Key points
- Chemotherapy tablets are not weaker than a drip. For some cancers both forms have been compared; for example, after surgery for bowel cancer, capecitabine tablets worked at least as well as the drug given into a vein [4].
- They are not safer either. Contact with chemotherapy tablets carries the same risks for you and the people around you as chemotherapy given into a vein, so they need the same care in storage and handling [9].
- Each tablet has its own instructions: some are taken after food, some on an empty stomach. Swallow tablets whole and do not split, crush or open them unless your doctor says so [6, 7, 8].
- If you miss a dose, do not take two doses together [6, 8, 9]. But missing doses often can make the treatment work less well [11].
- Give your doctor a list of all your medicines and supplements; some medicines, herbal remedies and even grapefruit juice change the amount of a cancer tablet in the blood [6, 8, 9].
- A temperature of 38 °C or higher, a lot of diarrhoea, repeated vomiting, or red and painful palms and soles: tell your treatment team straight away [6].
Chemo pills or a drip: which is better?
Neither is better in itself. Chemotherapy may come as tablets, capsules or a liquid, or be given into a vein [1]. Your doctor chooses the drugs according to the type of cancer, how far it has spread, any treatment you have had before and your other health problems [1]; whether it is a tablet or a drip follows from that choice.
For a few cancers, tablets and drips have been compared directly. In a large study of nearly 2,000 people whose bowel cancer had been removed by surgery, capecitabine tablets prevented the cancer from coming back at least as well as the drug fluorouracil given into a vein, and caused fewer side effects overall [4]. The kind of side effects differed: with the tablets there were fewer mouth sores and less diarrhoea, but much more hand–foot syndrome (red, painful palms and soles) [6].
Most patients prefer tablets. In one study, about 9 in 10 people chose tablets because they are more convenient, involve no needles or drips and can be taken at home. But most of them were not willing to accept a less effective treatment for that convenience [5]. So how well the treatment works comes first, and convenience second. If both options exist for your cancer, talk to your doctor about them.
Oral versus intravenous chemotherapy: the differences
| Topic | Oral chemotherapy (tablets or capsules) | Intravenous chemotherapy (drip) |
|---|---|---|
| Where it happens | At home [1, 2] | Usually in a clinic or hospital [1] |
| Who gives the drug | You or your family; you need to know exactly how to take it [9] | A nurse, supervised by the treatment team |
| Effect on the cancer | Depends on the drug itself, not on its being a tablet [4] | Depends on the drug itself [4] |
| Side effects and risks | Contact with the drug carries the same risks as a drip [9]; the kind of side effects depends on the drug itself [1] | The kind of side effects depends on the drug itself [1] |
| Tests and appointments | Regular blood tests and appointments are needed [1, 6] | Regular blood tests and appointments are needed [1] |
| Safety at home | Keep away from children, do not crush the tablets, return spare tablets to the pharmacy [9] | No drug is kept at home |
Chemo pill names: the main kinds of cancer tablets
| Group | Example | Used for (examples) |
|---|---|---|
| Chemotherapy tablet | Capecitabine | Cancer of the colon and rectum, breast, stomach and oesophagus, and pancreas [6] |
| Chemotherapy capsule | Temozolomide | Two types of brain tumour: glioblastoma and anaplastic astrocytoma [7] |
| Targeted therapy tablet | Imatinib; many other targeted drugs are also tablets or capsules [2] | Chronic myeloid leukaemia and several other cancers [8] |
| Hormone therapy tablet | For example tamoxifen and letrozole | Cancers that use hormones to grow, such as some breast and prostate cancers [3] |
Each drug has its own page on this site: capecitabine, temozolomide, imatinib, osimertinib, olaparib, palbociclib, tamoxifen and letrozole. To read about targeted tablets: What is targeted cancer therapy? and Chemotherapy or targeted therapy?
Targeted and hormone tablets are serious medicines too and must be taken exactly as prescribed; for example, people who missed doses of the targeted tablet imatinib responded less well to treatment [11].
