Capecitabine Side Effects and Hand-Foot Syndrome: What to Expect and What Helps

Capecitabine (Xeloda) is a chemotherapy tablet used for bowel (colorectal) cancer and breast cancer, and sometimes for other cancers¹². The body turns it into a chemotherapy drug called fluorouracil (5FU), which stops cancer cells making and repairing their DNA². Because it is a true chemotherapy, it can cause side effects, but many can be managed if you know what to look out for. The most talked-about is hand-foot syndrome.

How capecitabine is taken

Capecitabine is swallowed whole with water within 30 minutes after a meal, twice a day, about 12 hours apart. Do not chew, cut or crush the tablets¹. It is often taken for 2 weeks followed by a week off, in 3-week cycles, but the schedule depends on your cancer and other treatment². You may need two strengths of tablet to make up your dose².

If you are sick after a dose, do not take another one, and do not make up missed doses: carry on with the next planned dose¹. See our guide to taking cancer tablets at home for safe handling advice.

The DPD blood test before you start

DPD is an enzyme that helps the body break down capecitabine. Some people have low levels, usually because of changes in a gene called DPYD. A complete lack of DPD is very rare; a partial lack is more common³. People with low DPD are more likely to have severe side effects, and a complete lack can lead to serious or fatal reactions¹³.

That is why a test is done before treatment where possible. If your DPD is low, you may start on a lower dose or have a different treatment¹². Ask your team if you are not sure whether you have been tested.

Common side effects

The most common side effects of capecitabine on its own include hand-foot syndrome, diarrhoea, nausea, tiredness, anaemia and stomach pain¹. Cancer Research UK also lists loss of appetite, a sore mouth and mouth ulcers among the common ones².

Hand-foot syndrome

Hand-foot syndrome (also called palmar-plantar syndrome) makes the skin on the palms of your hands and soles of your feet sore, red or peeling. You may also feel tingling, numbness, pain or dryness². It usually starts a few weeks to a few months into treatment¹.

Things that help²⁴:

• Moisturise your hands and feet regularly with the cream your team recommends.
• Use mild soaps and avoid products containing alcohol or fragrance.
• Take short, lukewarm showers or baths rather than hot ones.
• Protect your skin from the sun.

Tell your team early if your hands or feet become painful, blistered or make everyday tasks hard. The label advice is to pause capecitabine and then restart at the same or a lower dose, depending on how severe it is¹. Do not stop or change the dose yourself.

Diarrhoea and dehydration

Diarrhoea can be severe. Contact your advice line if you have diarrhoea, for example 2 or more extra loose bowel movements in a day, or more output than usual from a stoma². Drink plenty of fluids, around 8 to 10 glasses a day, and take any anti-diarrhoea medicine you have been given². Dehydration can harm the kidneys, so your team checks your fluids and kidney function and may pause treatment¹.

Other important warnings

• Heart problems. Chest pain, heart attack, abnormal heart rhythms and heart failure have been reported, and may be more common in people with existing heart disease¹. Get help straight away for chest pain or a racing or irregular heartbeat.
• Warfarin. Capecitabine can make warfarin and similar blood thinners work more strongly, and serious bleeding, including deaths, has been reported. Your clotting tests (INR) need close checking¹.
• Low blood counts. Blood counts are checked before each cycle¹. Call your advice line straight away if you think you have an infection, such as a high temperature².
• Serious skin reactions. Rarely, capecitabine can cause severe skin reactions. Report any widespread rash or blistering¹.
• Pregnancy. Capecitabine can harm an unborn baby, so effective contraception is needed¹.

Sore mouth, nausea and appetite

Keep your mouth and teeth clean, drink plenty, and avoid acidic foods such as lemons if your mouth is sore. Eating small meals and snacks, and avoiding fatty or fried foods, can help with nausea and a poor appetite. Take anti-sickness medicine as prescribed, even if you do not feel sick².

Where to find capecitabine

Our generic Xeloda page explains the options. We stock capecitabine, including Cacit 500 mg and Capixet 500 mg; see our capecitabine page and our colorectal cancer medicines. All need a prescription.

Frequently asked questions

What are the most common side effects of capecitabine?

Hand-foot syndrome, diarrhoea, nausea, tiredness, anaemia and stomach pain are among the most common. Many can be managed with early advice from your team.

How soon does hand-foot syndrome start?

It usually starts a few weeks to a few months into treatment, but it can start earlier. Moisturise from the start and tell your team as soon as you notice soreness or redness.

Is capecitabine a strong chemotherapy?

It is a true chemotherapy, even though it is a tablet: the body turns it into fluorouracil. How it affects you depends on your dose, what it is combined with, and your own body, including your DPD level.

Can I take capecitabine with warfarin?

Only with close monitoring. Capecitabine can make warfarin act more strongly and cause serious bleeding, so your doctor will check your clotting tests often or may choose a different blood thinner.

Does capecitabine cause hair loss?

Hair loss or thinning is an occasional side effect, and hair usually grows back once treatment has finished.

Sources & references

1. US National Library of Medicine, DailyMed. Xeloda (capecitabine) prescribing information.
2. Cancer Research UK. Capecitabine (Xeloda). Last reviewed 4 September 2024.
3. Cancer Research UK. DPD deficiency. Last reviewed 14 July 2026.
4. National Cancer Institute. Skin and Nail Changes during Cancer Treatment. Reviewed 29 December 2022.

Related reading

• Is it chemotherapy?
• Taking cancer tablets at home

This content is for informational purposes only and is not medical advice. Contact your cancer team or advice line about any side effect that worries you. Used as prescribed by a licensed medical professional.