____________________________________________________________________________________________________________________________________
HIGHLIGHTS OF PRESCRIBING INFORMATION
----------------------- WARNINGS AND PRECAUTIONS------------------------
These hig hlights do not include all the informatio n nee ded to use
XELODA
safely and effectively. See full prescribing information for
XELODA
.
XELODA
(capecitabine) tablets, for oral use
Initial U.S. Approval: 1998
WARNING: XELODA-WARFARIN INTERACTION
See full prescribing information for complete boxed warning.
Patients receiving concomitant XELODA and oral coumarin-derivative
anticoagulants such as warfarin and phe nprocoumo n should have their
anticoagulant response (INR or prothrombin time) monitored frequently
in order to adjust the anticoagulant dose accordingly. Altered coagulation
parameters and/or bleeding, including de ath, have been re ported during
concomitant use.
• Occurrence: Within several days and up to several mo nths after
initiating XELODA therapy; may also be seen within 1 month after
stopping XELODA
• Predisposing factors: age>60 and diagnosis of cancer
--------------------------RECENT MAJOR CHANGES-------------------------
Dosage and Administration (2.0) 10/2014
Contraindications (4.1) 02/2015
Warnings and Precautions (5.1, 5.2, 5.5, and 5.7) 10/2014
Warnings and Precautions (5.4) 02/2015
--------------------------- INDICATIONS AND USAGE ----------------------------
XELODA (capecitabine) is a nucleoside metabolic inhibitor with
antineoplastic activity indicated for:
• Adjuv ant Colon Cancer (1.1)
– Patients with Dukes’ C colon cancer
• Metastatic Colorectal Cancer (1.1)
– First-line as monotherapy when treatment with fluoropyrimidine
therapy alone is preferred
• Metastatic Breast Cancer (1.2)
– In combination with docetaxel after failure of prior anthracycline-
containing therapy
– As monotherapy in patients resistant to both paclitaxel and an
anthracycline-containing regimen
----------------------- DOSAGE AND ADMINISTRATION -----------------------
• Take XELODA with water within 30 min after a meal (2)
• Monotherapy: 1250 mg/m
2
twice daily orally for 2 weeks followed by a
one week rest period in 3-week cycles (2.1)
• Adjuvant treatment is recommended for a total of 6 months (8 cycles)
(2.1)
• In combination with docetaxel, the recommended dose of XELODA is
1250 mg/m
2
twice daily for 2 weeks followed by a 7-day rest period,
combined with docetaxel at 75 mg/m
2
as a 1-hour IV infusion every 3
weeks (2.1)
• XELODA dosage may need to be individualized to optimize patient
management (2.2)
• Reduce the dose of XELODA by 25% in patients with moderate renal
impairment (2.3)
--------------------- DOSAGE FORMS AND STRENGTHS----------------------
• Tablets: 150 mg and 500 mg (3)
------------------------------ CONTRAINDICATIONS ------------------------------
• Severe Renal Impairment (4.1)
• Hypersensitivity (4.2)
• Coagulopathy: May result in bleeding, death. Monitor anticoagulant
response (e.g., INR) and adjust anticoagulant dose accordingly. (5.1)
• Diarrhea: May be severe. Interrupt XELODA treatment immediately
until diarrhea resolves or decreases to grade 1. Recommend standard
antidiarrheal treatments. (5.2)
• Cardiotoxicity: Common in patients with a prior history of coronary
artery disease. (5.3)
• Increased Risk of Severe or Fatal Adverse Reactions in Patients
with Lo w or Absent Dihydropyrimidine Dehydrogenase (DPD)
Activity: Withhold or permanently discontinue XELODA in patients
with evidence of acute early-onset or unusually severe toxicity, which
may indicate near complete or total absence of DPD activity. No
XELODA dose has been proven safe in patients with absent DPD
activity. (5.4)
• Dehydratio n and Renal Failure: Interrupt XELODA treatment until
dehydration is corrected. Potential risk of acute renal failure secondary
to dehydration. Monitor and correct dehydration. (5.5).
• Pregnancy: Can cause fetal harm. Advise women of the potential risk to
the fetus. (5.6, 8.1)
• Mucocutaneous and Dermatologic Toxicity: Severe mucocutaneous
reactions, Steven-Johnson Syndrome (SJS) and Toxic Epidermal
Necrolysis (TEN), have been reported. XELODA should be permanently
discontinued in patients who experience a severe mucocutaneous
reaction during treatment. XELODA may induce hand-and-foot
syndrome. Interrupt XELODA treatment until the hand-and-foot
syndrome event resolves or decreases in intensity. (5.7)
• Hyperbilirubinemia: Interrupt XELODA treatment immediately until
the hyperbilirubinemia resolves or decreases in intensity. (5.8)
• Hematologic: Do not treat patients with neutrophil counts <1.5 x 10
9
/L
or thrombocyte counts <100 x 10
9
/L. If grade 3-4 neutropenia or
thrombocytopenia occurs, stop therapy until condition resolves. (5.9)
------------------------------ ADVERSE REACTIONS ------------------------------
Most common adverse reactions (≥30%) were diarrhea, hand-and-foot
syndrome, nausea, vomiting, abdominal pain, fatigue/weakness, and
hyperbilirubinemia. Other adverse reactions, including serious adverse
reactions, have been reported. (6)
To report SUSPECTED ADVERSE REACTIONS, contact Genentech at
1-888-835-2555 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
------------------------------ DRUG INTERACTIONS-------------------------------
• Anticoagulants: Monitor anticoagulant response (INR or prothrombin
time) frequently in order to adjust the anticoagulant dose as needed. (5.2,
7.1)
• Phenytoin: Monitor phenytoin levels in patients taking XELODA
concomitantly with phenytoin. The phenytoin dose may need to be
reduced. (7.1)
• Leucovorin: The concentration of 5-fluorouracil is increased and its
toxicity may be enhanced by leucovorin. (7.1)
• CYP2C9 substrates: Care should be exercised when XELODA is
coadministered with CYP2C9 substrates. (7.1)
• Food reduced both the rate and extent of absorption of capecitabine. (2,
7.1, 12.3)
----------------------- USE IN SPECIFIC POPULATIONS -----------------------
• Nursing Mothers: Discontinue nursing when receiving XELODA
treatment. (8.3)
• Geriatric: Greater incidence of adverse reactions. Monitoring required.
(8.5)
• Hepatic Impairment: Monitoring is recommended in patients with mild
to moderate hepatic impairment. (8.6)
• Renal Impairme nt: Reduce XELODA starting dose in patients with
moderate renal impairment (2.3, 8.7, 12.3)
See 17 for PATIENT COUNSELING INFORMATION and FDA-
approved patient labeling
Revised: 03/2015
1
Reference ID: 3718670