Capecitabine Is an Oral Chemotherapy Drug Used to Treat Breast Cancer, Colon Cancer, and Several Other Cancers

Capecitabine — sold under the brand name Xeloda — is one of the most widely prescribed oral chemotherapy medications in the world. Unlike traditional IV chemotherapy that requires you to sit in an infusion center, Capecitabine is a tablet you take at home. It's a prodrug of 5-Fluorouracil (5-FU), meaning your body converts it into the active cancer-fighting compound after you swallow it.

If you or someone you love has been prescribed Capecitabine, this guide covers everything you need to know: what it treats, how to take it, who shouldn't take it, and what it costs in 2026.

What Is Capecitabine?

Here are the key facts:

• Generic name: Capecitabine
• Brand name: Xeloda
• Drug class: Fluoropyrimidine antimetabolite (antineoplastic agent)
• Manufacturer: Genentech/Roche (brand); generic versions available from Teva, Mylan, Sun Pharma, Accord Healthcare, and others
• FDA approval: Originally approved for metastatic breast cancer and colorectal cancer; additional indications for gastric, pancreatic, and esophageal cancers added under Project Renewal updates
• Controlled substance: No — Capecitabine is not a controlled substance
• Available forms: 150 mg tablets (light peach) and 500 mg tablets (peach)

Capecitabine works by converting to 5-FU primarily inside tumor cells, where the enzyme thymidine phosphorylase is found in higher concentrations. This targeted activation means it delivers chemotherapy preferentially to cancer tissue. For a deeper explanation, see our article on how Capecitabine works.

What Is Capecitabine Used For?

Capecitabine is FDA-approved to treat several types of cancer:

Breast Cancer

Capecitabine is used for metastatic breast cancer, either as a single agent (for patients resistant to Paclitaxel and anthracycline-containing regimens) or in combination with Docetaxel. It's an important option when other treatments have stopped working.

Colon Cancer (Adjuvant Treatment)

After surgery to remove stage III (Dukes C) colon cancer, Capecitabine is given as adjuvant therapy to reduce the risk of the cancer coming back. It's often preferred over IV 5-FU because patients can take it at home.

Metastatic Colorectal Cancer

Capecitabine is approved as first-line treatment for metastatic colorectal cancer when fluoropyrimidine therapy alone is preferred.

Gastric (Stomach) Cancer

Used in combination with platinum-based chemotherapy regimens for gastric cancer.

Pancreatic Cancer

Combined with Gemcitabine for the treatment of pancreatic cancer.

Esophageal Cancer

Added as an approved indication for esophageal cancer treatment.

Off-Label Uses

Oncologists may also prescribe Capecitabine off-label for hepatobiliary cancers, ovarian cancer, neuroendocrine tumors, head and neck cancers, and renal cell carcinoma.

How Is Capecitabine Taken?

Capecitabine is taken by mouth (orally) as a tablet. Here's what you need to know about the dosing:

• Typical dose: 1,000–1,250 mg/m² twice daily. Your oncologist calculates your exact dose based on your body surface area.
• Schedule: 14 days on treatment, followed by 7 days off, in 21-day cycles.
• When to take it: Within 30 minutes after a meal (breakfast and dinner), with water.
• How to take it: Swallow the tablets whole — do not cut, crush, or chew them.
• Treatment duration: Depends on your cancer type, stage, and how well you respond. Your oncologist will tell you how many cycles to expect.

Because the dose is calculated by body surface area, you'll likely take a combination of 150 mg and 500 mg tablets to get the right amount. Your pharmacist can help you understand exactly which tablets to take and when.

Who Should Not Take Capecitabine?

Capecitabine is not safe for everyone. You should not take it if you have:

• Known allergy to Capecitabine or 5-Fluorouracil
• Complete DPD deficiency — Dihydropyrimidine dehydrogenase (DPD) is the enzyme your body uses to break down 5-FU. If you're missing this enzyme entirely, Capecitabine can cause severe, life-threatening toxicity. Your doctor should test for DPD deficiency before starting treatment.
• Severe kidney impairment — If your creatinine clearance is below 30 mL/min, Capecitabine is contraindicated.

Special caution is also needed for:

• Older adults (60+) — Higher risk of side effects; closer monitoring and potential dose reduction needed.
• Moderate kidney impairment (CrCl 30–50 mL/min) — Dose reduction required.
• Liver problems — Careful monitoring needed, especially with liver metastases.
• Pregnant women — Capecitabine is Pregnancy Category D and can harm an unborn baby. Effective contraception is required during treatment.
• Patients taking Warfarin — Capecitabine has a dangerous interaction with blood thinners that can cause fatal bleeding.

How Much Does Capecitabine Cost?

The cost of Capecitabine varies significantly depending on whether you use brand or generic, your pharmacy, and your insurance:

• Brand-name Xeloda: $3,000–$6,000+ per treatment cycle at retail price.
• Generic Capecitabine (retail cash price): Typically $200–$800 per supply.
• Generic with discount coupons: As low as $48–$62 for 84 tablets (500 mg) through services like GoodRx or SingleCare.

Insurance Coverage

Most commercial insurance plans and Medicare Part D cover Capecitabine. It's generally classified as a specialty oral oncology medication. Some key points:

• Prior authorization may be required
• Some plans put it on a specialty tier with higher copays
• Step therapy is uncommon since Capecitabine is typically the preferred oral fluoropyrimidine

Patient Assistance Programs

If you're struggling with costs, several programs can help:

• Genentech Access to Care Foundation — Provides free Xeloda to eligible uninsured or underinsured patients.
• Prescription Hope — Can help patients access Capecitabine for approximately $70/month.
• NeedyMeds and RxAssist — Connect patients with various assistance programs.

For a complete breakdown, read our guide to saving money on Capecitabine.

Final Thoughts

Capecitabine is a well-established oral chemotherapy option that gives cancer patients the convenience of at-home treatment instead of regular IV infusions. It's effective across multiple cancer types and has been available in generic form for years, making it more accessible than many newer oncology drugs.

That said, it's still a serious medication that requires careful monitoring, DPD testing before starting, and regular follow-ups with your oncologist. If you've been prescribed Capecitabine, don't hesitate to ask your care team about side effects to watch for, drug interactions, and how to find the right doctor.

Need help finding Capecitabine at a pharmacy near you? Medfinder can help you locate it in stock quickly.