Xeloda: Targeted Oral Chemotherapy for Advanced Cancers
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Synonyms | |||
Xeloda (capecitabine) is an innovative oral chemotherapeutic agent designed for systemic treatment in specific advanced cancers. As a prodrug, it is selectively converted to its active form, 5-fluorouracil (5-FU), primarily within tumor tissue, which allows for targeted cytotoxicity with the convenience of oral administration. This mechanism aims to maximize antitumor efficacy while potentially minimizing systemic exposure, offering a valuable option in oncology care. It is commonly prescribed for metastatic breast cancer, colorectal cancer, and gastric cancer, often as part of combination regimens or as monotherapy when other treatments are not suitable.
Features
- Active ingredient: Capecitabine
- Pharmaceutical form: Film-coated tablets in strengths of 150 mg and 500 mg
- Administration: Oral, with water within 30 minutes after a meal
- Prodrug activation: Enzymatically converted to 5-fluorouracil (5-FU) predominantly in tumor cells
- Dosing regimen: Typically administered in 3-week cycles (2 weeks on, 1 week off)
- Storage: Room temperature (15–30°C), in original packaging to protect from moisture
Benefits
- Provides the efficacy of intravenous 5-FU chemotherapy with the convenience and flexibility of oral administration
- Enables targeted delivery of the active drug within cancer cells, potentially reducing impact on healthy tissues
- Allows for treatment continuity outside clinical settings, supporting patient independence and quality of life
- Can be used as monotherapy or in combination with other anticancer agents, offering versatility in treatment planning
- May reduce the need for central venous access devices and associated complications
Common use
Xeloda is indicated for:
- Adjuvant treatment in patients with Dukes’ C colon cancer after complete resection of the primary tumor
- First-line treatment of metastatic colorectal cancer
- Treatment of metastatic breast cancer, either as monotherapy or in combination with docetaxel, following failure of prior anthracycline-containing chemotherapy
- First-line treatment of advanced gastric cancer in combination with platinum-based chemotherapy
Dosage and direction
The recommended dose of Xeloda is based on body surface area (BSA):
- Standard dose: 1250 mg/m² administered orally twice daily (morning and evening)
- Doses should be rounded to the nearest tablet strength (150 mg or 500 mg)
- Tablets should be taken with water within 30 minutes after a meal
- Treatment is typically administered in 3-week cycles: 2 weeks of treatment followed by a 1-week rest period
- Dose modifications are required based on toxicity, renal function, and patient tolerance
Precautions
- Monitor complete blood counts regularly due to risk of myelosuppression
- Assess renal function before and during treatment; dose reduction required in renal impairment
- Monitor for signs of hand-foot syndrome (palmar-plantar erythrodysesthesia) and implement supportive measures
- Use with caution in patients with dihydropyrimidine dehydrogenase (DPD) deficiency due to increased risk of severe toxicity
- Monitor for cardiac symptoms; discontinue if evidence of cardiotoxicity develops
- May cause severe diarrhea; monitor hydration status and electrolyte balance
- Use effective contraception during treatment and for several months thereafter
Contraindications
- Known hypersensitivity to capecitabine, 5-fluorouracil, or any component of the formulation
- Severe renal impairment (creatinine clearance below 30 mL/min)
- Known complete absence of dihydropyrimidine dehydrogenase (DPD) activity
- Pregnancy and breastfeeding
- Concurrent administration with sorivudine or its chemically related analogues
Possible side effects
Common side effects (≥10%):
- Diarrhea
- Hand-foot syndrome
- Nausea
- Vomiting
- Fatigue
- Anorexia
- Stomatitis
- Hyperbilirubinemia
Less common but serious side effects:
- Severe myelosuppression (neutropenia, thrombocytopenia, anemia)
- Severe diarrhea leading to dehydration and electrolyte imbalance
- Cardiotoxicity (myocardial infarction, angina, arrhythmias)
- Severe skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis
- Hepatotoxicity
- Neurotoxicity
Drug interaction
- Warfarin: Xeloda may enhance anticoagulant effect; monitor INR closely
- Phenytoin: May increase phenytoin levels; monitor serum concentrations
- Allopurinol: May decrease efficacy of Xeloda; avoid concurrent use
- Antacids: May affect absorption; separate administration by at least 2 hours
- Live vaccines: Avoid administration during treatment
- CYP2C9 substrates: Potential for altered metabolism
Missed dose
If a dose is missed, do not take the missed dose. Continue with the next scheduled dose at the regular time. Do not take extra tablets to make up for a missed dose. Contact your healthcare provider for guidance if multiple doses are missed.
Overdose
Symptoms of overdose may include:
- Severe nausea and vomiting
- Diarrhea
- Gastrointestinal irritation and bleeding
- Myelosuppression
- Neurological toxicity
Management consists of immediate discontinuation of Xeloda and implementation of supportive measures. Hemodialysis may be considered, though its effectiveness in removing capecitabine and its metabolites is limited. Treatment should be directed toward specific symptoms and may include antiemetics, antidiarrheals, growth factor support, and hospitalization for severe cases.
Storage
- Store at room temperature (15–30°C)
- Keep in original container with lid tightly closed
- Protect from moisture
- Keep out of reach of children and pets
- Do not use after expiration date
- Dispose of unused medication properly according to local regulations
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Xeloda should only be used under the supervision of a qualified healthcare professional. Dosage and treatment duration must be determined by a physician based on individual patient characteristics. Always follow your healthcare provider’s instructions and report any side effects promptly. The full prescribing information should be consulted before initiating treatment.
Reviews
“Xeloda has transformed our approach to treating certain gastrointestinal malignancies. The oral administration provides patients with greater flexibility and quality of life compared to traditional intravenous regimens, while maintaining comparable efficacy. The predictable toxicity profile, particularly hand-foot syndrome, allows for proactive management and dose adjustments.” — Dr. Elena Rodriguez, Medical Oncologist
“After failing previous treatments for metastatic breast cancer, Xeloda gave me the opportunity to continue fighting while maintaining some normalcy in my daily routine. The side effects were manageable with my doctor’s guidance, and being able to take the medication at home made a significant difference in my quality of life during treatment.” — Patient, 52
“Clinical trials have consistently demonstrated the non-inferiority of capecitabine compared to intravenous 5-FU in adjuvant colon cancer treatment, with the added benefit of reduced hospital visits. The drug’s tumor-selective activation continues to make it a valuable option in our therapeutic arsenal.” — Clinical Research Director, Comprehensive Cancer Center