Mechanism of Action

Xeloda (capecitabine) is an oral chemotherapy medication that works through the following mechanism of action:Metabolic Activation to 5-FU:

• Capecitabine is an inactive prodrug that is metabolized in the body to the active chemotherapy agent 5-fluorouracil (5-FU) .
• The conversion to 5-FU occurs through a series of enzymatic steps, primarily in the liver and tumor tissues .
• First, capecitabine is converted to 5′-deoxy-5-fluorouridine (5′-DFUR) by the enzyme thymidine phosphorylase, which is often more highly expressed in tumor cells compared to normal cells .
• 5′-DFUR is then further metabolized to the active 5-FU by the enzyme cytidine deaminase .

Inhibition of Thymidylate Synthase:

• Once converted to 5-FU, the active metabolite inhibits the enzyme thymidylate synthase, which is essential for DNA synthesis .
• By blocking thymidylate synthase, 5-FU disrupts the synthesis and repair of DNA, leading to cancer cell death .

Disruption of RNA and DNA:

• In addition to thymidylate synthase inhibition, 5-FU can also be incorporated into RNA and DNA, further disrupting their normal function and contributing to the anti-cancer effects .                         
  

  Dosage

  • The recommended starting dose of Xeloda (capecitabine) is 1,250 mg/m2 taken orally twice daily (morning and evening) for 2 weeks followed by a 1-week rest period .
  • Dosage may need to be individualized based on patient tolerance and response to treatment .
  • Doses can be rounded to the nearest 150mg to allow for whole tablets .
  • Xeloda should be taken within 30 minutes after a meal and the tablets should be swallowed whole, not crushed, chewed or cut .

  Storage

  • Store Xeloda at room temperature between 68°F to 77°F (20°C to 25°C) .
  • Keep the container tightly closed and protect from light and moisture .
  • Follow special handling and disposal procedures for cytotoxic drugs .

  Patient Reviews

  • Xeloda is generally well-tolerated, but common side effects include hand-foot syndrome, diarrhea, nausea, vomiting, and fatigue .
  • Patients report the oral administration of Xeloda is more convenient compared to IV chemotherapy .
  • Some patients experience significant improvement in their cancer symptoms with Xeloda treatment .
  • Adherence to the prescribed dosing schedule and monitoring for side effects is important for optimal outcomes .                                                                                                                            When handling Xeloda (capecitabine), several precautions should be taken to ensure safe and effective use:
    1. Personal Protective Equipment:
       • Wear protective gloves, protective clothing, eye protection, and face protection to avoid exposure to the medication.
    2. Handling and Storage:
       • Keep Xeloda in a tightly closed container at room temperature between 68°F to 77°F (20°C to 25°C).
       • Store the medication in a dry and well-ventilated place, away from light and moisture.
    3. Disposal:
       • Dispose of unused or expired Xeloda according to local and national regulations to prevent environmental contamination and ensure proper disposal.
    4. Handling Tablets:
       • Do not crush, chew, or split the tablets. If you have trouble swallowing the tablets whole, consult a healthcare professional for advice.
    5. Handling by Pregnant Women:
       • Pregnant women should not handle Xeloda or breathe the dust from the tablets, as it can harm the unborn baby.
    6. Handling by People with Allergies:
       • If you are allergic to Xeloda or other medications, consult your doctor or pharmacist before handling the medication.
    7. Handling by People with Certain Medical Conditions:
       • Inform your doctor of any medical conditions or other factors affecting your health before taking Xeloda.
    8. Handling by People Taking Other Medications:
       • If you are taking other medications, especially blood thinners like warfarin, closely monitor blood lab tests and report any signs of bleeding or bruising.

    Protective Equipment for Handling Xeloda

    1. Gloves: Wear protective gloves, such as those made of neoprene, nitrile, or butyl rubber, to avoid skin exposure.
    2. Protective Clothing: Wear protective clothing, such as gowns or coveralls, to prevent skin contact with the medication.
    3. Eye Protection: Wear safety glasses or goggles to protect the eyes from dust or splashes.
    4. Face Protection: Wear a face mask or respirator to avoid breathing in dust or vapors from the medication.
    5. Proper Ventilation: Ensure adequate ventilation in the work area to minimize exposure to dust or vapors.