Can't find Xeloda? Learn about alternatives to Capecitabine, including 5-FU, Lonsurf, and other options your oncologist may consider for your treatment.
If you've been prescribed Xeloda (Capecitabine) and your pharmacy says it's unavailable, you're probably feeling anxious. Cancer treatment runs on a schedule, and interruptions are the last thing you want. While finding the medication in stock should always be your first step — try searching on Medfinder — there are situations where your oncologist may recommend an alternative medication.
This guide covers what Xeloda does, how it works, and the most common alternatives your doctor might consider. Important: Never switch medications on your own. Any change to your cancer treatment must be guided by your oncologist.
Xeloda is the brand name for Capecitabine, an oral chemotherapy medication manufactured by Genentech (Roche). It's a prodrug, which means it's inactive when you swallow it and gets converted into its active form — 5-fluorouracil (5-FU) — inside your body. This conversion happens primarily in tumor tissue, which is one of the reasons Capecitabine was designed as an oral alternative to IV 5-FU infusions.
Xeloda is FDA-approved for:
It's also used off-label for pancreatic cancer, gastric cancer, hepatobiliary cancers, and neuroendocrine tumors. For a complete overview, read our guide on what Xeloda is and how it's used.
Once absorbed, Capecitabine goes through a three-step enzymatic conversion to become 5-FU. The final step is catalyzed by the enzyme thymidine phosphorylase, which is found at higher concentrations in many tumor types compared to normal tissue. This means more of the active drug is generated at the tumor site.
5-FU works by inhibiting thymidylate synthase, an enzyme essential for DNA synthesis. Without it, cancer cells can't replicate their DNA and eventually die. For a deeper explanation, see our article on how Xeloda works.
The right alternative depends on your cancer type, stage, treatment history, and overall health. Here are the most commonly considered options:
What it is: 5-FU is the active metabolite of Capecitabine. It's the same cancer-fighting compound, but delivered intravenously instead of orally.
How it's given: 5-FU is administered through an IV at an infusion center, often as a continuous infusion over 46–48 hours using a portable pump, or as shorter bolus injections. It's frequently combined with leucovorin (folinic acid) to enhance its effectiveness.
Why your doctor might choose it: Since 5-FU is the same active drug as what Capecitabine produces in your body, switching from oral Capecitabine to IV 5-FU is one of the most direct substitutions. Multiple clinical studies have shown comparable effectiveness between oral Capecitabine and IV 5-FU regimens for colorectal and breast cancers.
Key differences: The main downside is convenience — you'll need to visit an infusion center rather than taking pills at home. Side effect profiles are similar, though hand-foot syndrome tends to be less common with IV 5-FU, while mucositis (mouth sores) may be more frequent.
Availability: IV 5-FU is widely available at oncology infusion centers and is generally not subject to the same shortage pressures as oral Capecitabine.
What it is: Lonsurf is an oral combination of trifluridine (a fluoropyrimidine) and tipiracil (which prevents the rapid breakdown of trifluridine). It belongs to the same broader drug class as Capecitabine.
How it's given: Oral tablets taken twice daily on days 1–5 and days 8–12 of each 28-day cycle.
Why your doctor might choose it: Lonsurf is FDA-approved for metastatic colorectal cancer that has progressed after standard therapies, including fluoropyrimidines. It's also approved for metastatic gastric cancer. If you have advanced disease and Capecitabine is unavailable, Lonsurf may be an appropriate oral alternative.
Key differences: Lonsurf has a different side effect profile. Myelosuppression (low blood counts) is more common with Lonsurf, while hand-foot syndrome is less frequent. Lonsurf is generally reserved for later-line treatment, so it may not be a direct substitute in all situations.
What it is: S-1 is an oral fluoropyrimidine combination containing tegafur (a 5-FU prodrug), gimeracil (which inhibits 5-FU breakdown), and oteracil (which reduces GI toxicity). It's widely used in Japan and other Asian countries for gastric and colorectal cancers.
Important note: S-1 is not FDA-approved in the United States. However, it's worth mentioning because patients researching alternatives may encounter it, and oncologists treating patients internationally may consider it. If you're being treated in the US, this is unlikely to be an option.
Depending on your cancer type and treatment history, your oncologist may recommend an entirely different chemotherapy approach rather than a direct Capecitabine substitute. For example:
These aren't one-for-one substitutes for Capecitabine but may achieve similar treatment goals depending on your situation.
Switching cancer medications is a significant decision. Before making a change, exhaust your options for finding Capecitabine:
For a complete guide, read our post on how to find Xeloda in stock near you.
Running out of options for filling your Xeloda prescription is stressful, but you're not without choices. The most direct alternative is usually IV 5-FU, which delivers the same active compound through an infusion center. For later-line treatment of certain cancers, Lonsurf offers another oral option. Whatever the situation, your oncologist is the right person to guide this decision — don't make changes to your cancer treatment on your own.
Stay informed about the current supply situation by reading our Xeloda shortage update for 2026.
You focus on staying healthy. We'll handle the rest.
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