Cisplatin and capecitabine (CX)

How does CX work?

These chemotherapy drugs destroy quickly dividing cells, such as cancer cells.

Find out more about how chemotherapy works

How do you have CX?

You have cisplatin as a drip into your bloodstream (intravenously).

You take capecitabine as a tablet. You swallow them whole with plenty of water. You take them within 30 minutes of finishing a meal.

Taking your tablets

Speak to your pharmacist if you have problems swallowing the tablets.

Whether you have a full or an empty stomach can affect how much of a drug gets into your bloodstream.

You should take the right dose, no more or less.

Talk to your healthcare team before you stop taking a cancer drug or if you miss a dose.

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line

• PICC line

• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Find out more about having chemotherapy

How often do you have CX?

You have CX chemotherapy as cycles of treatment. Each cycle of treatment lasts 21 days (3 weeks).

Each cycle varies depending on what type of cancer you have.

Generally, on day 1 of your treatment cycle you have cisplatin as a drip into your bloodstream.

For capecitabine you usually have it twice a day. You might have capecitabine in one of two ways, either:

• on day 1 to day 14, and then you have no treatment on day 15 to day 21

• on day 1 to day 21, you have no break in this cycle

Your doctor or nurse will tell you more about how you will have your treatment.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Before starting treatment with capecitabine you have a blood test to check levels of an enzyme called dihydropyrimidine dehydrogenase (DPD). A low DPD level means you are more likely to have severe side effects from these drugs. So you may start treatment with a lower amount (dose) of the drug or have a different treatment. Your doctor, pharmacist or nurse will talk to you about this.

Find our more about having a DPD deficiency

Before treatment starts you may have a blood test to check for viruses such as hepatitis B, hepatitis C, and HIV. This is called a viral screen.

It’s important for your doctor to know if you have had any of these viruses. This is because this treatment can weaken your immune system and can cause the virus to become active again (reactivation).

What are the side effects of CX?

Side effects can vary from person to person. They also depend on what other treatment you are having. 

When to contact your team

Your doctor, pharmacist or nurse will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects

• your side effects aren’t getting any better

• your side effects are getting worse

• the side effects are affecting your daily life

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Talk to your healthcare team if you have any new symptoms that you think might be a side effect of your treatment.

Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include: 

Increased risk of getting an infection 

Increased risk of getting an infection is due to a drop in white blood cells. Symptoms include a change in temperature, aching muscles, cough, headaches, feeling cold and shivery, pain or a burning feeling when peeing, or generally feeling unwell. You might have other symptoms depending on where the infection is.

Infections can sometimes be life threatening. You should contact your advice line urgently if you think you have an infection. 

Breathlessness and looking pale 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Bruising, bleeding gums or nosebleeds 

This is due to a drop in the number of platelets in your blood. These blood cells help the blood to clot when we cut ourselves. You may have nosebleeds or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs. This is known as petechiae.

Blood clots

Blood clots can develop in the deep veins of your body, usually the leg. This is called deep vein thrombosis (DVT). A blood clot can be very serious if it travels to your lungs (pulmonary embolism), although this isn’t common.

Symptoms of a blood clot include:

• pain, redness and swelling around the area where the clot is, and may feel warm to touch

• breathlessness

• pain in your chest or upper back – dial 999 if you have chest pain

• coughing up blood

Tiredness, weakness (fatigue) during and after treatment

Tiredness and weakness (fatigue) can happen during and after treatment. Doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Loss of appetite 

You might lose your appetite for various reasons while having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Diarrhoea 

Contact your advice line if you have diarrhoea. For example, in one day you have 2 or more loose bowel movements than usual. If you have a ​stoma, you might have more output than normal. Your doctor may give you anti diarrhoea medicine to take home with you after treatment.

Try to eat small meals and snacks regularly. It’s best to try to have a healthy balanced diet if you can. You don’t necessarily need to stop eating foods that contain fibre. But if your diet is normally very high in fibre, it might help to cut back on high fibre foods such as beans, nuts, seeds, dried fruit, bran and raw vegetables. 

Drink plenty to try and replace the fluid lost. Aim for 8 to 10 glasses per day.

Mouth and taste changes 

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Taste changes may make you go off certain foods and drinks. You may also find that some foods taste different from usual or that you prefer to eat spicier foods. Your taste gradually returns to normal a few weeks after your treatment finishes.

Your mouth may feel dry, it may have an abnormal sensation, but this is less common.

Throat changes

You may have a sore throat or an unpleasant tingling or burning sensation in the throat.

Less commonly, you may have throat pain, a hoarse voice or you may lose your voice.

Skin changes

This treatment can cause different skin problems, let your healthcare team know of any skin changes. They can give you advice or medicines to help.

