Generic Capecitabine

Introduction

Capecitabine is an oral chemotherapy pro‑drug used primarily in the United Kingdom for the treatment of several solid tumours, most notably breast and colorectal cancers. The active compound, capecitabine, belongs to the antimetabolite class of anticancer agents. It is supplied by a range of manufacturers worldwide and is listed under the cancer medication group by the UK Medicines and Healthcare products Regulatory Agency (MHRA). In addition to its main oncologic indications, capecitabine is sometimes employed off‑label in gastric and pancreatic malignancies where clinical evidence supports benefit.

What is Capecitabine?

Capecitabine is a fluoropyrimidine carbamate that is metabolised in the body to 5‑fluorouracil (5‑FU), the active chemotherapeutic moiety. The drug was first developed by Roche and marketed under the brand name Xeloda. Capecitabine is the generic version of Xeloda, containing the same active compound capecitabine. Our online pharmacy provides this generic alternative as a cost‑effective treatment option for patients who require oral chemotherapy but seek a more affordable supply.

Capecitabine is manufactured by several licensed pharmaceutical companies; the exact manufacturer may vary depending on the source country. All authorised products conform to the European Pharmacopoeia standards for potency, purity, and stability.

How Capecitabine Works

Capecitabine is a tumour‑selective pro‑drug. After oral ingestion, it is absorbed through the gastrointestinal tract and undergoes a three‑step enzymatic conversion:

1. Carboxylesterase in the liver hydrolyses capecitabine to 5′‑deoxy‑5‑fluorocytidine (5′‑DFCR).
2. Cytidine deaminase converts 5′‑DFCR to 5′‑deoxy‑5‑fluorouridine (5′‑DFUR).
3. Thymidine phosphorylase, which is present at higher concentrations in many tumour tissues, finally transforms 5′‑DFUR into 5‑fluorouracil (5‑FU).

The locally generated 5‑FU interferes with DNA synthesis by inhibiting thymidylate synthase and incorporating falsified nucleotides into RNA. This dual action leads to cell‑cycle arrest and apoptosis in rapidly dividing tumour cells while sparing most normal tissues, because tumour cells often express higher levels of thymidine phosphorylase.

Pharmacokinetic studies show that capecitabine reaches peak plasma concentrations of 5‑FU within 1–2 hours after dosing. The drug’s half‑life is approximately .5 hours for capecitabine itself, but the active metabolite 5‑FU persists for 3–5 hours, providing sufficient exposure for cytotoxic effect. Renal excretion accounts for 80 % of unchanged capecitabine and its metabolites, making dose adjustment necessary in patients with impaired kidney function.

Conditions Treated with Capecitabine

• Metastatic breast cancer (MBC) – Capecitabine is approved in the UK for patients whose disease has progressed after anthracycline, taxane, or trastuzumab therapy. Clinical trials (e.g., the ABC trial) demonstrated response rates of 20–30 % and a median overall survival of 12 months when used as monotherapy.
• Colorectal cancer (CRC) – In both adjuvant and metastatic settings, capecitabine is used alone or in combination with oxaliplatin (CAPOX regimen). The MOSAIC trial showed comparable efficacy to infusional 5‑FU with improved convenience.
• Gastric adenocarcinoma – Capecitabine combined with cisplatin is approved for advanced disease, offering a tolerable safety profile compared with continuous 5‑FU infusion.
• Pancreatic cancer (off‑label) – Although not formally approved, several phase II studies report modest activity when capecitabine is added to gemcitabine‑based regimens.

In the United Kingdom, colorectal cancer accounts for over 42 % of all cancer diagnoses, while breast cancer represents the most common malignancy among women. Capecitabine’s oral administration and proven efficacy make it a valuable option for patients who wish to avoid frequent hospital visits for intravenous chemotherapy.

Who is Capecitabine For?

Capecitabine is most appropriate for adult patients (≥ 18 years) with confirmed solid tumours that are sensitive to fluoropyrimidine therapy. Typical candidates include:

• Individuals with metastatic breast cancer who have exhausted standard anthracycline or taxane regimens.
• Patients with stage III or IV colorectal cancer, particularly those who prefer oral chemotherapy or have limited venous access.
• Those with gastric or pancreatic cancers where combination regimens containing capecitabine have demonstrated benefit.

