School of Medicine
Professor J N Primrose MD FRCS
Professor of Surgery, Chair of Department
University Surgical Unit
Level F (816) Centre Block
Southampton General Hospital
Tremona Road Southampton
SO16 6YD United Kingdom
Tel +44 (0)23 8079 6144
Fax +44 (0)23 8079 4020
Email j.n.primrose@soton.ac.uk
Supplementary Information for Patients Receiving CAPOX
chemotherapy
This sheet gives some information about the chemotherapy you will be receiving. ‘CAPOX’
is short for Capecitabine (also known as Xeloda) and Oxaliplatin; these are the names of the
two chemotherapy drugs you will be receiving. Oxaliplatin is an injection, and is also known
by the trade name Eloxatin. Capecitabine is a tablet, from now on we will refer to
Capecitabine as Cap.
How is the treatment given?
CAPOX treatment starts with a drip treatment, done at the hospital. For this, a nurse or doctor
will fit a small plastic needle called a “cannula” into one of the veins in your hand or arm. Then
a drip containing the Ox treatment will be connected to the cannula. It takes about 2 hours for
this to run in, then the cannula is removed and you will be able to go home.
At home, you will have a course of Cap tablets to take each morning and evening for two
weeks, followed by a one-week rest period with no Cap tablets. We call the whole three-week
period (the drip treatment, plus two weeks of tablets and one week off) one “cycle” of CAPOX
chemotherapy.
The dose of tablets is prescribed by your specialist, based on your body size and other
factors. Different patients need different doses. The tablets come in two sizes, large (500 mg)
and small (150 mg). The hospital pharmacist will work out how many large and small tablets
you should take to give you the right dose, and will dispense one full cycle at a time (i.e. 14
days = 28 doses). You should take your first dose of Cap on the evening after your Ox drip
treatment at the hospital; the last dose of the cycle will be due on the morning 2 weeks later.
Take your dose of Cap tablets twice a day, approximately twelve hours apart (for example 8
a.m. and 8 p.m). Try to stick to the same time each day, give-or-take two hours. It is best not
to take Cap on an empty stomach, so have something to eat during the half-hour before your
tablets are due. Swallow the tablets with water; they may be crushed if you find them too
large to swallow whole.
How will I remember the tablets?
Everybody finds it difficult to remember to take tablets sometimes! When you start each cycle
of CAPOX you will be given a diary sheet with a space for each dose you are due. Please
keep the sheet with your tablets, and make a note of the time you take each dose.
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If you forget a dose but remember it within the next 6 hours, take it then and mark the time
on the sheet. If you forget a dose completely, just write “forgot” in the box for that dose. Do
not try to squeeze in extra doses the next day, and do not add on any missed doses at the
end of the course, during your week’s rest from treatment.
What about my other medications?
Most other medications (though not all) can be taken safely alongside CAPOX treatment. If
you are on regular medications, please make sure your specialist knows about them before
you start your treatment so that they can be checked.
After starting your CAPOX treatment, if any new medication is required it is important that the
doctor prescribing it knows you are on CAPOX.
It is particularly important to tell your specialist about any of the following medications:
warfarin, allopurinol, phenytoin, sorivudine, brivudine.
Are there any other precautions?
Please keep your Cap tablets well away from children, and do not let them become mixed up
with anybody else’s tablets. If there are any left over at the end of a cycle (for example if you
forgot a dose, or missed some doses because of illness) please bring these along to your
next hospital appointment and return them to the nurse or pharmacist along with your diary
sheet – do not throw them away or store them at home.
Will CAPOX chemotherapy have unwanted effects?
Any chemotherapy can cause side effects. For most patients the side effects of CAPOX are
mild, and some have no side effects at all. However, you may find it helpful to be forewarned
about some of the side effects that could occur.

For a few hours or days after starting treatment, you may feel pins and needles in the
hands and feet if you touch cold things or go out in the cold. You may also feel tingling in
the throat. This is quite normal and not harmful. If affected, you may wish to wear gloves
and avoid cold places for the periods when you are affected.

After several months of treatment, some patients find that the temporary tingling
sensations, instead of lasting just a few hours or days, persist for longer. As a general
rule, if this symptom persists right through the 2 weeks until your next treatment is due,
and especially you have numbness as well as tingling, it is time to drop one of the drugs
– Oxaliplatin – from the chemotherapy. Please ensure you discuss this with your doctors
if you are affected.
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
Some people feel discomfort or pain up their arm during the 2 hours that the Ox drip is
running. If you are affected please tell the nurse on the chemotherapy unit straight away:
this symptom can usually be relieved by placing a warm pad over the arm.

Just occasionally, people can become allergic to Ox, though usually only after several
treatments. If, while the Ox drip is running, you develop palpitations, an itchy rash,
wheezing or a swollen tongue, please tell the nurses immediately.

Some patients feel a little sick for a few days after starting treatment. You will be provided
with some anti-sickness tablets to take if you start feeling sick. If you vomit more than
once in a 24-hour period please stop taking your Cap tablets and telephone the
hospital for advice.

Some people notice soreness in the mouth or a change in taste for some foods. You will
be provided with a mouthwash that may help. If you develop ulcers or pain in the mouth,
stop taking your Cap tablets and telephone the hospital for advice.

CAPOX can cause diarrhoea. You will be given anti-diarrhoea tablets to use if this is mild,
but if you have severe diarrhoea (more than 4 watery stools in a day) please stop taking
your Cap tablets and telephone the hospital for advice.

Some people feel more tired than usual during chemotherapy treatment. There is no easy
answer to this, but if you are affected you may find it helps to set aside a rest period in
the middle of each day.

In the longer term, usually after more than one cycle of treatment, your hands and feet
may become rather tingly or sore, with redness or dryness of the skin. If you get pain,
swelling or blistering/peeling of the skin, please stop taking your Cap tablets and
telephone the hospital for advice

All these side-effects can be helped by medication, so if you are affected please talk to
your oncology team. If medication has been tried but the side effects persist, it is usually
possible to get rid of them by slightly reducing the dose of chemotherapy. This does not
compromise the effectiveness of treatment.

Chemotherapy can reduce the number of white cells in your blood. This can lead to
increased vulnerability to infections. Your medical team will be monitoring your white cell
count each time you come for treatment to make sure it is safe to continue.
If you have to stop taking your Cap tablets for any of these reasons, please make a note on
the diary sheet. Do not add on the missed doses at the end of the course.
It is important to stop taking the Cap tablets if the side effects become troublesome. Some
patients worry that this might reduce the effectiveness of the treatment, but research has
shown this is not the case.
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Rare side-effects
Very rarely, CAPOX chemotherapy can cause heart palpitations, chest pain (angina), or poor
co-ordination. It is most unlikely that you will be affected, but if you suspect you have one of
these problems, please discuss it with your oncology doctor or nurse.
And finally:
If you become suddenly unwell between hospital visits, and especially if you develop a high
temperature, shivering attacks or severe diarrhoea, please telephone immediately for advice
from your hospital team. You may need to be admitted to the Oncology Unit.
Your contact numbers are:
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