It is common with this treatment that the skin on your hands and feet may become sore, red, or may peel. You may also have tingling, numbness, pain and dryness. This is called hand-foot syndrome or palmar plantar syndrome.

Less commonly you might develop other skin changes including a rash, dry skin, reddening and itching. You may have red raised bumps or spots, or raised, itchy bumps (hives). Your skin may turn darker or lighter in areas.

Your skin might be sensitive to sunlight. Or previously treated areas of skin with radiation can become irritated and inflamed. These side effects are uncommon.

Rarely, you may have a severe skin reaction that may start as tender red patches, which lead to peeling or blistering of the skin. You might also feel feverish, and your eyes may be more sensitive to light. This is serious and could be life threatening.

Pain in different parts of the body

You might have aches or pain in your tummy, arms, legs, muscles or joints.

Less commonly, you may have jaw pain or pain at the site of your drip. Chest pain is also less common, but let your healthcare team know straightaway if you have this. It could be a sign of something else.

Rarely you might have bone, ear or facial pain.

Changes in levels of minerals in your blood 

You may have changes in levels of minerals and salts in your blood, including low levels of sodium or high levels of uric acid (causing gout). You have regular blood tests during treatment to check this.

High temperature or chills

You might get a high temperature. Or you might feel cold or start shivering (chills), but this is less common.

Difficulty adjusting your body temperature

Your body may find it hard to adjust its temperature. You may be more sensitive to hot or cold environments.

Nerve changes

Nerve changes can cause your skin to feel different which can be uncomfortable. It might feel numb, tingle, prickly or have a burning feeling.

Numbness or tingling in fingers or toes can make it difficult to do fiddly things such as doing up buttons. It is often temporary and can improve after you finish treatment.

Less commonly, you may have a sharp, severe shooting pain along a nerve.

Tell your healthcare team if you're in pain, finding it difficult to walk or complete fiddly tasks.

Headaches

Tell your healthcare team if you keep getting headaches. They can give you painkillers to help.

Eye changes

You might have watery eyes. Watery eyes is also called excessive tearing. Tell your doctor or nurse if this is a problem for you. They can prescribe medicines to help. Try to avoid dust, pollen or animal hairs as they can make the watering worse.

Less commonly, you may have dry eyes or eye pain. The eye may be itchy, feel gritty, red, and sticky with discharge. Your vision may be blurred. Rarely you might have double or partial loss of vision.

Let your healthcare team know of any eyesight changes.

Fluid build up (oedema)

Swelling of your legs and feet due to fluid build up. This is called oedema.

You might get this in your arms and hands, but this is less common. Rarely, you might have face swelling.

Let your doctor or nurse know if you have any swelling.

Blood pressure changes

Tell your doctor or nurse if you have headaches, nosebleeds, blurred or double vision or shortness of breath. These symptoms may be caused by high blood pressure.

Less commonly, you may have low blood pressure causing you to feel dizzy, lightheaded or faint.

You will have your blood pressure checked regularly.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your healthcare team if you think you are constipated. They can give you a laxative if needed.

Tell your healthcare team about any changes to your bowel habits.

Indigestion

This treatment can cause indigestion. Symptoms can include a pain or burning sensation in the chest, feeling full or bloated, and burping.

Contact your healthcare team if you have this, they can prescribe medicines to help.

Nail changes

Nail changes include discolouration, nails separating from the nailbed or nail inflammation.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• sepsis - a serious reaction to an infection. Signs can include feeling very unwell, not passing urine, a very high or very low temperature, shivering, slurred speech or confusion, breathlessness, mottled or discoloured skin, extreme shivering or muscle pain. Call 999 or go to Accident and Emergency (A&E) immediately if you have any of these symptoms

• an allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness. Some allergic reactions can be life threatening. Tell your nurse if you notice any of these symptoms

• kidney changes, including blood or protein in your urine. Rarely, your kidneys may stop working or urine may build up in the kidney

• pain or burning when peeing. You may get the urge to pee at night which is unusual for you, or you might pee without knowing

• breathing problems, such as a cough or shortness of breath. Tell your doctor if you have any shortness of breath

• changes to your heart, this can include an irregular heartbeat, your heart may beat fast or slow. Or the heart muscle may not get enough oxygen. Rarely this treatment can cause a fluttering or pounding heart, angina or a heart attack. Call 999 or go to Accident and Emergency (A&E) immediately if you have any of these symptoms

• liver changes, these are usually mild and unlikely to cause symptoms. They are usually picked up on blood tests. Rarely you might have yellowing of the skin and whites of the eyes (jaundice)

• feeling low (depressed)

