ORAL CHEMOTHERAPY EDUCATION CAPECITABINE Page 1 of 6 1 Name of your medication Generic Name Capecitabine (ka peh SY tuh been) Brand Name Xeloda (zeh LOH duh) Uses (Indications for this medication) Capecitabine is used t treat patients with: Breast cancer Colorectal cancer Dose and schedule Capecitabine is recommended t be dosed based on your height and weight. Take by mouth twice daily with water within 30 minutes after eating a meal. The dose may be adjusted by your care provider based your individual patient specific factors. D not crush or dissolve capecitabine; swallow whole. If you are unable t swallow capecitabine, discuss possible or available options with your care provider or pharmacist. If you miss a dose of capecitabine, take your next dose at the regularly scheduled time. D not take tw doses at the same time t make up for the missed dose. Taking your capecitabine as instructed is important t getting the best treatment effect. Keep track of any missed doses and report these t your care provider. Available dosage forms and identification Tw types of tablets are commercially available 150 mg and 500 mg. These tablets are oblong in shape. Given that capecitabine has many manufacturers, the tablets may appear different. Ask your pharmacist if you have any questions regarding appearance. Storage and handling Store capecitabine at room temperature (68 °F t 77 °F) in a dry location away from light. Wash hands with soap and water before and after handling capecitabine. Keep capecitabine in the provided packaging until it is ready t be taken, and keep capecitabine out of the reach of children and pets. When it is time t take capecitabine, gently transfer the medication int a medicine cup and ingest it immediately. Whenever possible, patients should administer capecitabine t themselves. If the dose needs t be given by a caregiver, the caregiver should wear gloves and avoid touching the medication. D not use the gloves for anything else and discard used gloves in the household trash. Pill containers can be used if they help t take capecitabine as prescribed, but can become contaminated with dust from the chemotherapy. If it is needed, use a separate pill container for your chemotherapy. The person filling the pill container should wear gloves. When empty, the container should be washed with soap and water. ORAL CHEMOTHERAPY EDUCATION CAPECITABINE Page 1 of 6 2 If you have unused capecitabine, d not dispose of tablets in the trash or flush down the sink. Talk with your care provider or pharmacist about options for proper disposal of capecitabine. If traveling, seal your capecitabinein a plastic bag. Ask your pharmacist if additional travel precautions are needed. Handling body secretions and waste Chemotherapy remains in the body for several days after it is taken. Your body may get rid of the capecitabine in urine and/or stool, and it may be present in sweat and/or vomit (if you vomit). It is important t wash hands thoroughly with soap and water after using the toilet or touching anything (linens, clothing) that may be soiled with chemotherapy or body fluids. Pregnant women should avoid touching anything that may be soiled with body fluids. You may use the same toilet (septic tank or sewer) that you usually use. If you have a low flow toilet, close the lid and flush twice t ensure all waste has been removed. If the toilet or seat becomes soiled with urine, stool, or vomit, clean the surface before others use the toilet. For those wh lose control of bladder or bowels, use a disposable, plastic backed pad, diaper, or sheet t absorb waste. Wash exposed skin with soap and water. If the patient uses a bedpan, caregivers should wear gloves t assist with cleanup, and wash the equipment with soap and water daily. Linens or clothing that is soiled with urine, stool, or vomit should be washed separately from other household linens. All other laundry may be washed normally. If you d not have a washer, place soiled items int a plastic bag until they can be washed. Drug and food interactions Capecitabine has many drug interactions, please inform your care provider of all prescription medications, over the counter medications, vitamins, and herbal products. Talk with your care provider or pharmacist before receiving any vaccines. Boxed warnings (this type of warning is commonly referred t as a “Black Box warning” and is issued by the U.S. Food and Drug Administration (FDA). These warnings are designed t call attention t serious adverse events which have been associated with a medication). Increased risk of bleeding when taking warfarin (Coumadin®) with capecitabine or within 1 month after stopping capecitabine therapy. ORAL CHEMOTHERAPY EDUCATION CAPECITABINE Page 1 of 6 3 Common side effects: (Side effects listed below happen in greater than 30% of patients). You may not experience all of these side effects. Options exist t minimize and prevent these side effects noted in the Management section. Side Effect Management Your white blood cells (WBCs) may decrease. Your WBCs should be monitored using a blood test. When your WBCs are low, you are at a greater risk of having an infection. Seek medical help immediately if you experience any signs or symptoms of an infection such as: fever (temperature more than 100.4°F or 38°C), chills, sore throat, burning with urination, or a sore that does not heal.  Wash your hands often, especially before eating and after using the bathroom  Avoid people with fevers, flu, or other infections  Maintain good personal hygiene ORAL CHEMOTHERAPY EDUCATION CAPECITABINE Page 1 of 6 4 Your hemoglobin may decrease. Your hemoglobin should be monitored using a blood test. When your hemoglobin is low, you may notice that you get tired or fatigued more easily.  Try t get 7 t 8 hours of sleep per night  Avoid operating heavy machinery if you feel to tired  Find a balance between “work” and “rest”  Stay as active as possible, but know that it is okay t rest as needed, too  You might notice that you are more pale than usual ORAL CHEMOTHERAPY EDUCATION CAPECITABINE Page 1 of 6 5 You may experience diarrhea (loose and/or urgent bowel movements). Monitor how many bowel movements you have each day.  