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- Consider withholding Capecitabine until diarrhoea resolves to Grade ≤1 (baseline)
- Initiate loperamide 4 mg after the first loose stool, then 2 mg after each subsequent loose stool — maximum 16 mg per day
- Ensure adequate oral hydration; consider oral rehydration salts
- On recovery, resume Capecitabine at 75% of original dose for first recurrence
- Do not reduce dose more than twice; consider discontinuation if Grade 3 or 4 recurs
- Drink at least 8–10 glasses of clear fluids daily to prevent dehydration
- Avoid dairy, spicy foods, high-fibre foods, and caffeine until symptoms fully resolve
- Take loperamide exactly as directed — do not exceed the recommended dose
- Rest and avoid strenuous physical activity during the episode
- Keep a simple stool diary — note frequency and consistency to share at next review
- Contact the clinic if symptoms worsen or you are unable to take oral fluids
✓ Do's
- Hydrate with water, clear broths, electrolyte drinks
- Take loperamide as directed
- Rest and sleep adequately
- Eat small, bland, frequent meals
- Keep a stool diary
✗ Don'ts
- Avoid dairy, spicy, fried, or high-fibre food
- Don't take OTC anti-diarrhoeals without guidance
- Don't skip loperamide doses
- Don't continue Capecitabine without checking with your doctor first
"Diarrhoea means the medicine is working — it should be tolerated."
Diarrhoea is a known but manageable side effect of Capecitabine. It is not a sign of efficacy and requires prompt clinical management to prevent complications such as dehydration or dose interruption.
"The drug must be stopped immediately at the first sign of diarrhoea."
For Grade 1–2 diarrhoea, a temporary dose hold combined with supportive care (loperamide, hydration) is often sufficient. Permanent discontinuation is generally reserved for Grade 3/4 or recurrent events.
- More than 7 loose stools per day above baseline
- Blood in stool or rectal bleeding
- Signs of severe dehydration — dizziness, no urination, sunken eyes, dark urine
- Fever above 38.5°C
- Inability to take or retain oral fluids for more than 24 hours
- Sudden worsening or new onset of severe abdominal pain