Alpelisib precautions: how to use Piqray safely

Hyperglycemia (high blood sugar) is one of the most common problems when people take alpelisib. If you or your caregiver don’t check sugars regularly, you can end up in the ER. Before you start, get a fasting glucose and HbA1c. If you already have diabetes, talk to your oncologist and your diabetes provider about a plan — expect more frequent checks and medication adjustments.

Blood sugar: practical steps

Buy a glucometer and learn to test at home. A typical approach is daily or even twice-daily checks during the first weeks, then at least weekly once things settle. If readings climb, your care team may add metformin or other diabetes meds, or hold/reduce alpelisib until levels improve. Don’t ignore symptoms like extreme thirst, frequent urination, nausea, or confusion — those need immediate attention.

Other common issues and what to do

Skin reactions: Rash happens often. For mild rash, antihistamines and topical steroid creams usually help. For a widespread or blistering rash, stop treatment and call your doctor — you may need steroids and a delay or dose change.

Diarrhea and nausea: Start loperamide for loose stools at the first sign. Drink fluids and replace salts. If diarrhea is severe or causes dehydration, your team may pause alpelisib and treat you in clinic or hospital if needed.

Liver tests: Get baseline ALT, AST, and bilirubin. Your doctor will repeat blood tests during treatment. If liver enzymes rise, they may lower the dose or stop the drug until values come down.

Breathing problems: New cough, shortness of breath, or chest tightness could signal drug-related lung inflammation (pneumonitis). Stop the medicine and get evaluated right away — prompt steroid treatment is often needed.

Infections and immune issues: While not the top risk, any fever, chills, or signs of infection should be reported quickly. Your team may want cultures, antibiotics, or temporary treatment holds.

Drug interactions and vaccines: Tell your doctor about all meds, supplements, and herbal products. Alpelisib can interact with other drugs. Avoid live vaccines while on treatment and for a time after — check with your oncology clinic.

Pregnancy and contraception: Alpelisib can harm a fetus. Use effective birth control during treatment and for the recommended period afterward. If pregnancy is possible, get pregnancy testing before starting and immediately if pregnancy is suspected.

Communication and record-keeping: Keep a simple symptom log (glucose numbers, stools, rashes, breathing changes) and bring a current medication list to every visit. Dose reductions and short holds are common and often avoid worse complications — don’t try to 'tough it out.'

Your oncology team has protocols for monitoring and managing these risks. If anything feels off, call them early. Acting fast usually keeps problems small and lets you stay on the drug safely when it’s needed.