Xeloda - patient leaflet, side effects, dosage

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet (see section 4).

What is in this leaflet

• 1. What Xeloda is and what it is used for

• 2. What you need to know before you take Xeloda

• 3. How to take Xeloda

• 4. Possible side effects

• 5. How to store Xeloda

• 6. Contents of the pack and other information

1. What Xeloda is and what it is used for

Xeloda belongs to the group of medicines called „cytostatic medicines“, which stop the growth of cancer cells. Xeloda contains capecitabine, which itself is not a cytostatic medicine. Only after being absorbed by the body is it changed into an active anti-cancer medicine (more in tumour tissue than in normal tissue).

Xeloda is used in the treatment of colon, rectal, gastric, or breast cancers.

Furthermore, Xeloda is used to prevent new occurrence of colon cancer after complete removal of the tumour by surgery.

Xeloda may be used either alone or in combination with other medicines.

2. What you need to know before you take Xeloda

Do not take Xeloda:

• if you are allergic to capecitabine or any of the other ingredients of this medicine (listed in section 6). You must inform your doctor if you know that you have an allergy or over-reaction to this medicine,
• if you previously have had severe reactions to fluoropyrimidine therapy (a group of anticancer medicines such as fluorouracil),
• if you are pregnant or breast-feeding,
• if you have severely low levels of white cells or platelets in the blood (leucopenia, neutropenia or thrombocytopenia),
• if you have severe liver or kidney problems,
• if you know that you do not have any activity of the enzyme dihydropyrimidine dehydrogenase

(DPD) (complete DPD deficiency).

• if you are being treated now or have been treated in the last 4 weeks with brivudine as part of herpes zoster (chickenpox or shingles) therapy.

Warnings and precautions

Talk to your doctor or pharmacist before taking Xeloda

• if you know that you have a partial deficiency in the activity of the enzyme dihydropyrimidine dehydrogenase (DPD)
• If you have a family member who has partial or complete deficiency of the enzyme dihydropyrimidine dehydrogenase (DPD)
• if you have liver or kidney diseases
• if you have or had heart problems (for example an irregular heartbeat or pains to the chest, jaw and back brought on by physical effort and due to problems with the blood flow to the heart)
• if you have brain diseases (for example, cancer that has spread to the brain, or nerve damage (neuropathy)
• if you have calcium imbalances (seen in blood tests)
• if you have diabetes
• if you cannot keep food or water in your body because of severe nausea and vomiting
• if you have diarrhoea
• if you are or become dehydrated
• if you have imbalances of ions in your blood (electrolyte imbalances, seen in tests)
• if you have a history of eye problems as you may need extra monitoring of your eyes
• if you have a severe skin reaction.

DPD deficiency : DPD deficiency is a genetic condition that is not usually associated with health problems unless you receive certain medicines. If you have DPD deficiency and take Xeloda, you are at an increased risk of severe side effects (listed under section 4 Possible side effects). It is recommended to test you for DPD deficiency before start of treatment. If you have no activity of the enzyme you should not take Xeloda. If you have a reduced enzyme activity (partial deficiency) your doctor might prescribe a reduced dose. If you have negative test results for DPD deficiency, severe and life-threatening side effects may still occur.

Children and adolescents

Xeloda is not indicated in children and adolescents. Do not give Xeloda to children and adolescents.

Other medicines and Xeloda

Before starting treatment, tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines. This is extremely important, as taking more than one medicine at the same time can strengthen or weaken the effect of the medicines.

You must not take brivudine (an anti-viral medicine for treatment of shingles or chickenpox) at the same time as capecitabine treatment (including during any rest periods when you are not taking any capecitabine tablets).

If you have taken brivudine you must wait for at least 4 weeks after stopping brivudine before starting to take capecitabine. See also section “Do not take Xeloda”.

Also, you need to be particularly careful if you are taking any of the following:

• gout medicines (allopurinol),
• blood-thinning medicines (coumarin, warfarin),
• medicines for seizures or tremors (phenytoin),
• interferon alpha,
• radiotherapy and certain medicines used to treat cancer (folinic acid, oxaliplatin, bevacizumab,

cisplatin, irinotecan),

• medicines used to treat folic acid deficiency.

Xeloda with food and drink

You should take Xeloda no later than 30 minutes after meals.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think you may be pregnant or are planning to have a baby, ask your doctor or pharmacist for advice before taking this medicine. You must not take Xeloda if you are pregnant or think you might be.

You must not breast-feed if you are taking XELODA and for 2 weeks after the last dose.

If you are a woman who could become pregnant you should use effective contraception during treatment with XELODA and for 6 months after the last dose.

