Cacit 500mg Tablet

Cacit 500mg Tablet (Capecitabine) – Oral Fluoropyrimidine Chemotherapy by Zydus Lifesciences | Breast Cancer, Colorectal Cancer, Gastric Cancer

Medically reviewed by a qualified oncologist | Last updated: April 2026 Prescription-only medicine | Cytotoxic chemotherapy — handle with care | Take only under oncologist supervision

What Is Cacit 500mg Tablet?

Cacit 500mg Tablet is an oral fluoropyrimidine antimetabolite chemotherapy agent manufactured and marketed by Zydus Lifesciences Ltd (formerly Zydus Cadila), Zydus Tower, Satellite Cross Roads, Ahmedabad — 380015, Gujarat, India. Each film-coated tablet contains Capecitabine 500mg as the active substance.

Capecitabine is a rationally designed oral prodrug — it is pharmacologically inactive when swallowed and undergoes a precise three-step enzymatic conversion inside the body to become 5-fluorouracil (5-FU), one of the most clinically important and widely used cytotoxic agents in oncology. Crucially, the final enzyme in this conversion pathway — thymidine phosphorylase (TP) — is expressed at significantly higher concentrations in tumour tissue than in normal healthy tissue. This tumour-selective activation generates higher concentrations of 5-FU at the cancer site while minimising systemic 5-FU exposure and associated toxicity compared to intravenous 5-FU administration.

Cacit 500mg delivers the clinical benefits of 5-FU in a convenient oral tablet form — transforming patients from intravenous chemotherapy infusion room dependency to home-based oral treatment.

Key Facts at a Glance

Active substance: Capecitabine 500mg. Form: Film-coated tablet. Pack: 10 tablets per strip. Manufacturer: Zydus Lifesciences Ltd, Ahmedabad, Gujarat, India. Storage: 15–30°C. Keep in a dry place, protected from light and humidity. Prescription: Required. Cytotoxic: Yes — handle with care; do not crush or split tablets without appropriate protective measures.

Why Cacit 500mg Matters in 2025/2026 — The Guideline Context

Capecitabine has been elevated across multiple 2025/2026 guideline updates, cementing its role as one of the most clinically versatile oral chemotherapy agents in modern oncology:

The NCCN Colon Cancer Guidelines Version 5.2025 introduced CAPOX (capecitabine plus oxaliplatin) in combination with atezolizumab as a preferred Category 2A recommendation for adjuvant treatment of stage III dMMR/MSI-H colon cancer — one of the most significant colorectal cancer practice changes in 2025. The same update recognised capecitabine-containing FOLFOX/CAPOX regimens as the preferred perioperative chemotherapy backbone in multiple gastrointestinal cancers. The NCCN Gastric Cancer Guidelines Version 2.2025 confirmed capecitabine (as part of CAPOX and XP regimens) as a standard first-line fluoropyrimidine partner in HER2-negative and HER2-positive gastric cancer, with fluoropyrimidine plus oxaliplatin or cisplatin as preferred regimens. The NCCN Esophageal and Esophagogastric Junction Cancer Guidelines added fluoropyrimidine (capecitabine or fluorouracil) plus oxaliplatin or cisplatin combined with immunotherapy (nivolumab, pembrolizumab, tislelizumab) as Category 1 first-line recommendations for PD-L1 positive disease.

Capecitabine's central position across breast, colorectal, gastric, and oesophagogastric cancer guidelines in 2025/2026 is unambiguous — and Cacit 500mg by Zydus Lifesciences delivers this proven molecule at an accessible price point.

What Is Cacit 500mg Used For?

1. Breast Cancer

Metastatic Breast Cancer — Monotherapy: Cacit is indicated as monotherapy for the treatment of metastatic breast cancer in patients who have failed prior therapy including taxanes and anthracyclines, or for whom anthracycline therapy is not indicated.

Metastatic Breast Cancer — Combination Therapy: Cacit is indicated in combination with docetaxel for the treatment of metastatic breast cancer in patients who have not responded to, or who have relapsed following, anthracycline-containing chemotherapy.

