What You Should Know About Xeloda Side Effects

Xeloda (Capecitabine) is an oral chemotherapy medication used to treat breast cancer and colorectal cancer. Like all chemotherapy drugs, it comes with side effects — some mild and manageable, others that need immediate medical attention.

Knowing what to expect can help you prepare, manage symptoms early, and know when it's time to call your doctor. This guide covers the most common side effects, the serious ones to watch for, and practical tips for staying as comfortable as possible during treatment.

What Is Xeloda?

Xeloda is the brand name for Capecitabine, an oral prodrug that converts to 5-fluorouracil (5-FU) inside your body. It's FDA-approved for metastatic breast cancer, adjuvant treatment of colon cancer after surgery, and metastatic colorectal cancer. For a deeper dive, see our guide on what Xeloda is and how it's used.

Xeloda is taken in 3-week cycles — 14 days on, 7 days off. Side effects often follow this pattern too, sometimes getting worse toward the end of the 14-day treatment period and improving during the rest week.

Common Side Effects

Most people taking Xeloda experience some side effects. These are the most frequently reported:

Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia)

This is the most distinctive side effect of Xeloda. Hand-foot syndrome causes redness, swelling, tingling, and sometimes blistering or peeling on the palms of your hands and soles of your feet. It affects a significant percentage of patients and can range from mild discomfort to severe pain.

Tips for managing it:

• Use thick moisturizing creams (like Udderly Smooth, Bag Balm, or urea-based creams) on hands and feet
• Avoid hot water, tight shoes, and excessive friction
• Wear soft cotton gloves and socks at night after moisturizing
• Tell your doctor early if symptoms start — dose adjustments can help prevent it from getting worse

Diarrhea

Diarrhea is common with Xeloda and can range from mild to severe. Stay well hydrated and keep anti-diarrheal medications (like loperamide) on hand. If you have more than 4–6 loose stools per day or any signs of dehydration, contact your doctor.

Nausea and Vomiting

Taking Xeloda with food (within 30 minutes of a meal) helps reduce nausea. Your doctor may prescribe anti-nausea medications if needed.

Fatigue

Tiredness is very common during Xeloda treatment. Pace yourself, rest when you need to, and don't feel guilty about it. Fatigue often improves during the off-week of each cycle.

Other Common Side Effects

• Loss of appetite — Try smaller, more frequent meals
• Abdominal pain — Usually mild; report persistent or severe pain
• Mouth sores (stomatitis) — Use gentle mouthwash and avoid spicy or acidic foods
• Skin rash — Use fragrance-free moisturizers and sun protection

Serious Side Effects: When to Call Your Doctor

Some Xeloda side effects are medical emergencies or require immediate dose changes. Call your doctor or go to the emergency room if you experience any of the following:

Severe Diarrhea

More than 6 watery stools per day, bloody diarrhea, or signs of dehydration (dizziness, dark urine, dry mouth) require urgent medical attention. Severe dehydration from Xeloda-related diarrhea can be life-threatening.

Severe Hand-Foot Syndrome

If your hands or feet develop painful blisters, ulcers, or swelling that makes it hard to walk or use your hands, your doctor will likely reduce your dose or pause treatment.

Signs of Infection

Xeloda can lower your white blood cell count (neutropenia), making you more susceptible to infections. Call your doctor immediately if you develop a fever of 100.4°F (38°C) or higher, chills, or other signs of infection.

Heart Problems

Capecitabine can cause cardiotoxicity in some patients. Seek emergency care if you experience chest pain, shortness of breath, irregular heartbeat, or sudden swelling in your legs. Patients with a history of heart disease are at higher risk.

Unusual Bleeding or Bruising

Xeloda can affect your blood's ability to clot. This is especially important if you take warfarin or other blood thinners — Xeloda significantly increases the effects of warfarin. See our guide on Xeloda drug interactions for more details.

DPD Deficiency Reactions

People with dihydropyrimidine dehydrogenase (DPD) deficiency cannot break down Capecitabine properly, leading to potentially fatal toxicity. Symptoms may include severe versions of the side effects above, appearing quickly and intensely. DPD testing is recommended before starting Xeloda.

Side Effects in Specific Populations

Elderly Patients

Patients aged 80 and older have a higher chance of experiencing grade 3 and 4 (severe) adverse events. Doctors may start with a lower dose in older patients.

Patients With Kidney Problems

Xeloda is processed through the kidneys. If your kidney function is reduced, you may need a lower dose. Capecitabine is contraindicated if your creatinine clearance is below 30 mL/min.

Pregnant or Breastfeeding Women

Xeloda can harm an unborn baby and is classified as a Pregnancy Category D drug. It should not be used during pregnancy or breastfeeding. Effective contraception is essential during treatment.

How to Manage Side Effects

Here are general strategies to help you get through Xeloda treatment with fewer complications:

• Take it with food — Always take Xeloda within 30 minutes of breakfast and dinner
• Stay hydrated — Drink at least 8 glasses of water daily, more if you have diarrhea
• Report side effects early — Don't wait for symptoms to get severe. Your doctor can adjust your dose to prevent serious complications
• Keep a symptom diary — Track what you experience and when. This helps your oncologist make better dosing decisions
• Protect your skin — Use sunscreen, moisturizers, and gentle products
• Avoid certain medications — Some drugs and supplements interact with Xeloda. Check our drug interactions guide before taking anything new

Final Thoughts

Xeloda side effects are real, but most are manageable with the right preparation and communication with your care team. The key is knowing what's normal, what's not, and when to speak up.

If you're just starting Xeloda, talk to your oncologist about what to expect during your specific treatment plan. If you're having trouble finding Xeloda at your pharmacy, Medfinder can help you locate it in stock near you. And if cost is a concern, explore our guide on saving money on Xeloda.