If you are a male patient and your female partner could become pregnant, you should use effective contraception during treatment with XELODA and for 3 months after the last dose.

Driving and using machines

Xeloda may make you feel dizzy, nauseous or tired. It is therefore possible that Xeloda could affect your ability to drive a car or operate machines.

Xeloda contains anhydrous lactose

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before you take this medicine.

Xeloda contains sodium

Xeloda contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

3. How to take Xeloda

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

Xeloda should only be prescribed by a doctor experienced in the use of anticancer medicines.

Your doctor will prescribe a dose and treatment regimen that is right for you. The dose of Xeloda is based on your body surface area. This is calculated from your height and weight. The usual dose for adults is 1250 mg/m2 of body surface area taken two times daily (morning and evening). Two examples are provided here: A person whose body weight is 64 kg and height is 1.64 m has a body surface area of 1.7 m2 and should take 4 tablets of 500 mg and 1 tablet of 150 mg two times daily. A person whose body weight is 80 kg and height is 1.80 m has a body surface area of 2.00 m2 and should take 5 tablets of 500 mg two times daily.

Your doctor will tell you what dose you need to take, when to take it and for how long you need to take it.

Your doctor may want you to take a combination of 150 mg and 500 mg tablets for each dose.

• Take the tablets morning and evening as prescribed by your doctor.
• Take the tablets within 30 minutes after the end of a meal (breakfast and dinner) and

swallow whole with water. Do not crush or cut tablets. If you cannot swallow Xeloda tablets whole, tell your healthcare provider.

• It is important that you take all your medicine as prescribed by your doctor.

Xeloda tablets are usually taken for 14 days followed by a 7 day rest period (when no tablets are taken). This 21 day period is one treatment cycle.

In combination with other medicines the usual dose for adults may be less than 1250 mg/m2 of body surface area, and you may need to take the tablets over a different time period (e.g. every day, with no rest period).

If you take more Xeloda than you should

If you take more Xeloda than you should, contact your doctor as soon as possible before taking the next dose.

You might get the following side effects if you take a lot more capecitabine than you should: feeling or being sick, diarrhoea, inflammation or ulceration of the gut or mouth, pain or bleeding from the intestine or stomach, or bone marrow depression (reduction in certain kinds of blood cells). Tell your doctor immediately if you experience any of these symptoms.

If you forget to take Xeloda

Do not take the missed dose at all. Do not take a double dose to make up for a forgotten dose. Instead, continue your regular dosing schedule and check with your doctor.

If you stop taking Xeloda

There are no side effects caused by stopping treatment with capecitabine. In case you are using coumarin anticoagulants (containing e.g. phenprocoumon), stopping capecitabine might require that your doctor adjusts your anticoagulant dose.

If you have any further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them.

STOP taking Xeloda immediately and contact your doctor if any of these symptoms occur:

• Diarrhoea: if you have an increase of 4 or more bowel movements compared to your normal

bowel movements each day or any diarrhoea at night.

• Vomiting: if you vomit more than once in a 24-hour time period.
• Nausea: if you lose your appetite, and the amount of food you eat each day is much less than usual.
• Stomatitis: if you have pain, redness, swelling or sores in your mouth and/or throat.
• Hand-and-foot skin-reaction: if you have pain, swelling, redness or tingling of hands and/or

feet

• Fever: if you have a temperature of 38°C or greater.
• Infection: if you experience signs of infection caused by bacteria or virus, or other organisms.
• Chest pain: if you experience pain localised to the centre of the chest, especially if it occurs during exercise.
• Steven-Johnson syndrome: if you experience painful red or purplish rash that spreads and

blisters and/or other lesions begin to appear in the mucous membrane (e.g. mouth and lips), in particular if you had before light sensitivity, infections of the respiratory system (e.g. bronchitis) and/or fever.

• Angioedema: Seek medical attention straight away if you notice any of the following symptoms

– you may need urgent medical treatment: Swelling mainly of the face, lips, tongue or throat which makes it difficult to swallow or breathe, itching and rashes. This could be a sign of angioedema.

If caught early, these side effects usually improve within 2 to 3 days after treatment discontinuation. If these side effects continue, however, contact your doctor immediately. Your doctor may instruct you to restart treatment at a lower dose.

If severe stomatitis (sores in your mouth and/or throat), mucosal inflammation, diarrhoea, neutropenia (increased risk for infections), or neurotoxicity occurs during the first cycle of treatment, a DPD deficiency may be involved (see Section 2: Warning and precautions).

Hand and foot skin-reaction can lead to loss of fingerprint, which could impact your identification by fingerprint scan.