Early Breast Cancer — Adjuvant Therapy: Capecitabine is used as adjuvant therapy in HER2-negative early breast cancer patients with residual invasive disease after neoadjuvant chemotherapy — a practice supported by the landmark CREATE-X trial, which demonstrated a significant improvement in disease-free and overall survival in patients with residual disease receiving post-neoadjuvant capecitabine. This has become a key treatment strategy in triple-negative breast cancer (TNBC) management.

HER2-Positive Metastatic Breast Cancer: Capecitabine combined with trastuzumab and/or pertuzumab, or with lapatinib (XELODA-based regimens), forms established combination options for HER2-positive metastatic breast cancer in later lines of therapy.

2. Colorectal Cancer (Colon and Rectal Cancer)

Metastatic Colorectal Cancer — First-Line: Cacit is used as part of the CAPOX (capecitabine plus oxaliplatin; also called XELOX) regimen — a Category 1 first-line recommendation in the NCCN Colon Cancer Guidelines and non-inferior to FOLFOX for metastatic colorectal cancer. CAPOX plus bevacizumab is a preferred first-line standard for metastatic colorectal cancer in NCCN and ESMO guidelines.

Adjuvant Colorectal Cancer (Dukes' C / Stage III): Cacit monotherapy is indicated as adjuvant treatment for Dukes' C (stage III) colon cancer after complete resection of the primary tumour. Multiple clinical trials including X-ACT have confirmed that oral capecitabine monotherapy is at least as effective as bolus 5-FU/leucovorin in the adjuvant setting, with a more convenient oral dosing schedule. The 2025 NCCN Colon Cancer update added CAPOX plus atezolizumab as a preferred regimen for stage III dMMR/MSI-H adjuvant therapy.

Rectal Cancer — Concurrent Chemoradiation: Capecitabine is used concurrently with radiotherapy in the neoadjuvant (preoperative) treatment of locally advanced rectal cancer as a radiosensitising agent — replacing intravenous 5-FU infusion in many protocols due to equivalent efficacy and superior oral convenience.

3. Gastric Cancer (Stomach Cancer)

Cacit is indicated as part of first-line combination regimens for locally advanced or metastatic gastric and gastro-oesophageal junction (GEJ) adenocarcinoma. NCCN Gastric Cancer Guidelines Version 2.2025 confirm fluoropyrimidine (capecitabine or fluorouracil) combined with oxaliplatin or cisplatin as standard first-line therapy for HER2-negative gastric cancer. In HER2-positive gastric cancer, capecitabine combined with cisplatin and trastuzumab was validated in the landmark ToGA trial, which established trastuzumab plus cisplatin and a fluoropyrimidine (capecitabine or 5-FU) as the standard of care, demonstrating significant OS improvement of 13.8 vs 11 months.

CAPOX (capecitabine plus oxaliplatin) is a standard preferred regimen in gastric cancer. XP (capecitabine plus cisplatin) combined with immunotherapy (nivolumab or pembrolizumab for PD-L1 positive tumours) is also a Category 1 NCCN recommendation in 2025/2026.

4. Oesophageal and Gastro-Oesophageal Junction Cancer

NCCN 2025/2026 guidelines confirm fluoropyrimidine (capecitabine or fluorouracil) combined with oxaliplatin or cisplatin plus immunotherapy checkpoint inhibitors (nivolumab or pembrolizumab) as Category 1 first-line recommendations for PD-L1 CPS ≥1 oesophageal and EGJ adenocarcinoma. Capecitabine combined with FLOT (fluorouracil/leucovorin/oxaliplatin/docetaxel) serves as perioperative chemotherapy backbone in resectable locally advanced disease.

5. Other Cancers (Off-Label and Emerging)

Capecitabine is used off-label in pancreatic cancer (particularly with gemcitabine or concurrent radiotherapy in locally advanced disease), ovarian cancer, cervical cancer, and hepatocellular carcinoma in selected patients and clinical trial settings.

How Cacit 500mg Works — Tumour-Selective 5-FU Generation

Capecitabine's mechanism of action is a masterpiece of rational drug design — a three-step enzymatic cascade that generates cytotoxic 5-fluorouracil preferentially inside tumour tissue:

Step 1 — Hepatic activation: After oral absorption from the gastrointestinal tract, capecitabine is rapidly and almost completely absorbed and immediately converted in the liver by carboxylesterase to 5'-deoxy-5-fluorocytidine (5'-DFCR).