How should I take chemotherapy tablets?
- 1
Know the exact instructions
When you collect your medicine, check the name and strength on the box against your prescription. Ask how many tablets to take each time, at what times, for how many days in a row and when to take a break; if anything is unclear, ask again [9]. For example, capecitabine is taken twice a day, about 12 hours apart, at the same times each day, and the number of days you take it depends on the type of cancer [6].
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With food or on an empty stomach?
It depends on the drug: capecitabine within half an hour after a meal [6], imatinib with a meal and a large glass of water [8], and temozolomide on an empty stomach or at bedtime to reduce nausea [7]. Ask your doctor or pharmacist how to take your own tablets.
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Swallow tablets whole
Swallow tablets whole with water; do not chew, split or crush them [6, 9]. Do not open temozolomide capsules; if the powder gets on your skin, in your eyes or in your mouth, wash it off with water straight away [7]. If you find tablets hard to swallow, tell your doctor [6]; for some drugs there is another way, for example imatinib tablets can be dissolved in water or apple juice [8].
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Set a reminder
A phone alarm or a simple chart helps you not to miss any dose. If you use a weekly pill box, keep a separate one for your cancer tablets [9]. To note your treatment and rest days: chemotherapy calendar.
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If you miss a dose or vomit
Do not make up a missed dose by doubling the next one, and do not take two doses together unless your doctor has told you to [9]. With capecitabine, skip the missed dose and take the next one at the usual time; if you vomit after taking a dose, do not take another [6]. With imatinib, too, take the next dose at its usual time and do not take two doses together [8]. Because the instructions differ from drug to drug, ask in advance what to do with your tablets.
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Oral chemotherapy side effects
Chemotherapy tablets have side effects too. Chemotherapy, whether tablets or a drip, harms not only cancer cells but also healthy cells that grow quickly [1]. The side effects depend on the drug itself, not on its being a tablet:
- Capecitabine: the most common side effects are hand–foot syndrome, diarrhoea and nausea [6]. In hand–foot syndrome the palms and soles become red, swollen and painful, or numb and tingly; sometimes fingerprints can be lost [6]. Tell your treatment team as soon as these signs start, so that they can be treated early [6].
- Temozolomide: hair loss, tiredness, nausea, vomiting, headache, constipation and loss of appetite are common [7].
- Low blood counts: these happen with tablets too, which is why regular blood tests are needed during treatment [6].
- Targeted tablets have their own particular side effects; read about them on each drug's page.
Most side effects can be controlled if they are reported early. Your doctor may stop the drug for a few days or lower the dose [6]; do not do this yourself. Read more: What are the side effects of chemotherapy?, Constipation and diarrhoea during cancer treatment and Nausea and vomiting during cancer treatment.
Oral chemotherapy drug interactions: what not to take with your tablets
Cancer tablets interact with many other medicines. Before you start, give your doctor or pharmacist a list of everything you take, including medicines bought without a prescription, vitamins, supplements and herbal remedies [9]; and do not start anything new during treatment without checking first. Some important examples:
- The blood thinner warfarin: taken with capecitabine it can cause serious bleeding; if you take warfarin, your blood clotting test needs to be checked more often [6].
- Epilepsy medicines: capecitabine raises the level of the epilepsy medicine phenytoin in the blood [6]. Epilepsy medicines such as carbamazepine and phenytoin, and the tuberculosis medicine rifampicin, lower the level of imatinib in the blood [8].
- Folic acid supplements: take them with capecitabine only if your doctor tells you to [6].
- St John's wort (a herbal remedy taken for depression) lowers the level of imatinib in the blood [8].
- Grapefruit juice raises the level of imatinib in the blood and should be avoided [8]. Read more: Grapefruit, Seville oranges and cancer tablets.
- Stomach acid medicines (such as omeprazole) can change how well some targeted tablets are absorbed [12]. Do not start or stop them without advice.
This list is not complete. Whenever another doctor prescribes something for you, say that you are taking a cancer tablet [12].
