Brivudine and Capecitabine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Capecitabine
Brivudine
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased exposure of 5-fluorouracil (active moiety of capecitabine)
Interaction Deep Dive
Concomitant use of capecitabine (prodrug of 5-fluorouracil, which is a DPD substrate)2 with brivudine, an irreversible DPD inhibitor, may result in increased exposure of 5-fluorouracil and enhanced toxicity. It has been reported that coadministration may result in a 5- to 15-fold increase in exposure of 5-fluorouracil 4. Two case reports, including 1 fatality have been reported 43. To avoid significant toxicity with potentially fatal outcomes, 4 weeks should elapse after the last dose of brivudine before initiating a fluoropyrimidine 1, such as capecitabine.
Why it happens (mechanism)
Inhibition of dihydropyrimidine dehydrogenase (DPD)-mediated 5-fluorouracil metabolism (active moiety of capecitabine) by brivudine
Literature reports
2 reports — tap to read
a) Concomitant use of capecitabine with brivudine resulted in a fatal reaction in an 80-year-old female with colorectal cancer. The patient was receiving capecitabine 3 g daily for 14 days followed by 1 drug-free week. Three months later, administration of 2 brivudine 125-mg doses resulted in rash, edema of lips, and inflammation of oral mucosa. Brivudine was discontinued, however she continued to deteriorate with exanthema, mucositis, vomiting, and diarrhea. Despite discontinuation of capecitabine and medical management, the patient died 3 weeks following onset of symptoms 4.
b) A 66-year-old woman with metastatic breast cancer, treated with 7 cycles of capecitabine experienced vesicular cutaneous lesions that were typical of herpes zoster infection. Brivudine was initiated at 125 mg/day for 7 days. Four days later, the patient complained of oral and pharyngeal grade 2 mucositis, and grade 2 hand-foot syndrome. Mucositis worsened and caused serious ulcerations, and medulla aplasia developed requiring hospitalization and administration of platelets, filgrastim, and parenteral nutrition 3.
Common questions
Can I take Brivudine and Capecitabine together?
Increased exposure of 5-fluorouracil (active moiety of capecitabine) Always confirm with your pharmacist or prescriber before making any change.
How serious is the Brivudine and Capecitabine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Brivudine or Capecitabine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (4)
- Product Information: Teysuno oral capsules, tegafur gimeracil oteracil monopotassium oral capsules. Nordic Group BV (per EMA), Hoofddorp, Netherlands, 2015.
- Product Information: XELODA(R) oral tablets, capecitabine oral tablets. Genentech USA, Inc. (per manufacturer), South San Francisco, CA, 2015. DailyMed
- Baena-Canada J, Martinez M, Garcia-Olmedo O, et al: Interaction between capecitabine and brivudin in a patient with breast cancer. Nat Rev Clin Oncol 2010; 7(1):55-58. PubMed
- Ratz Bravo AE, Hofer S, Krahenbuhl S, et al: Fatal drug-drug interaction of brivudine and capecitabine. Acta Oncol 2009; 48(4):631-633. PubMed
Keep reading about Capecitabine
Keep reading about Brivudine
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