CAPECITABINE

CAPECITABINe
(cap-e-si'ta-been)
Xeloda
Classifications: antineoplastic; antimetabolite, pyrimidine;
Therapeutic: antineoplastic; antimetabolite
Prototype: 5-Fluorouracil (5-FU)
Pregnancy Category: D

Availability

150 mg, 500 mg tablets

Action

Pyrimidine antagonist and cell cycle-specific antimetabolite. Prodrug of 5-FU. Blocks actions of enzymes essential to normal DNa and RNA synthesis. May become incorporated into RNA molecules of tumor cells, thereby interfering with RNA and protein synthesis.

Therapeutic Effect

Reduces or stabilizes tumor size in metastatic breast cancer.

Uses

Metastatic breast cancer refractory to other treatments, colorectal cancer, single-agent adjuvant therapy for colon cancer after surgery.

Contraindications

Hypersensitivity to capecitabine, doxifluridine, 5-FU; myelosuppression; dihydropyrimidine dehydrogenase (DPD) deficiency; females of childbearing age; active infection; jaundice; severe renal failure or impairment; pregnancy (category D); lactation, children <18 y.

Cautious Use

Mild to moderate renal or hepatic dysfunction; bacterial or viral infection; coronary artery disease, angina, cardiac arrhythmias; history of varicella zoster or other herpes infections; older adults.

Route & Dosage

Breast Cancer, Colorectal Cancer
Adult: PO 2500 mg/m²/d in 2 divided doses x 2 wk, then 1 wk off. Repeat.

Renal Impairment
Cl_cr 30–50 mL/min: reduce dose by 25%; <30 mL/min: do not use

Administration

Oral

Morning and evening doses (about 12 h apart) should be given within 30 min of the end of a meal. Water is the preferred liquid for taking this drug.

Adverse Effects (≥1%)

Body as a Whole: Fatigue, pyrexia, pain, myalgia. CV: Edema. GI: Severe diarrhea, nausea, vomiting, stomatitis, abdominal pain, constipation, dyspepsia, anorexia. Hematologic: Neutropenia, thrombocytopenia, anemia, lymphopenia. Metabolic: Dehydration, hyperbilirubinemia. CNS: Paresthesias, headache, dizziness, insomnia. Skin: Hand-and-foot syndrome, dermatitis, nail disorder. Special Senses: Eye irritation.

Interactions

Drug: Leucovorin increases concentration and toxicity of 5-FU, altered coagulation and/or bleeding reported with warfarin. Food: Food decreases extent of absorption.

Pharmacokinetics

Absorption: Absorption significantly reduced by food. Peak: 1.5–2 h. Distribution: Approx 35% protein bound. Metabolism: Extensively metabolized to 5-FU. Elimination: In urine. Half-Life: 45 min.

Nursing Implications

Assessment & Drug Effects

Lab tests: Monitor periodically CBC with differential and liver functions including bilirubin, transaminases, alkaline phosphatase.
Monitor carefully for S&S of grade 2 or greater toxicity: diarrhea >4 BMs/day or at night; vomiting >1 time/24 h; significant loss of appetite or anorexia; stomatitis; hand-and-foot syndrome (pain, swelling, erythema, desquamation, blistering); temperature = 100.5° F; and S&S of infection.
Withhold drug and immediately report S&S of grade 2 or greater toxicity.
Monitor for dehydration and replace fluids as needed.
Monitor carefully patients with coronary artery disease for S&S of cardiotoxicity (e.g., increasing angina).

Patient & Family Education

Report immediately significant nausea, loss of appetite, diarrhea, soreness of tongue, fever of 100.5° F or more, or signs of infection. Review patient drug package insert carefully for more detail.
Inform physician immediately if you become pregnant.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(69)