Step 2 — Further conversion: 5'-DFCR is then converted by cytidine deaminase — present predominantly in the liver and peripheral tumour tissues — to 5'-deoxy-5-fluorouridine (5'-DFUR).

Step 3 — Tumour-selective 5-FU generation: 5'-DFUR is converted to the active cytotoxin 5-fluorouracil (5-FU) by thymidine phosphorylase (TP). Critically, thymidine phosphorylase is expressed at concentrations up to 3.2 times higher in tumour tissue than in adjacent normal tissue — and is further upregulated in tumour cells in response to hypoxia and other tumour microenvironment factors. This differential TP expression drives preferential 5-FU generation at the tumour site, improving therapeutic selectivity and reducing systemic toxicity compared to intravenous 5-FU.

5-FU's cytotoxic mechanisms: 5-FU acts through two complementary pathways. First, it inhibits thymidylate synthase (TS) — the enzyme essential for DNA synthesis — by forming a stable ternary complex with TS and the cofactor 5,10-methylenetetrahydrofolate. This blocks the synthesis of thymidine monophosphate (dTMP), depleting the nucleotide pool required for DNA replication and repair, leading to irreparable DNA strand breaks. Second, 5-FU is incorporated as fraudulent base analogues into both RNA and DNA, disrupting RNA processing, ribosomal RNA function, and protein synthesis — further inhibiting cancer cell proliferation. The combined result is cell cycle arrest and cancer cell death.

Why oral capecitabine mimics continuous 5-FU infusion: The three-step conversion of capecitabine generates sustained exposure to 5-FU at tumour sites throughout the dosing period — pharmacokinetically mimicking the prolonged cytotoxic exposure achieved by continuous intravenous 5-FU infusion, which has superior efficacy over bolus 5-FU. This makes oral capecitabine the preferred oral substitute for continuous 5-FU infusion protocols.

Dosage and Administration

Cacit 500mg must be prescribed and dosed by a qualified oncologist. Never self-prescribe or adjust doses without oncologist guidance.

Standard dose: 1,250 mg/m² orally twice daily (morning and evening) for 14 consecutive days, followed by a 7-day rest period — constituting one 21-day treatment cycle. Dose is calculated based on the patient's body surface area (BSA).

With food — mandatory: Cacit 500mg tablets must be taken within 30 minutes after completing a meal. Taking capecitabine with food improves tolerability and is required per the prescribing information. Do not take on an empty stomach.

Swallow whole: Swallow tablets whole with a full glass of water. Do not crush, break, split, or chew tablets. If a tablet needs to be broken or crushed for administration, this must be performed by a trained oncology professional using appropriate protective equipment.

Twice daily dosing schedule: Take the morning dose approximately 30 minutes after breakfast and the evening dose approximately 30 minutes after the evening meal, at approximately 12-hour intervals.

Combination regimens and adjusted dosing:

CAPOX (capecitabine plus oxaliplatin): Capecitabine 1,000 mg/m² twice daily on days 1–14 of a 21-day cycle, combined with oxaliplatin 130 mg/m² IV on day 1. This reduced capecitabine dose in CAPOX is standard when combined with oxaliplatin to manage combined toxicity.

Capecitabine plus docetaxel (breast cancer): 1,250 mg/m² twice daily for 14 days every 21 days, combined with docetaxel 75 mg/m² IV on day 1.

Concurrent chemoradiation (rectal cancer): 825 mg/m² twice daily on radiation treatment days — a lower radiosensitising dose used during concurrent radiotherapy.

Dose reductions for toxicity: Capecitabine dose reductions follow a standardised algorithm based on the grade of adverse effects observed. Grade 2 toxicity (first occurrence): interrupt treatment until resolved to Grade 0–1, then resume at 75% of starting dose. Grade 2 (second occurrence) or Grade 3 (first occurrence): interrupt and resume at 50% of starting dose. Grade 2 (third occurrence) or Grade 3 (second occurrence) or Grade 4: permanently discontinue capecitabine. Do not attempt to make up for missed doses.

