Capnat (Capecitabine)

Capnat (Capecitabine): Patient Information for Australia

Basic Product Information

Mechanism of Action

For Patients: Capecitabine is a chemotherapy medicine that is taken by mouth, used mainly to treat certain types of cancer such as breast and bowel (colorectal) cancer. Once you swallow Capnat, your body converts it into another medicine called 5-fluorouracil (5-FU), which targets and destroys cancer cells by stopping them from making more copies of themselves.

For Specialists: Capecitabine is an orally administered prodrug of 5-FU. It is metabolised through a 3-step enzymatic process, culminating in conversion to 5-FU primarily within tumour tissues due to higher thymidine phosphorylase activity. 5-FU then inhibits thymidylate synthase, impeding DNA synthesis and inducing apoptosis in rapidly dividing tumour cells.

Pharmacokinetics

• Absorption: Capecitabine is rapidly absorbed from the gastrointestinal tract after oral administration, with peak plasma concentrations (Cmax) reached within 1.5 hours.
• Metabolism: It undergoes hepatic and extrahepatic conversion to 5-FU, with the final step catalysed predominantly in tumour tissues.
• Elimination: Mainly excreted in urine as metabolites; less than 3% is excreted unchanged.
• Duration of Action: Capecitabine’s systemic exposure is relatively short, but it delivers sustained cytotoxic effects in tumour tissues due to localized activation.

Use in Everyday Life and Best Practices

• Who should use Capnat? Patients diagnosed with specific types of cancer, as recommended by their oncologist.
• How is it typically taken? Capnat tablets are swallowed whole, usually twice daily (morning and evening), within 30 minutes after a meal.
• Lifestyle considerations: Routine is important. Set reminders, and try to take it at the same times each day. Talk to your pharmacist about safe handling of chemotherapy medicines at home.
• Storage: Store at room temperature away from moisture and sunlight; keep out of reach of children.

Dosing: Morning vs Evening

• Standard Schedule: Usually twice daily—morning and evening approximately 12 hours apart.
• Advantages: Spacing doses evenly helps maintain a steady drug level in the body, supporting treatment effectiveness and reducing side effects.
• Tips: Consistency is key. Select meal times you can maintain, e.g., after breakfast and after dinner.
• Missed doses: If you forget, take the dose as soon as you remember unless you’re close to the time of your next dose. Do not double up.

Taking Capnat with Food or on an Empty Stomach

• With Food: Capnat must be taken within 30 minutes after finishing a meal. This helps improve absorption and reduces the chance of stomach upset.
• Australian Dietary Advice: There is no need to change your normal healthy diet, but avoid grapefruit or products containing grapefruit as they can interact with some medications.
• On an Empty Stomach: Not recommended, as it may increase side effects and reduce efficacy.

Interaction Warnings

Indications

Dosing According to Indication

Note: Dose adjustments may be required for kidney or liver problems, elderly patients, or if side effects occur. Dosing by body surface area (mg/m²) is based on patient size.

Safety Profile and Side Effects

• Common side effects:
  • Diarrhoea
  • Tiredness, weakness
  • Nausea and vomiting
  • Sore mouth (stomatitis)
  • Loss of appetite
  • Hand-foot syndrome (redness, soreness, peeling of palms and soles)
• Uncommon but serious side effects:
  • Severe diarrhoea/dehydration
  • Unusual bleeding/bruising
  • Chest pain or heart symptoms
  • Allergic reactions (rash, swelling, breathlessness)
  • Infection (fever, chills, sore throat)
• Warnings:
  • Notify your doctor if you have known DPD enzyme deficiency—a rare genetic condition that increases side effect risk.
  • Discuss all medicines, including over-the-counter and herbal supplements, with your doctor or pharmacist before starting Capnat.
  • Special caution in patients with kidney or liver dysfunction, elderly, or those undergoing radiotherapy.