Capecitabine may be unsuitable for:

• Patients with severe renal impairment (creatinine clearance < 30 mL/min) without dose adjustment.
• Individuals with a known hypersensitivity to fluoropyrimidines, including 5‑FU or its metabolites.
• Pregnant or breastfeeding women, as the drug crosses the placenta and is excreted in breast milk; contraception is mandatory during treatment.

Clinical decision‑making should incorporate performance status (ECOG ≤ 2), comorbidities, and prior chemotherapy exposure.

Risks, Side Effects, and Interactions

Common

• Hand‑foot syndrome (palmar‑plantar erythrodysesthesia) – Redness, swelling, and pain on the palms and soles; may require dose reduction.
• Diarrhoea – Usually mild to moderate; hydration and antidiarrhoeal agents (e.g., loperamide) are recommended.
• Nausea and vomiting – Antiemetic prophylaxis (5‑HT₃ antagonists) often mitigates symptoms.
• Fatigue – Generalised tiredness is frequently reported; adequate rest and activity pacing help.

Rare

• Hepatotoxicity – Elevations in transaminases; monitoring of liver function tests (LFTs) is advised.
• Cardiotoxicity – Rare cases of angina or myocardial ischaemia have been described; patients with cardiac history should be observed.
• Severe mucositis – Painful inflammation of the oral mucosa; may necessitate treatment interruption.

Serious

• Bone marrow suppression – Neutropenia, thrombocytopenia, and anaemia can be life‑threatening; complete blood counts (CBC) are required before each cycle.
• Severe hand‑foot syndrome – Grade 3/4 may lead to ulceration and infection, requiring temporary discontinuation.
• Life‑threatening hypersensitivity reactions – Anaphylaxis, angioedema, or severe skin rash; immediate medical attention is essential.

Drug–Drug Interactions

• Warfarin – Increased bleeding risk; monitor INR closely if combined.
• Antiepileptics (e.g., carbamazepine) – May increase capecitabine plasma levels; dose adjustment may be needed.
• Fluorouracil‑related agents – Concomitant use can heighten toxicity; avoid overlapping fluoropyrimidine therapy.
• Sulfasalazine – Can potentiate hand‑foot syndrome; consider alternative anti‑inflammatory agents.

Patients should disclose all concurrent medications, including over‑the‑counter products and herbal supplements, to their healthcare team.

Practical Use: Dosing, Missed Dose, Overdose

• Standard dosing – For metastatic breast cancer, the typical regimen is 1,250 mg/m² taken orally twice daily for 14 days, followed by a 7‑day rest (21‑day cycle). For colorectal cancer (CAPOX), capecitabine is given at 1,000 mg/m² twice daily for 14 days, combined with oxaliplatin on day 1 of a 21‑day cycle. Dosing is weight‑ and surface‑area based; clinicians adjust based on renal function and tolerance.
• Missed dose – If a dose is forgotten, patients should take it as soon as they remember provided it is at least 6 hours before the next scheduled dose. If the scheduled dose is imminent, the missed dose should be skipped; double‑dosing must be avoided.
• Overdose – Acute overdose may present with severe diarrhoea, vomiting, and myelosuppression. Patients should seek immediate medical attention, preferably to an emergency department, where supportive care (IV fluids, anti‑emetics, and monitoring of blood counts) is instituted.
• Food and alcohol – Capecitabine can be taken with or without food; however, a high‑fat meal may slightly delay absorption. Alcohol can exacerbate gastrointestinal side effects and should be limited.
• Comorbidities – Patients with hepatic impairment require careful monitoring of LFTs; those with diabetes should be aware that capecitabine may affect blood glucose levels. Renal dosage adjustments are essential for creatinine clearance < 50 mL/min.

Buying Capecitabine from Our Online Pharmacy

Capecitabine can be purchased from our online pharmacy in the UK with confidence in quality, affordability, and discretion.

• Affordable pricing – We source the generic product near manufacturer cost, passing savings directly to the patient.
• Verified quality – All suppliers are licensed, and each batch is accompanied by a certificate of analysis confirming compliance with the European Pharmacopoeia.
• Guaranteed delivery – Orders are dispatched securely; standard delivery arrives within 7 days (express) or approximately 3 weeks via regular airmail, with tracking available.
• Discreet service – As a pharmacy‑broker service, we work with overseas licensed pharmacies to ensure your medication arrives in unmarked packaging, protecting privacy.
• Online‑only access – Our platform provides a streamlined checkout without the need for a physical pharmacy visit, facilitating access for patients who face geographical or insurance barriers.