Renal impairment: Dose reduction to 75% of standard dose is recommended for patients with moderate renal impairment (creatinine clearance 30–50 mL/min). Cacit is contraindicated in patients with creatinine clearance below 30 mL/min.

Elderly patients (over 65 years): Elderly patients may have increased risk of Grade 3–4 adverse effects. Careful monitoring and early dose adjustment are essential.

DPYD genetic testing: Dihydropyrimidine dehydrogenase (DPYD) metabolises fluoropyrimidines including 5-FU generated from capecitabine. Patients with DPYD gene variants have reduced DPD enzyme activity, leading to potentially life-threatening fluoropyrimidine toxicity including severe mucositis, diarrhoea, neutropenia, and neurotoxicity. NCCN Colorectal Cancer Guidelines Version 2.2025 now recommend discussing DPYD genetic variant testing prior to fluoropyrimidine therapy and considering it in the context of the individual patient's circumstances. Testing is mandatory in several European countries.

Treatment cycle duration: Cacit is given in repeated treatment cycles. Cycle length is typically 21 days (14 days on, 7 days off). The total number of cycles depends on cancer type, stage, treatment intent (curative or palliative), response, and tolerability — as determined by the treating oncologist.

Who Should Not Use Cacit 500mg

Do not use if: you are allergic to capecitabine, fluorouracil, or any excipient; you have previously had severe unexpected reactions to fluoropyrimidine therapy; you have known complete or partial DPD enzyme deficiency (DPYD variant homozygous or compound heterozygous); you have severe renal impairment (creatinine clearance below 30 mL/min); you have severe hepatic impairment; you are pregnant or may become pregnant; you are breastfeeding; you have severely low white cell count (leucopenia) or platelet count (thrombocytopenia); you are currently taking sorivudine or brivudine — a life-threatening interaction.

Use under close oncologist supervision in: patients with moderate renal impairment (CrCl 30–50 mL/min — dose reduction required); patients with mild to moderate liver disease; patients with known or suspected coronary artery disease or cardiac history; elderly patients over 65 years; patients with diabetes or ocular conditions; patients with known neurological impairment; children and adolescents — not indicated.

Important Warnings

DPYD Deficiency and Life-Threatening Fluoropyrimidine Toxicity: Patients with partial or complete DPD enzyme deficiency are at significantly increased risk of severe, potentially fatal, fluoropyrimidine-associated toxicity. Prior to initiating Cacit, consider DPYD genotyping to identify patients at risk. If DPD deficiency is confirmed, capecitabine is contraindicated in complete deficiency and dose reductions are mandatory in partial deficiency.

Brivudine and Sorivudine Interaction — Fatal: Concurrent use of brivudine or sorivudine (antiviral medicines for herpes zoster/shingles) with capecitabine is absolutely contraindicated and potentially fatal. Brivudine irreversibly inhibits DPD enzyme activity, causing catastrophic accumulation of 5-FU to lethal levels. A 4-week washout period must elapse after stopping brivudine before starting capecitabine.

Hand-Foot Syndrome (Palmar-Plantar Erythrodysesthesia — PPE): Hand-foot syndrome is the most characteristic dose-limiting toxicity of capecitabine. It presents as progressive redness, tenderness, swelling, and peeling of the palms and soles — ranging from mild discomfort (Grade 1) to severe blistering, ulceration, and inability to walk or use hands (Grade 3). Interrupt capecitabine immediately at Grade 2 or higher. Preventive measures include regular moisturisation with urea-based creams, wearing comfortable footwear, and avoiding pressure or friction on the palms and soles.

Cardiotoxicity: Cardiotoxicity — including angina, myocardial infarction, arrhythmias, heart failure, and sudden death — has been reported with capecitabine, particularly in patients with pre-existing coronary artery disease. If cardiac symptoms develop during treatment, discontinue Cacit immediately and seek urgent cardiac evaluation.

Embryo-Foetal Toxicity: Capecitabine is highly teratogenic and can cause severe harm to the developing foetus, including birth defects and foetal death. Cacit must not be used during pregnancy. Women of childbearing age must use effective contraception during treatment and for 6 months after the final dose. Men with female partners of childbearing potential must use effective contraception during treatment and for 3 months after the final dose.

