Brivudine
Contraindicated
Database
Irreversible DPD inhibition → fatal 5-FU accumulation
Absolute avoidance; ≥4-week gap
Source: Kimi deep-research + Cla
Drug reference
Capecitabine
Oral fluoropyrimidine (5-FU prodrug) · Antineoplastic
Also known as Xeloda, 5'-deoxy-5-fluorocytidine
START
1250 mg/m² PO BID days 1–14 q21d (1000 mg/m² with oxaliplatin); within 30 min of food
TYPICAL MAX
1250 mg/m²/dose; 2500 mg/m²/day (monotherapy)
STOP IF
DPD deficiency, severe diarrhoea/HFS, cardiac ischaemia, or INR spike on warfarin
WATCH
Diarrhoea/HFS grading, INR if on warfarin, cardiac symptoms, renal function
CDSCO approvedJan AushadhiNPPA price-controlledATC L01BC06
KDIGO 2024 + manufacturer label
- ONSET
- 1h · absorption/activation
- PEAK
- 2h · 5-FU Cmax
- t½
- 45min · 5-FU t½
- DURATION
- 3w · 21-day cycle
EXCRETION
~95% renal as inactive FBAL metabolite
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Avoid — embryo-fetal toxicity; effective contraception during and 6 months after
FDA category + note
Top interactionssee all 12 →
- BrivudineContraindicatedDatabaseKimi deep-research + Cla
- Live VaccinesContraindicatedDatabaseKimi deep-research + Cla
- AdalimumabSevereDatabaseDDInter
- AnisindioneSevereDatabaseDDInter
Available in India
56 branded formulations and 1 fixed-dose combination. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Tumour-selectively activated in three steps (carboxylesterase → cytidine deaminase → thymidine phosphorylase, the last enriched in tumour) to 5-fluorouracil, which (as FdUMP) inhibits thymidylate synthase and (as FUTP) is incorporated into RNA, blocking DNA synthesis.
Indications
Metastatic/adjuvant colorectal cancerMetastatic breast cancer (after anthracycline/taxane)Gastric and oesophagogastric adenocarcinomaPancreatic and biliary (regimen-dependent)
Dosing
- Adult
- 1250 mg/m² PO twice daily, days 1–14 of a 21-day cycle (monotherapy); 1000 mg/m² BID with oxaliplatin; take within 30 min of food.
- Pediatric
- Not established.
- Renal adjustment
- CrCl 30–50 mL/min: reduce to 75% of starting dose. CrCl <30: contraindicated.
- Hepatic adjustment
- Mild–moderate (hepatic metastases): monitor closely, no fixed reduction. Severe: caution/avoid.
- Geriatric
- ≥60–80 years higher toxicity (diarrhoea, HFS); monitor, consider dose reduction.
- Max dose
- 1250 mg/m²/dose; 2500 mg/m²/day (monotherapy schedule)
Pharmacokinetics
Onset
Cycle-based antitumour effect
Peak effect
5-FU Cmax ~2 h
Duration
14-day on / 7-day off cycle
Half-life
Parent and 5-FU ~0.5–1 h
Bioavailability
Well absorbed; extensive prodrug conversion
Protein binding
<60% (parent ~54%)
Metabolism
Hepatic + tissue 3-step activation to 5-FU; 5-FU catabolised by DPD
Excretion
Renal (~95% of dose, mainly as inactive FBAL)
Contraindications
- Known dihydropyrimidine dehydrogenase (DPD) complete deficiency
- Severe hypersensitivity to capecitabine or 5-fluorouracil
- Severe renal impairment (CrCl <30 mL/min)
- Severe hepatic impairment / coagulopathy with warfarin (caution)
Side effects
Common
Hand–foot syndrome (palmar-plantar erythrodysaesthesia)DiarrhoeaNausea/vomiting, stomatitisFatigueHyperbilirubinaemia
Serious
- Severe diarrhoea/dehydration
- Cardiotoxicity (coronary vasospasm, ischaemia)
- Severe HFS
- Myelosuppression
- DPD-deficiency–related life-threatening toxicity
- Severe enterocolitis
Pregnancy & lactation
Pregnancy
Avoid — embryo-fetal toxicity; effective contraception during and 6 months after
Lactation
Do not breastfeed during and ≥2 weeks after therapy
Drug interactions
Live Vaccines
Contraindicated
Database
Immunosuppression — disseminated vaccine infection
Avoid during therapy
Source: Kimi deep-research + Cla
Adalimumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Anisindione
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Baricitinib
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Certolizumab
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Cladribine
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Clozapine
Severe
Database
Drug interaction classified as: synergy.
Source: DDInter
Deferiprone
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Dicoumarol
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Etanercept
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Fingolimod
Severe
Database
Drug interaction classified as: synergy
Source: DDInter
Related guidelines
Ask House about Capecitabine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e, Katzung·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19