Celabin Drug Interactions

Coumarin-derivative Anticoagulants: Altered coagulation parameters and/or bleeding have been reported in patients taking capecitabine concomitantly with coumarin-derivative anticoagulants such as warfarin and phenprocoumon. The dose of these agents may need to be reduced when administered concomitantly with capecitabine.
Phenytoin: Some patients receiving capecitabine and phenytoin had toxicity associated with elevated phenytoin levels. The level of phenytoin should be carefully monitored in patients taking capecitabine and phenytoin dose may need to be reduced.
Leucovorin: The antineoplastic activity of fluorouracil, the active drug of capecitabine, is potentiated by the addition of leucovorin that may also increase its toxicity. There have been reports of death due to severe enterocolitis, diarrhea and dehydration in geriatric patients receiving weekly regimen of leucovorin and fluorouracil combination.
Folinic Acid: Though folinic acid has no major effect on capecitabine's pharmacokinetics, it may, however, enhance capecitabine's toxicity. Capecitabine, when taken alone, has a maximum tolerated dose (MTD) of 3000 mg/m² daily whereas it is only 2000 mg/m² daily when combined with 30 mg twice a day oral folinic acid.
Sorivudine and analogues: Dihydropyrimidine dehydrogenase is an enzyme that converts fluorouracil into its much less toxic form. Sorivudine inhibits dihydropyrimidine dehydrogenase and this result to increased toxicity of capecitabine. Therefore, capecitabine must not be administered together with sorivudine or its chemically related analogues, such as brivudine. Wait for 4 weeks after ending treatment with sorivudine or its analogues before starting with capecitabine.
Antacid: Antacids containing aluminum hydroxide and magnesium hydroxide cause an increase in plasma concentration of capecitabine and one of its metabolite, 5'-deoxy-5-fluorocytidine.
Allopurinol: Allopurinol decreases the efficacy of fluorouracil. Thus, concomitant administration of capecitabine and allopurinol should be avoided.
Interferon alpha: Interferon alpha may enhance capecitabine toxicity because capecitabine, when taken alone, has a maximum tolerated dose (MTD) of 3000 mg/m² daily whereas it is only 2000 mg/m² daily when combined with interferon alpha.
Radiotherapy: The MTD of capecitabine alone using intermittent regimen is 3000 mg/m² daily, whereas, when combined with radiotherapy for rectal cancer, the MTD of capecitabine is 2000 mg/m² daily using either continuous schedule or given daily (Monday-Friday) during a 6-week course of radiotherapy.
Oxaliplatin: Free platinum or total platinum occurred when capecitabine is administered in combination with oxaliplatin or in combination with oxaliplatin and bevacizumab.
Bevacizumab: When given in the presence of oxaliplatin, bevacizumab causes no clinically significant effect on the pharmacokinetic parameters of capecitabine.
Food interaction: Food decreases the rate of capecitabine absorption. However, based on current safety and efficacy data, the drug is administered with food.