Bone Marrow Suppression: Capecitabine can suppress bone marrow function, reducing white blood cell, red blood cell, and platelet counts — increasing the risk of serious infections, anaemia, and bleeding. Regular full blood count monitoring is mandatory throughout treatment.

Drug Interactions

Brivudine and sorivudine — fatal contraindication: Absolutely do not use concurrently. See warning above.

Warfarin (oral anticoagulants): Capecitabine significantly increases warfarin anticoagulant effect, raising the risk of serious bleeding including haemorrhage. INR must be monitored frequently and warfarin dose adjusted. Consider switching to LMWH in patients requiring anticoagulation during capecitabine therapy.

Phenytoin: Capecitabine increases phenytoin plasma levels, potentially causing phenytoin toxicity (drowsiness, confusion, nystagmus, ataxia). Monitor phenytoin levels closely and adjust dose.

Antacids (aluminium/magnesium hydroxide): Increase plasma concentrations of capecitabine and one metabolite (5'-DFCR). Use with caution; avoid concurrent administration where possible.

Leucovorin (folinic acid): Enhances 5-FU activity and toxicity — combined use increases both efficacy and adverse effects. Monitor closely when capecitabine is used in CAPOX regimens with folinic acid-containing combinations.

Allopurinol: May reduce the efficacy of capecitabine. Avoid concurrent use.

Interferon alfa: May increase capecitabine toxicity when used in combination. Close monitoring required.

Colony-stimulating factors (molgramostim, pegfilgrastim, sargramostim, lenograstim): Do not administer from 1 day before until 1 day after capecitabine (molgramostim/sargramostim/lenograstim) or from 14 days before until 24 days after (pegfilgrastim) — concurrent use may impair bone marrow function.

Natalizumab: Concurrent use may increase the risk of serious opportunistic infections. Avoid combination.

Oxaliplatin, docetaxel, cisplatin, bevacizumab, trastuzumab: These standard combination partners in CAPOX, XP, and other capecitabine-based regimens are clinically validated. Each adds its own toxicity profile — combined monitoring is essential. Neurotoxicity monitoring with oxaliplatin; cardiac monitoring with trastuzumab; renal function and ototoxicity monitoring with cisplatin.

Side Effects

Very common: Hand-foot syndrome (palmar-plantar erythrodysesthesia) — redness, pain, swelling, and peeling of palms and soles. Diarrhoea — often dose-limiting; severe diarrhoea requires dose interruption. Nausea. Vomiting. Abdominal pain. Fatigue and weakness. Decreased white blood cell, red blood cell, and platelet counts. Mouth sores and mucositis. Decreased appetite. Elevated liver enzymes.

Common: Hair thinning or hair loss. Headache. Dizziness. Skin rash, dry skin, and nail changes. Peripheral neuropathy (particularly with oxaliplatin-based combinations). Fever. Eye irritation and watering. Dehydration from severe diarrhoea or vomiting.

Serious — seek immediate medical attention for: Signs of severe infection — high fever (over 38°C/100.4°F), chills, rigors, severe sore throat. Grade 3 or 4 diarrhoea — frequent loose stools with dehydration and weakness. Severe hand-foot syndrome — blistering, ulceration, inability to use hands or walk. Chest pain, shortness of breath, irregular heartbeat. Blood in stool or vomit. Yellowing of skin or eyes (jaundice). Severe mouth ulcers preventing eating or drinking.

Monitoring throughout treatment: Full blood count (FBC) before each cycle and as clinically indicated. Liver function tests and renal function tests regularly. Cardiac monitoring in patients with cardiovascular history. INR monitoring in patients on warfarin. Body weight and hydration status. Hand and foot inspection at each consultation.

Storage and Handling

Store at 15–30°C in a cool, dry place protected from light and humidity. Do not refrigerate. Keep in original packaging. Keep out of reach of children and pets — capecitabine is a cytotoxic chemotherapy agent and must not be handled by pregnant women or those of childbearing age without protective gloves. Dispose of unused tablets and packaging as cytotoxic waste in accordance with local regulations. Do not flush down the drain or discard in household waste.