In addition to the above, when Xeloda is used alone, very common side effects, which may affect more than 1 in 10 people are:

• abdominal pain
• rash, dry or itchy skin

tiredness

loss of appetite (anorexia)

These side effects can become severe; therefore, it is important that you always contact your doctor immediately when you start to experience a side effect. Your doctor may instruct you to decrease the dose and/or temporarily discontinue treatment with Xeloda. This will help reduce the likelihood that the side effect continues or becomes severe.

Other side effects are:

Common side effects (may affect up to 1 in 10 people) include:

• decreases in the number of white blood cells or red blood cells (seen in tests)
• dehydration, weight loss
• sleeplessness (insomnia), depression
• headache, sleepiness, dizziness, abnormal sensation in the skin (numbness or tingling sensation), taste changes
• eye irritation, increased tears, eye redness (conjunctivitis)
• inflammation of the veins (thrombophlebitis),
• shortness of breath, nose bleeds, cough, runny nose
• cold sores or other herpes infections
• infections of the lungs or respiratory system (e.g. pneumonia or bronchitis)
• bleeding from the gut, constipation, pain in upper abdomen, indigestion, excess wind, dry

mouth

• skin rash, hair loss (alopecia), skin reddening, dry skin, itching (pruritus), skin discolouration, skin loss, skin inflammation, nail disorder
• pain in the joints, or in the limbs (extremities), chest or back
• fever, swelling in the limbs, feeling ill
• problems with liver function (seen in blood tests) and increased blood bilirubin (excreted by the liver)

Uncommon side effects (may affect up to 1 in 100 people) include:

• blood infection, urinary tract infection, infection of the skin, infections in the nose and throat, fungal infections (including those of the mouth), influenza, gastroenteritis, tooth abscess,
• lumps under the skin (lipoma)
• decreases in blood cells including platelets, thinning of blood (seen in tests)
• allergy
• diabetes, decrease in blood potassium, malnutrition, increased blood triglycerides
• confusional state, panic attacks, depressed mood, decreased libido
• difficulty speaking, impaired memory, loss of movement coordination, balance disorder, fainting, nerve damage (neuropathy) and problems with sensation
• blurred or double vision
• vertigo, ear pain
• irregular heartbeat and palpitations (arrhythmias), chest pain and heart attack (infarction)
• blood clots in the deep veins, high or low blood pressure, hot flushes, cold limbs (extremities), purple spots on the skin
• blood clots in the veins in the lung (pulmonary embolism), collapsed lung, coughing up blood, asthma, shortness of breath on exertion
• bowel obstruction, collection of fluid in the abdomen, inflammation of the small or large intestine, the stomach or the oesophagus, pain in the lower abdomen, abdominal discomfort, heartburn (reflux of food from the stomach), blood in the stool
• jaundice (yellowing of skin and eyes)
• skin ulcer and blister, reaction of the skin with sunlight, reddening of palms, swelling or pain of the face
• joint swelling or stiffness, bone pain, muscle weakness or stiffness
• fluid collection in the kidneys, increased frequency of urination during the night, incontinence, blood in the urine, increase in blood creatinine (sign of kidney dysfunction)
• unusual bleeding from the vagina
• swelling (oedema), chills and rigours

Rare side effects (may affect up to 1 in 1,000 people) include:

• narrowing or blockage of tear duct (lacrimal duct stenosis)
• liver failure
• inflammation leading to dysfunction or obstruction in bile secretion (cholestatic hepatitis)
• specific changes in the electrocardiogram (QT prolongation)
• certain types of arrhythmia (including ventricular fibrillation, torsade de pointes, and bradycardia)
• eye inflammation causing eye pain and possibly eyesight problems
• inflammation of the skin causing red scaly patches due to an immune system illness
• swelling mainly of the face, lip, tongue or throat, itching and rashes (angioedema)

Very rare side effects (may affect up to 1 in 10,000 people) include:

• severe skin reaction such as skin rash, ulceration and blistering which may involve ulcers of the mouth, nose, genitalia, hands, feet and eyes (red and swollen eyes)

Some of these side effects are more common when capecitabine is used with other medicines for the treatment of cancer. Other side-effects seen in this setting are the following:

Common side effects (may affect up to 1 in 10 people) include:

• decrease in blood sodium, magnesium or calcium, increase in blood sugar
• nerve pain
• ringing or buzzing in the ears (tinnitus), loss of hearing
• vein inflammation
• hiccups, change in voice
• pain or altered/abnormal sensation in the mouth, pain in the jaw
• sweating, night sweats
• muscle spasm
• difficulty in urination, blood or protein in the urine
• bruising or reaction at the injection site (caused by medicines given by injection at the same

time)

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist or nurse. This includes any possible side effects not listed in this leaflet. Y ou can also report side effects directly via the national reporting system listed in By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Xeloda

Keep this medicine out of the sight and reach of children.