• feeling anxious - symptoms include a feeling of unease, worry or fear. Rarely you may feel other symptoms such as a fast heartbeat, shortness of breath, dizzy, trembling, or sweating. This is a panic attack. Let your team know so they can get you help or ways to manage this fear

• difficulty falling or staying asleep

• lack of fluid in your body (dehydration)

• weight loss

• dizziness, rarely it may feel like the area around you is spinning and you may lose your balance (vertigo)

• you might have bleeding from other areas of the body. You may pass blood in your poo or vomit blood. Rarely you might have abnormal bleeding from your vagina. Let your team know if you notice any bleeding

• passing wind or farting (flatulence)

• sweating more than usual or you might have night sweats

• generally feeling unwell

• flu-like symptoms - you might have symptoms such as headaches, aching muscles, a high temperature or runny nose

• difficulty opening your mouth, due to tightening of the jaw muscles

• hiccups

• sudden reddening and warmth of the neck, upper chest and face (flushing) or hot flushes

• shaking or trembling (tremor)

• high blood sugar levels that can cause headaches, feeling thirsty and blurred vision. You may have tests to check your blood sugar levels. Rarely you may have diabetes

• chest pain. Call 999 or go to Accident and Emergency (A&E) if you have chest pain

• muscle spasms or weakness

• inflammation of the lining of the stomach (gastritis) – symptoms include bloating, tummy pain or discomfort or indigestion

• bloating of the tummy (abdomen)

• runny nose

Rare side effects

These side effects happen in fewer than 1 in 100 people (fewer than 1%). You might have one or more of them. They include: 

• ear problems such as ear pain or problems with your hearing. You might have ringing in your ears (tinnitus) or hearing loss, but it is unknown how often this happens

• a non cancerous (benign) fatty lump under the skin (lipoma)

• feeling stiff or muscle weakness

• a risk of developing a second cancer such as acute leukaemia

• feeling cold in your hands or feet

• abnormal sperm production

• your blood taking longer to form a blood clot

• a blood disorder where your red blood cells get destroyed faster than they can be made (haemolytic anaemia)

• a high level of fat in your blood. You may have tests to check this

• loss of interest in sex

• you may have difficulty speaking or understanding speech (aphasia)

• fainting

• feelings of unsteadiness or dizziness (balance disorder)

• memory loss and problems with your thinking and concentration

• a collapsed lung, symptoms include a sudden shortness of breath and chest pain. Chest pain could be worse when coughing or breathing

• coughing up blood

• asthma, which can cause breathing problems. Symptoms include wheezing, coughing, shortness of breath, and your chest feeling tight

• a blocked bowel – symptoms include feeling bloated and full, pain, feeling sick, vomiting large amounts or constipation

• a build up of fluid in the tummy (ascites) – symptoms include your clothes feeling tighter, bloating, tummy pain or breathlessness

• joint swelling

• changes in the brain that are usually reversible, causing a sudden onset of symptoms including headaches, dizziness, confusion, fits (seizures) and changes to your vision

Other side effects

If you have side effects that aren't listed on this page, you can look at the individual drug pages:

• capecitabine

• cisplatin

Coping with side effects

We have more information about side effects and tips on how to cope with them.

Read more about how to cope with side effects

What else do you need to know?

Other medicines, foods and drinks 

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception 

This treatment may harm a baby developing in the womb. It is important not to become pregnant or get someone pregnant while you are having treatment.

Women must not become pregnant for at least 7 months after the end of treatment.

Men should not get someone pregnant for at least 4 months after treatment.

Talk to your doctor or nurse about effective contraception before starting treatment. Let them know straight away if you or your partner become pregnant while having treatment.

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with these drugs. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.

Breastfeeding 

Do not breastfeed during this treatment and for 1 month after your last dose. This is because the drugs may come through in your breast milk.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having.

Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, and yellow fever.

You can usually have:

• other vaccines, but they might not give you as much protection as usual

• the flu vaccine (as an injection)

• the coronavirus (COVID-19) vaccine

Talk to your doctor or pharmacist about the best time to have a vaccine in relation to your cancer treatment.

Contact with others who have had immunisations

You can be in contact with other people who have had live vaccines as injections. If someone has had a live vaccine by mouth or nasal spray there may be a small risk the vaccine virus can be passed onto you if your immune system is weakened.

Your healthcare team will let you know if you need to take any precautions if you are in close contact with someone who has had a live vaccine.

Read more about immunisations and cancer treatment

More information about this treatment

For further information about each drug and the possible side effects go to the electronic Medicines Compendium (eMC) website. You can find patient information leaflets for each drug on this website.

eMC website

You can report any side effect you have to the Medicines and Healthcare products Regulatory Agency (MHRA) as part of their Yellow Card Scheme.

Report a side effect to the MHRA