Alpelisib Medication Tips: Practical Advice for Safe Use

Alpelisib (brand name Piqray) can be an important option for people with HR+, HER2‑, PIK3CA‑mutated advanced breast cancer. It works, but it often brings side effects you can prepare for and manage. These tips focus on what to check before starting, how to reduce risks, and what to do if problems come up.

Before you start

Get the right test first: confirm a PIK3CA mutation in your tumor. Ask your doctor for baseline blood work: fasting glucose, HbA1c, liver tests, and a complete blood count. If you have diabetes or prediabetes, talk through a plan to monitor and treat high blood sugar—alpelisib commonly raises glucose.

Tell your care team about all medicines, supplements, and herbal products you take. Some drugs can affect alpelisib levels or make side effects worse. Also discuss pregnancy plans—alpelisib can harm a fetus, so use effective contraception if that applies.

Plan how you’ll take the pill: alpelisib is usually taken once daily with food. Pick a consistent time, link it to a routine (breakfast, for example), and use a pillbox or phone alarm to help with adherence.

Managing common side effects

High blood sugar: Check fasting glucose often—weekly at first is common. If your glucose rises, your team may start metformin or other glucose‑lowering meds, or pause/reduce alpelisib. Don’t try to manage this on your own—get medical advice early.

Rash and skin problems: A rash can appear early. Ask if a preventative antihistamine is right for you. For mild rashes, topical steroids or antihistamine tablets help. For more severe reactions, doctors usually hold the drug and may restart at a lower dose.

Diarrhea and tummy upset: Keep loperamide handy and stay hydrated. Light food, small meals, and avoiding greasy or spicy dishes can help. Call your clinic if diarrhea is severe or doesn’t stop after a day or two.

Mouth sores (stomatitis): Good oral hygiene and saltwater rinses help. Your doctor may recommend a steroid mouthwash if soreness becomes a problem.

Breathing changes or persistent cough: Rare but serious. Stop the drug and contact your provider right away if you have new shortness of breath, cough, or chest pain.

Dose adjustments are normal. If side effects are bad, your team may pause treatment and restart at a lower dose (for example, stepping down from 300 mg to 250 mg, then to lower levels if needed). Always follow your oncologist’s plan—don’t change the dose on your own.

Keep a simple symptoms log and bring it to appointments: glucose numbers, new rashes, bowel changes, and any new meds. That record helps your team act quickly and keeps treatment on track. If something feels off, speak up—early action prevents bigger problems.