Pectibine can cause two serious problems that you and your doctor should be aware of before and during treatment:

• Serious reactions in people who are missing the DPD enzyme. Some people lack an enzyme called dihydropyrimidine dehydrogenase (DPD) that the body needs to break down Pectibine. In these people, Pectibine can cause severe — and sometimes life-threatening — side effects, often early in treatment. Pectibine should not be used if you completely lack this enzyme. Tell your doctor right away if you develop severe mouth sores, severe diarrhea, signs of infection, or numbness and tingling early in treatment.
• Increased bleeding if you take a blood thinner. Pectibine can strengthen the effect of blood-thinning medicines called vitamin K antagonists (for example, warfarin or acenocoumarol), which can lead to serious or even fatal bleeding. This can happen within a few days of starting Pectibine and up to a month after stopping it. If you take one of these blood thinners, your doctor will check your blood clotting (INR) more often and may change your blood-thinner dose. Tell your doctor right away about any unusual bleeding or bruising, blood in your urine or stool, black or tarry stools, or coughing up or vomiting blood.

Before starting Pectibine, tell your doctor about all of your medical conditions and all the medicines you take, including if you:

• Have ever had an allergic reaction to capecitabine or to fluorouracil (5-FU) — you should not take Pectibine;
• Are known to be missing the enzyme DPD (dihydropyrimidine dehydrogenase)
• Have kidney problems — Pectibine should not be used if you have severe kidney problems, and the dose may need to be lowered for moderate kidney problems;
• Have liver problems;
• Have heart problems, including a history of coronary artery disease, chest pain (angina), or an irregular heartbeat;
• Take a blood thinner (a vitamin K antagonist) such as warfarin or acenocoumarol
• Are pregnant or plan to become pregnant — Pectibine can harm your unborn baby.
  • Females who are able to become pregnant should use effective birth control (contraception) during treatment with Pectibine and for 6 months after the last dose.
  • Males with female partners who are able to become pregnant should use effective birth control during treatment and for 3 months after the last dose.
• Are breastfeeding or plan to breastfeed. Do not breastfeed during treatment with Pectibine and for 2 weeks after the last dose.

Also tell your doctor about all other prescription and non-prescription medicines, vitamins, and herbal supplements you take.

• Take Pectibine exactly as your doctor tells you. Your doctor will work out your dose based on your body size and may adjust it if you have side effects.
• Take Pectibine two times a day, about 12 hours apart.
• Swallow the tablets whole with water, within 30 minutes after a meal. Do not crush, chew, or split the tablets.
• Pectibine is usually given in 3-week (21-day) treatment cycles, and you may take it only on certain days of each cycle (for example, for the first 2 weeks, followed by a rest week). Follow your doctor's instructions.
• If you miss a dose, do not take the missed dose and do not take a double dose. Continue with your next scheduled dose and tell your doctor.

Serious side effects

Pectibine can cause serious side effects, some of which can be life-threatening. Tell your doctor right away — or get emergency medical help — if you have any of the following:

• Serious reactions from DPD deficiency.Tell your doctor right away about severe mouth sores, severe diarrhea, signs of infection, or numbness and tingling, especially early in treatment.
• Bleeding while taking a blood thinner.Tell your doctor right away about any unusual bleeding or bruising, blood in your urine or stool, or black or tarry stools.
• Severe diarrhea. Diarrhea can be severe and can quickly lead to dehydration. Tell your doctor right away if you have several loose stools a day, or diarrhea that does not stop, and keep drinking fluids. Your doctor may pause treatment.
• Dehydration and kidney problems. Severe diarrhea, vomiting, or not drinking enough fluids can cause dehydration, which can harm the kidneys and, rarely, be fatal. Tell your doctor about dizziness, passing much less urine, or feeling very weak.
• Heart problems. Pectibine can cause chest pain, heart attack, an irregular heartbeat, or heart failure, especially in people who already have heart disease. Get emergency help for chest pain, shortness of breath, or a fast or irregular heartbeat.
• Low blood cell counts. Pectibine can lower your white blood cells (raising the risk of infection), red blood cells (tiredness), and platelets (bleeding or bruising). Your doctor will check your blood counts. Tell your doctor about fever, chills, unusual tiredness, or easy bruising or bleeding.
• Hand-foot syndrome. Redness, swelling, tingling, pain, blistering, or peeling of the palms of your hands and the soles of your feet. This can become severe and make walking or using your hands difficult. Tell your doctor if this starts.
• Severe mouth sores (stomatitis). Painful sores in the mouth that can make eating and drinking difficult. Tell your doctor if they are severe.
• Serious skin reactions. Rarely, severe reactions such as Stevens-Johnson syndrome can happen. Get medical help right away for a spreading red or purple rash, blistering or peeling skin, or sores in your mouth, nose, eyes, or genital area.
• Liver problems. Pectibine can affect your liver. Your doctor will check your liver with blood tests. Tell your doctor about yellowing of your skin or the white part of your eyes (jaundice).
• Harm to an unborn baby. Pectibine can harm an unborn baby. See the pregnancy information above.

Common side effects

These may include:

• Nausea and vomiting
• Loss of appetite
• Tiredness (fatigue)
• Stomach (abdomen) pain
• Dizziness
• Dry or itchy skin
• Hair loss

This is not a complete list of side effects. Tell your doctor about any side effect that bothers you or does not go away.

For further information

This page answers common questions about Pectibine. It is for general information only and does not replace advice from your doctor or the full prescribing information.