Storing and handling chemo pills safely at home
Storage
Keep the tablets in their original box or bottle and as the label says: out of reach of children and pets, away from sunlight and damp, and away from places where food and drink are stored or eaten [9].
Handling the tablets
If you can, use gloves to pick up the tablets, and wash your hands well before and after. Pregnant or breastfeeding women and children should not handle the tablets [9]. Do not crush tablets; contact with the powder of crushed capecitabine tablets has caused eye irritation and skin rashes [6].
Spare or damaged tablets
Do not throw away or flush spare, wet, broken or out-of-date tablets; take them back to the pharmacy or hospital. Do not give your tablets to anyone else [9].
Toilet and laundry
While you are taking the tablets and for 4 to 7 days after the last one, flush the toilet twice after use. Wash the patient's clothes and bedding separately from other laundry [9]. Read more: Is chemotherapy dangerous for the people around me?
Why every dose counts
When a medicine is taken at home, taking it correctly and on time is up to you. Studies show that many patients do not take their cancer tablets exactly as prescribed [10].
This matters. In a study of people with chronic myeloid leukaemia who had taken imatinib tablets for years, those who missed 1 dose in 10 or more were much less likely to reach a good response on blood tests; and in those who missed 2 doses in 10 or more, this response was not seen at all [11]. Read more: CML treatment with a single tablet.
If side effects are bothering you or you find the tablets hard to take, do not stop them yourself; tell your doctor [9]. Sometimes a pause of a few days or a lower dose allows treatment to continue [6]. Your doctor checks whether the treatment is working with examinations, blood tests and scans [1]: How do I know if chemotherapy is working?
When should I call my doctor?
Ask your treatment team which side effects you must report straight away, and write them down [9]. For example, with capecitabine tablets, contact your treatment team straight away if you have any of the following; with diarrhoea, vomiting, severe nausea, mouth sores, hand and foot problems or dehydration, also stop the tablets until you have spoken to them [6]:
- a temperature of 38 °C (100.5 °F) or higher, or any other sign of infection
- diarrhoea: 4 or more extra bowel movements a day compared with what is usual for you, or diarrhoea at night; or bloody diarrhoea with severe stomach pain and fever
- vomiting 2 or more times in 24 hours, or nausea that has made you eat much less
- painful sores in your mouth or on your tongue
- redness, swelling, pain or numbness of the palms and soles that makes everyday tasks hard
- yellow skin or eyes, passing less urine or signs of dehydration
- any sign of bleeding, especially if you take warfarin
Chest pain, shortness of breath, dizziness, blistering or peeling skin, or swelling of the face, lips, tongue or throat: report it at once or go to the emergency department [6]. If you suddenly feel very unwell, call your local emergency number. Night-time or a weekend is no reason to wait. Read more: Fever and warning signs during chemotherapy.
Frequently asked questions
Is oral chemotherapy weaker than chemotherapy given into a vein?
No. Being a tablet does not make a drug weaker. For example, after surgery for bowel cancer, capecitabine tablets prevented the cancer from coming back at least as well as the drug given into a vein [4]. Contact with chemotherapy tablets also carries the same risks as chemotherapy given into a vein, so they should be stored and handled just as carefully [9].
I forgot to take my chemo pill: what should I do?
I vomited after taking my tablet: should I take it again?
With capecitabine, no; do not take another tablet, and take the next dose at the usual time [6]. For other drugs, ask your treatment team. If you vomit 2 or more times in 24 hours, get in touch [6]. Read more: Nausea and vomiting during cancer treatment.
Can I split, crush or dissolve my tablet?
Not without your doctor's permission [6, 9]. The powder of a crushed tablet can harm your eyes and skin and those of the people around you [6]. For some drugs, such as imatinib, there is a set way to dissolve the tablet in water or apple juice [8]; if you find tablets hard to swallow, tell your doctor [6].
Do chemo pills make your hair fall out?