Do not store above 30°C, store in the original package in order to protect from moisture.

Do not use this medicine after the expiry date which is stated on the outer carton and blister after EXP. The expiry date refers to the last day of that month.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Contents of the pack and other information

What Xeloda contains

• The active substance is capecitabine.
• Xeloda 150 mg film-coated tablets:

Each tablet contains 150 mg capecitabine

• Xeloda 500 mg film-coated tablets:

Each tablet contains 500 mg capecitabine

• The other ingredients are:
• Tablet core: anhydrous lactose, croscarmellose sodium, hypromellose (3 mPa.s), microcrystalline cellulose, magnesium stearate (see section 2 “Xeloda contains anhydrous lactose and sodium”).
• Tablet coating: hypromellose, titanium dioxide, yellow iron oxide, red iron oxide and talc.

What Xeloda looks like and contents of the pack

Xeloda 150 mg film-coated tablets:

Light peach film-coated tablet of biconvex, oblong shape with the marking ‘150’ on the one side and ‘Xeloda’ on the other side.

Each pack contains 60 film-coated tablets (6 blisters of 10 tablets).

Xeloda 500 mg film-coated tablets:

Peach film-coated tablet of biconvex, oblong shape with the marking ‘500’ on the one side and ‘Xeloda’ on the other side.

Each pack contains 120 film-coated tablets (12 blisters of 10 tablets).

Marketing Authorisation Holder

Roche Registration GmbH

Emil-Barell-Strasse 1

79639 Grenzach-Wyhlen

Germany

Manufacturer:

Roche Pharma AG

Emil-Barell-Str. 1

D-79639 Grenzach-Wyhlen

Germany

For any information about this medicine, please contact the local representative of the Marketing Authorisation Holder:

Belgie/Belgiqu­e/Belgien N.V. Roche S.A. Tél/Tel: +32 (0) 2 525 82 11	Lietuva UAB “Roche Lietuva” Tel: +370 5 2546799
Efcnrapua Pom Etnrapua EOOfl Ten: +359 2 818 44 44	Luxembourg/Lu­xemburg (Voir/siehe Belgique/Belgien)
Česká republika Roche s. r. o. Tel: +420 – 2 20382111	Magyarország Roche (Magyarország) Kft. Tel: +36 – 1 279 4500
Danmark Roche a/s Tlf: +45 – 36 39 99 99	Malta (See Ireland)
Deutschland Roche Pharma AG Tel: +49 (0) 7624 140	Nederland Roche Nederland B.V. Tel: +31 (0) 348 438050
Eesti Roche Eesti OÜ Tel: + 372 – 6 177 380	Norge Roche Norge AS Tlf: +47 – 22 78 90 00
EZZáSa Roche (Hellas) A.E. Tql: +30 210 61 66 100	Österreich Roche Austria GmbH Tel: +43 (0) 1 27739
España Roche Farma S.A. Tel: +34 – 91 324 81 00	Polska Roche Polska Sp.z o.o. Tel: +48 – 22 345 18 88.
France Roche Tél: +33 (0)1 47 61 40 00	Portugal Roche Farmacéutica Química, Lda Tel: +351 – 21 425 70 00
Hrvatska Roche d.o.o. Tel: + 385 1 47 22 333	Romania Roche Romania S.R.L. Tel: +40 21 206 47 01
Ireland Roche Products (Ireland) Ltd. Tel: +353 (0) 1 469 0700	Slovenija Roche farmacevtska družba d.o.o. Tel: +386 – 1 360 26 00
island Roche a/s c/o Icepharma hf Sími: +354 540 8000	Slovenská republika Roche Slovensko, s.r.o. Tel: +421 – 2 52638201
Italia Roche S.p.A. Tel: +39 – 039 2471	Suomi/Finland Roche Oy Puh/Tel: +358 (0) 10 554 500

Kûnpoç r.A.ETapaTnç & Sia At5. Tql: +357 – 22 76 62 76	Sverige Roche AB Tel: +46 (0) 8 726 1200
Latvija Roche Latvija SIA Tel: +371 – 6 7039831	United Kingdom (Northern Ireland) Roche Products (Ireland) Ltd. Tel: +44 (0) 1707 366000

This leaflet was last revised in < {MM/YYYY }><{month YYYY }>.

Other sources of information

Detailed information on this medicine is available on the European Medicines Agency web site:

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