Guidelines for Proper Use: Australian Practical Advice

1. Always follow the prescribed dose and schedule—do not self-adjust your treatment.
2. Swallow tablets whole with a glass of water; do not crush or chew.
3. Handle tablets carefully, and wash your hands after handling.
4. If vomiting occurs shortly after a dose, do not retake the dose. Wait for the next scheduled dose unless told otherwise by your healthcare team.
5. Maintain regular blood test appointments as guided by your treating team to monitor for side effects and response.
6. Speak with your healthcare team about managing common side effects. Early advice can prevent complications.
7. Capecitabine may impair your ability to drive or operate machinery if you feel dizzy or tired—use caution.
8. Let your pharmacist know if you are pregnant, planning a family, or breastfeeding—Capnat is not suitable in pregnancy and can harm an unborn baby.

Alternative Treatment Options

Below are some alternatives to Capecitabine for the treatment of cancers in Australia. Most are PBS-subsidised:

• 5-Fluorouracil (5-FU): Administered intravenously; similar effectiveness, but requires clinic visits. Pros: established efficacy; Cons: needs IV line, more hospital time.
• Oxaliplatin: Often used with 5-FU or Capecitabine. Pros: valuable in combination; Cons: higher risk of nerve toxicity.
• Capecitabine generics: Equally effective, potentially lower cost.
• Eribulin, Paclitaxel, Docetaxel (for breast cancer): Each has distinct side effect and administration profiles; may be preferred if oral therapy isn’t possible.
• Immunotherapy/targeted therapies: Such as pembrolizumab, cetuximab—used in selected patients based on cancer type/genetic testing.

Legal, Registration, and Reimbursement Status in Australia

• Regulatory Authority: Therapeutic Goods Administration (TGA)
• Legal Status: S4, prescription required by a doctor, dispensed by a registered pharmacist.
• PBS Reimbursement: Capecitabine and generics are PBS-listed for approved indications (bowel, breast, gastric cancers).
• Availability: Widely available through hospital and community pharmacies.
• Documentation: Standard monitoring required—regular blood tests and prescription review.

Latest Research and Clinical Guidance (2022–2025)

• Recent studies (e.g. The Lancet Oncology, 2023) confirm Capecitabine maintains a key role for adjuvant and metastatic colorectal and breast cancer, with growing personalised dosing based on tolerability.
• Emerging evidence supports lower, continuous doses (“metronomic” schedules) in elderly or frail patients to improve quality of life and reduce toxicity (Australian Family Physician, 2024).
• The Cancer Council Australia and ESMO guidelines (2022) continue to recommend oral capecitabine as equivalent to IV 5-FU regimens, but highlight importance of regular toxicity monitoring.
• Pharmacogenetic testing for DPD enzyme deficiency is increasingly recommended prior to starting capecitabine to reduce risk of severe side effects (NEJM, 2023).

Availability and Delivery

Note: Patients with a concession card may pay less. Home delivery is available through most major pharmacy chains in Sydney, Melbourne, Brisbane, Adelaide, Perth, and Hobart. Regional deliveries may take longer. Contact your pharmacy for details.

Frequently Asked Questions (FAQ)

1. Is Capnat the same as Xeloda?
   Yes, both Capnat and Xeloda contain the same active ingredient (capecitabine) and work in the same way against cancer.
2. Can I drive while taking Capnat?
   It depends—some people feel tired, dizzy, or confused. Use caution until you know how you react. Avoid driving if you don’t feel well.
3. What should I do if I miss a dose?
   Take it as soon as you remember, unless it’s almost time for your next dose. Do not double up to make up for a missed dose.
4. Is it safe to drink alcohol?
   It is best to limit or avoid alcohol as it can worsen side effects and stress your liver.
5. Can I crush Capnat tablets?
   No. Swallow tablets whole. If you have trouble swallowing, speak to your pharmacist or nurse about alternative solutions.

Need more help? Speak with your doctor, hospital pharmacist, or cancer nursing team for tailored advice. You’re also welcome to contact Cancer Council Australia on 13 11 20.