It depends on the drug. For example, hair loss is a common side effect of temozolomide [7], but it is not among the most common side effects of capecitabine taken on its own [6]. Read more: Hair loss during chemotherapy and Does hair grow back after chemotherapy?
Are tamoxifen and other hormone tablets chemotherapy?
No. Hormone therapy is a separate treatment that slows or stops the growth of cancers that use hormones to grow, such as some breast and prostate cancers, and it may be given as tablets or injections [3]. Take these tablets exactly as prescribed too, and do not stop them without advice. Read more: Tamoxifen.
Are chemo pills dangerous for my family?
A few simple precautions keep your family safe: keep the tablets out of reach of children, handle them with gloves or clean hands, and make sure pregnant or breastfeeding women and children do not touch them [9]. Read more: Is chemotherapy dangerous for the people around me?
Related pages
Evidence and prescribing notes for oral anticancer drugs (for doctors)
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- Oral versus intravenous (X-ACT): 1987 patients with resected stage III colon cancer; capecitabine for 24 weeks versus bolus 5-FU/leucovorin (Mayo Clinic regimen). Disease-free survival was at least equivalent (P<0.001 for the comparison of the upper limit of the HR with the non-inferiority margin of 1.20), relapse-free survival was improved (HR 0.86; 95% CI 0.74–0.99; P=0.04) and adverse events were fewer (P<0.001) [4]. In the FDA label (X-ACT data): PPES 60% (grade 3–4: 17%) versus 9% (<1%), diarrhoea 47% versus 65% and stomatitis 22% versus 60% [6].
- Patient preference: of 103 patients with incurable cancer, 92 preferred oral chemotherapy; but 70% were not willing to accept a lower response rate and 74% a shorter duration of response to keep their preference [5].
- Adherence: in a systematic review (51 studies of adherence rates and 12 intervention studies), adherence ranged from 46% to 100%, and only 1 randomised trial and 2 cohort studies of interventions showed benefit [10]. In chronic-phase CML on imatinib 400 mg/day (87 patients in complete cytogenetic response, 3 months of electronic monitoring), adherence was ≤90% in 26.4%; the 6-year probability of MMR was 28.4% versus 94.5% (P<0.001) and of CMR 0% versus 43.8% (P=0.002), and no molecular responses were seen with adherence ≤80% [11].
- Interactions: most clinically relevant interactions of tyrosine-kinase inhibitors involve altered bioavailability through changes in gastric pH, metabolism by CYP450 isoenzymes and QTc prolongation; a medication review is needed for every patient [12]. Imatinib: avoid strong CYP3A4 inducers (if unavoidable, increase the dose by at least 50%); enzyme-inducing antiepileptics lowered AUC by 73% and St John's wort by 30%; avoid grapefruit juice [8]. Capecitabine: boxed warning for bleeding with vitamin K antagonists (monitor INR more often), monitor phenytoin levels, avoid folate/leucovorin unless directed, and test for DPYD variants before starting unless immediate treatment is needed [6]; DPYD and UGT1A1 testing; interactions in detail: Drug interactions with oral anticancer drugs.
- Administration: capecitabine swallowed whole with water within 30 minutes after a meal, about 12 hours apart; missed or vomited doses are not replaced [6]. Temozolomide swallowed whole, on an empty stomach or at bedtime to reduce nausea; capsules not opened, chewed or dissolved [7]. Imatinib with a meal and a large glass of water; if the patient cannot swallow, the tablets may be dispersed in water or apple juice [8].
- Handling safety: oral agents carry the same exposure risk as intravenous ones; education on storage and handling, a separate pill organiser and returning unused medicine to the pharmacy are recommended [9].
Related cancer types
Related guides
References
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Numbers in the text, such as [1], refer to these sources. Sources with a “Study card” button are summarised in the site’s evidence library.
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This page is based on reputable scientific sources and was last updated on 28 October 2026. The content of this website is for educational and informational purposes only and does not replace consultation, diagnosis or treatment by a specialist physician. Consult your treating physician about any treatment decision.
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