grade 3 events 1
- Diarrhea, which can be severe and may require anti-diarrheal medications like loperamide
- Neutropenia, which can increase the risk of infection
- Fatigue, decreased appetite, and mouth sores, which can impact a patient's quality of life More serious but less common side effects include:
- Severe diarrhea with dehydration
- Severe hand-foot syndrome that interferes with daily activities
- Chest pain, irregular heartbeat, and severe allergic reactions
- Low blood cell counts that increase infection risk Patients should be closely monitored for these side effects, and dose adjustments should be made at the earliest signs of certain side effects, such as hand-foot syndrome, to minimize the risk of morbidity and mortality 1. It is also important to note that the incidence of adverse events with Xeloda can be higher in certain patient populations, such as older patients or those with diminished creatinine clearance, and may require dose modification 1. Overall, the management of Xeloda side effects requires careful monitoring and prompt intervention to minimize the risk of morbidity and mortality and improve patient outcomes.
From the FDA Drug Label
The most common side effects of XELODA are: – diarrhea, nausea, vomiting, sores in the mouth and throat (stomatitis), stomach area pain (abdominal pain), upset stomach, constipation, loss of appetite, and too much water loss from the body (dehydration). These side effects are more common in patients age 80 and older – hand-and-foot syndrome (palms of the hands or soles of the feet tingle, become numb, painful, swollen or red), rash, dry, itchy or discolored skin, nail problems, and hair loss – tiredness, weakness, dizziness, headache, fever, pain (including chest, back, joint, and muscle pain), trouble sleeping, and taste problems
The common side effects of XELODA include:
- Gastrointestinal symptoms: diarrhea, nausea, vomiting, stomatitis, abdominal pain, constipation, loss of appetite, and dehydration
- Dermatological symptoms: hand-and-foot syndrome, rash, dry skin, itchy skin, discolored skin, nail problems, and hair loss
- General symptoms: tiredness, weakness, dizziness, headache, fever, pain, trouble sleeping, and taste problems 2
From the Research
Xeloda Side Effects
- The most common side effects of Xeloda (capecitabine) include diarrhea, stomatitis, nausea, alopecia, and neutropenia, although these are significantly less frequent than with intravenous 5-fluorouracil (5-FU) 3.
- Hand-foot syndrome (HFS) is a common side effect of Xeloda, occurring in over 50% of patients, and is characterized by erythema, dysesthesia, pain, cracking, and desquamation on the palms and soles 4, 5.
- Other side effects of Xeloda include hyperbilirubinemia, myelosuppression, fatigue, weakness, abdominal pain, and nausea 6.
- The incidence of side effects can vary depending on the patient population, with a gradient of fluoropyrimidine toxicity observed, with higher incidence in the US and lower incidence in East Asia 7.
- Patient education and awareness of the possibility of side effects, as well as supportive measures, are crucial in managing Xeloda-related side effects 3, 4, 5.
Management of Side Effects
- Treatment interruption and dose reduction are common strategies for managing Xeloda-related side effects, including HFS 3, 4, 5.
- Supportive measures, such as topical formulations and systemic treatment regimens, can also be used to alleviate symptoms of HFS 5.
- COX-2 inhibitors have been proposed as a promising agent for the management of HFS, although large prospective randomized controlled trials are needed to establish evidence-based treatment algorithms 5.