Frequently Asked Questions

What is Cacit 500mg used for? Cacit 500mg is used to treat breast cancer (metastatic and early), colorectal cancer (colon, rectal, and metastatic), gastric cancer, and oesophageal cancer — as monotherapy or in combination regimens including CAPOX, XP, and capecitabine plus docetaxel. It is oral chemotherapy — taken at home as a tablet.

How does Cacit 500mg work? Capecitabine is a prodrug that converts to 5-fluorouracil (5-FU) preferentially inside tumour cells through a three-step enzymatic process. The final converting enzyme — thymidine phosphorylase — is expressed at much higher levels in tumour tissue than in normal tissue, driving tumour-selective 5-FU generation. 5-FU inhibits DNA synthesis and is incorporated into cancer cell RNA, blocking growth and killing cancer cells.

When should I take Cacit 500mg? Within 30 minutes after completing a meal — morning dose after breakfast, evening dose after the evening meal. Never on an empty stomach.

What is the most common serious side effect? Hand-foot syndrome (redness, pain, peeling of palms and soles) and diarrhoea are the most commonly dose-limiting side effects. Both require prompt reporting to your oncologist and dose adjustment if Grade 2 or higher.

Can I crush or break Cacit 500mg tablets? No — unless carried out by a trained oncology professional with appropriate protective equipment. Swallow whole with water.

Is Cacit 500mg safe during pregnancy? No — capecitabine is highly teratogenic and contraindicated in pregnancy. Effective contraception is mandatory during treatment and for 6 months post-treatment in women, and 3 months in men.

What is DPYD testing and should I have it before starting Cacit? DPYD genetic testing identifies patients with reduced dihydropyrimidine dehydrogenase enzyme activity, who are at risk of severe or fatal toxicity from fluoropyrimidine chemotherapy including capecitabine. NCCN 2025 guidelines recommend discussing DPYD testing before fluoropyrimidine therapy. Testing is mandatory in some European countries. Ask your oncologist.

Do you ship Cacit 500mg internationally? Yes — discreet, secure shipping to USA, UK, UAE (Dubai, Abu Dhabi), Canada, Japan, Russia, China, Thailand, India, Saudi Arabia, and Australia.

Is a prescription required? Yes. Cacit 500mg is a prescription-only cytotoxic chemotherapy medicine. Always consult a qualified oncologist before starting, adjusting, or stopping capecitabine therapy.

References

1. NCCN Colon Cancer Guidelines Version 5.2025 — CAPOX plus atezolizumab as preferred Category 2A adjuvant for stage III dMMR/MSI-H disease; DPYD testing recommendation; capecitabine dose adjustment guidance https://www.nccn.org/guidelines/nccn-guidelines
2. NCCN Gastric Cancer Guidelines Version 2.2025 — Capecitabine as preferred fluoropyrimidine in CAPOX and XP first-line regimens https://jnccn.org/view/journals/jnccn/23/5/article-p169.xml
3. NCCN Esophageal and EGJ Cancer Guidelines Versions 1.2025–3.2025 — Fluoropyrimidine (capecitabine or fluorouracil) plus oxaliplatin or cisplatin combined with nivolumab/pembrolizumab as Category 1 first-line for PD-L1 CPS ≥1 https://bookcafe.yuntsg.com/ueditor/jsp/upload/file/20250913/1757744324162014180.pdf
4. Experts Unpack the Most Notable NCCN Guideline Changes Heading Into 2026 — OncLive (April 2026). CAPOX updates, DPYD testing, BRAF V600E colorectal cancer. https://www.onclive.com/view/experts-unpack-the-most-notable-nccn-guideline-changes-heading-into-2026
5. A Comprehensive and Comparative Review of Global Gastric Cancer Treatment Guidelines: 2024 Update — PMC. NCCN, ESMO, JGCA, KGCA, CSCO capecitabine regimen comparisons. https://pmc.ncbi.nlm.nih.gov/articles/PMC11739642/
6. NCCN 2025 Clinical Practice Guidelines Updates — ASCO Post (May 2025). DPYD testing for fluoropyrimidines; CAPOX updates. https://ascopost.com/issues/may-25-2025/nccn-clinical-practice-guidelines-in-oncology-2025-updates/