Drink 8 10 glasses of water/fluid each day unless your care provider has instructed you t limit your fluid intake due to some other health problem  Eat small, frequent meals throughout the day rather than a few large meals  Eat bland, low fiber foods (such as bananas, applesauce, potatoes, chicken, rice, and toast)  Avoid high fiber foods, such as raw vegetables, raw fruits and whole grains  Avoid foods that cause gas, such as broccoli and beans  Avoid lactose containing foods, such as yogurt and milk  Avoid spicy, fried, and greasy foods Contact your provider if any of the following occur:  The number of bowel movements you have in a day increases by 4 or more  You feel dizzy or lightheaded Your care provider may recommend an over the counter medication called loperamide (Immodium®) t help with your diarrhea, but talk t your care provider before starting this medication. You may experience nausea or vomiting.  Eat and drink slowly  Drink 8 10 glasses of water/fluid each day unless your care provider has instructed you t limit your fluid intake due t some other health problem  Eat small, frequent meals throughout the day rather than a few large meals  Eat bland foods  Avoid spicy, fried, and greasy foods  Avoid vigorous exercise immediately after eating  Don’t lay down immediately after eating  Avoid strong odors Let your provider know if you experience nausea or vomiting. Your provider may prescribe medication t help with the nausea or vomiting. ORAL CHEMOTHERAPY EDUCATION CAPECITABINE Page 1 of 6 6 You may experience pain or discomfort in your hands and/or feet Hand and foot syndrome (HFS) is a skin reaction that appears on the palms of the hands and soles of the feet. It can appear as a rash, peeling skin, or “pins and needles” sensation. Let your care provider know right away if you experience this side effect. T prevent HFS, you can:  Keep hands and feet moisturized  Avoid hot showers or baths that may dry out the skin  Avoid tight shoes or socks You may experience fatigue. If you are more tired than usual or have less energy, take rests during the day, limit your activities, and d activities at a time of day when you feel a bit more energetic. Avoid operating heavy machinery if you feel to tired. You may experience rash or itchy skin.  Keep your skin moisturized with creams and moisturizing lotions t decrease the risk of rash or itchiness, and wear loose fitting clothing.  Avoid using perfumes and cologne as these products may increase rash symptoms.  Avoid being in the heat for long periods of time.  If rash occurs or continues t worsen, contact your care provider.  Your provider may recommend an over the counter antihistamine or a topical cream. If your rash continues t worsen, contact your care provider. Changes in your liver function may occur. Contact your care provider if you notice any of the following:  Yellowing of the skin or whites of your eyes  Dark or brown urine  Bleeding or bruising ORAL CHEMOTHERAPY EDUCATION CAPECITABINE If you experience ANY uncontrolled side effect, call your physician/health care center immediately: (INSTITUTIONAL CONTACT INFO) Pregnancy and contraception D not become pregnant while taking capecitabine. Females of reproductive potential should use effective contraception during therapy and for a minimum of 6 months after the last dose of capecitabine. Males of reproductive potential should use effective contraception during therapy and for a minimum of 3 months after the last dose of capecitabine. D not breastfeed while taking capecitabine and for 2 weeks after the last dose of capecitabine. Please inform your care provider if you become pregnant. It is safe t hug and kiss. Special precautions may be needed for sexual activity while on oral chemotherapy, and you are encouraged t ask your care provider. Obtaining medication Talk with your care provider about the process for obtaining your capecitabine. (PHARMACY/SPECIALTY PHARMACY CONTACT INFO) Additional resources Product website https://www.gene.com/patients/medicines/xeloda Product prescribing information https://www.gene.com/download/pdf/xeloda prescribing.pdf Product resources https://www.gene.com/patients/patient access Updated June 14, 2017 Additional instructions ORAL CHEMOTHERAPY EDUCATION CAPECITABINE Important notice: The Association of Community Cancer Centers (ACCC), Hematology/Oncology Pharmacy Association (HOPA), National Community Oncology Dispensing Association, Inc. (NCODA), and Oncology Nursing Society (ONS) have collaborated in gathering information for and developing this patient guide. This guide represents a brief summary of the medication derived from information provided by the drug manufacturer and other resources. This guide does not cover all existing information related t the possible uses, directions, doses, precautions, warnings, interactions, adverse effects, or risks associated with this medication and should not substitute for the advice of a qualified healthcare professional. Provision of this guide is for informational purposes only and does not constitute or imply endorsement, recommendation, or favoring of this medication by ACCC, HOPA, NCODA, or ONS, wh assume n liability for and cannot ensure the accuracy of the information presented. The collaborators are not making any representations with respect t the medications whatsoever, and any and all decisions, with respect t such medications, are at the sole risk of the individual consuming the medication. All decisions related t taking this medication should be made with the guidance and under the direction of a qualified healthcare professional. Permission: Oral Chemotherapy Education Sheets (OCS) are provided as a free educational resource for patients with cancer in need of concise, easy to understand information about oral cancer drugs. Healthcare providers are permitted t copy and distribute the sheets t patients as well as direct patients t the OCS website for information. However, commercial reproduction or reuse, as well as rebranding or reposting of any type, are strictly prohibited without permission of the copyright holders. Permission requests and licensing inquiries will be made through a link on the website which NCODA will forward t HOPA upon receipt. Copyright © 2016 by Hematology /Oncology Pharmacy Association. All rights reserved.