Choosing our pharmacy offers a safe, cost‑effective alternative for individuals seeking reliable generic capecitabine when conventional channels are limited.

FAQ

• Is capecitabine available in both brand‑name and generic forms in the UK?
  Yes. The original brand‑name product, Xeloda, is marketed by Roche, while numerous generic manufacturers supply capecitabine with identical active ingredient. Generic versions are typically less expensive while maintaining the same therapeutic profile.

• What is the appearance of capecitabine tablets?
  Capecitabine tablets are usually film‑coated, round, and white to off‑white. They are imprinted with the strength (e.g., “250 mg”) and a manufacturer code. Appearance may vary slightly between suppliers, but the active ingredient remains consistent.

• Can capecitabine be stored at home without refrigeration?
  The medication is stable at room temperature (15–25 °C). It should be kept in a dry place, away from direct sunlight, heat, and moisture. Refrigeration is not required and may cause condensation that degrades the tablet.

• What should I do if I travel abroad while taking capecitabine?
  Carry the medication in its original packaging with a copy of the prescription and a letter from your prescriber. Keep the tablets in a temperature‑controlled environment, and avoid exposure to extreme heat or humidity during transit.

• Does capecitabine contain any allergens such as lactose or gluten?
  In most formulations, the inactive ingredients include lactose, magnesium stearate, and povidone. Patients with severe lactose intolerance should discuss alternative formulations with their pharmacist.

• Can capecitabine be imported for personal use in the UK?
  Personal import of a single‑patient supply is permitted under UK law, provided the medication is for a declared personal use and is accompanied by a valid prescription from a UK‑registered prescriber. Importation must comply with MHRA guidelines.

• Are there any specific warnings for Asian populations taking capecitabine?
  Pharmacogenomic studies have identified a higher prevalence of dihydropyrimidine dehydrogenase (DPD) deficiency in certain Asian groups, which can increase toxicity risk. Testing for DPD activity is recommended before initiating therapy in these patients.

• How does capecitabine compare to traditional 5‑fluorouracil infusion?
  Capecitabine offers oral convenience and tumour‑selective activation, potentially reducing systemic exposure. Clinical trials have shown comparable efficacy to continuous 5‑FU infusion, with a different side‑effect profile, notably a higher incidence of hand‑foot syndrome.

• Is there a difference in formulation between EU and US capecitabine products?
  EU‑licensed capecitabine tablets conform to the European Pharmacopoeia, whereas US products meet United States Pharmacopeia standards. Both contain the same amount of active ingredient, but excipients may vary, influencing tolerability in some patients.

• What are the recommended storage conditions for capecitabine during prolonged travel?
  Store the tablets in a sealed, opaque container to protect from light and moisture. Avoid extreme temperatures; if traveling to hot climates, keep the medication in a cooled compartment – not a freezer – and limit exposure to temperatures above 30 °C.

• Can capecitabine affect drug testing for employment or sport?
  Capecitabine and its metabolites are not typically screened for in standard workplace drug tests. However, some anti‑doping agencies include fluoropyrimidines on their prohibited substance list. Athletes should disclose therapeutic use to the relevant governing body.

Glossary

Thymidine phosphorylase

An enzyme that catalyses the conversion of 5′‑deoxy‑5‑fluorouridine to the active chemotherapeutic 5‑fluorouracil; it is often over‑expressed in tumour tissue, providing the basis for capecitabine’s tumour‑selective activation.

Hand‑foot syndrome

A dermatologic toxicity characterised by redness, swelling, and pain on the palms and soles, commonly associated with fluoropyrimidine chemotherapy.

DPD deficiency

A genetic impairment of dihydropyrimidine dehydrogenase, the primary enzyme responsible for metabolising fluoropyrimidines; deficiency can lead to severe toxicity and is screened for before initiating capecitabine in high‑risk groups.

ECOG performance status

A scale ranging from (fully active) to 5 (death) used to assess a patient’s functional ability and suitability for chemotherapy.

⚠️ Disclaimer

The information provided about Capecitabine is for general knowledge only. It does not replace professional medical consultation. All treatment decisions should be made under the supervision of a qualified healthcare provider. We assume all readers are responsible adults capable of making informed decisions about their health. Our online pharmacy offers access to Capecitabine for individuals who may have limited availability through traditional pharmacies, prescription‑based insurance schemes, or who are seeking affordable generic alternatives. Always consult your doctor before starting, changing, or discontinuing any medication.