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Home > Drug Category > Cancer Medications > Piqray and Equivalent

Piqray Information

Piqray (Alpelisib) is a targeted therapy used primarily in the treatment of advanced or metastatic breast cancer. It is used for the treatment of individuals whose breast cancer is hormone receptor-positive and human epidermal growth factor receptor 2-negative. More importantly, it is only effective in individuals with breast cancer whose tumors have a specific mutation in the PIK3CA gene, which is found in about 40% of HR+ advanced breast cancers. It is worth noting that Piqray is almost always prescribed alongside fulvestrant, a hormone therapy. Alpelisib, the active ingredient in Piqray, is a PI3K inhibitor. In healthy cells, the PI3K pathway helps regulate growth and survival. However, when the PIK3CA gene mutates, this pathway becomes overactive, essentially acting like a stuck gas pedal that tells cancer cells to divide uncontrollably. Alpelisib works by blocking this overactive pathway, which appears to slow down tumor growth and can even help overcome resistance to previous hormone therapies.

While it is primarily for use in breast cancer, alpelisib can also be used for the treatment of individuals 2 years of age and older with severe manifestations of PIK3CA-Related Overgrowth Spectrum (PROS), a group of rare genetic disorders, in which the same mutation causes certain tissues or body parts (like limbs, blood vessels, or skin) to grow excessively and abnormally.

Piqray Side Effects

Like other medications, alpelisib can cause some side effects. Common side effects of this medication include rash, nausea, tiredness and weakness, decreased appetite, mouth sores, vomiting, weight loss, and hair loss. Contact your doctor if these mild side effects persist or worsen.

Stop taking this medicine and contact your doctor immediately if you experience any serious side effects, including the following:
• Allergic reactions such as breathing difficulties, body itching, body rash, skin blistering, especially on the hands and feet, swelling of the face, mouth, tongue, lips, or throat;
• Bleeding problems such as vomiting blood or if your vomit looks like coffee-grounds, bloody or pink urine, bloody or dark tarry stools;
• Gastrointestinal problems such as severe diarrhea, blood in stool, and abdominal pain;
• High blood sugar with symptoms like excessive thirst, frequent urination, dry mouth, and increased appetite;
• Lung problems with symptoms such as shortness of breath, cough, and chest pain;
• Osteonecrosis of the jaw (deterioration of the jawbone) with symptoms like pain, swelling, or infection of the jaw;
• Pancreatitis with symptoms like abdominal pain on the upper left side, back pain;
• Signs of infection such as fever, severe chills, sore throat, and mouth ulcers;
• Urinary tract infection with symptoms like pain when urinating, urinating more often than usual, low back or flank pain

Inform your doctor about any other side effects you notice that are not listed here.

Piqray Precautions

Do not take this medication if you are allergic to alpelisib, other ingredients in Piqray, or any other medicines. Before you start taking this medication, ensure that you inform your doctor about any prior or current medical conditions, including the following:
• Active infection;
• Blood count or bleeding disorders;
• Dehydration;
• Diabetes or impaired blood sugar;
• Gastrointestinal problems such as inflammatory bowel conditions;
• Lung problems

Piqray is not recommended for use during pregnancy. Animal studies suggest it can cause significant fetal harm or even loss of the pregnancy. Women of reproductive age must have a negative pregnancy test before taking this medication. Both men and women are advised to use effective contraception. For women, this should continue for at least one week after the last dose. For men with female partners who could become pregnant, the same one-week rule applies to condom use. It is currently unknown if the drug passes into breast milk. However, because of the potential for serious adverse reactions in a nursing infant, it is advised that women do not breastfeed during treatment and for at least one week after the final dose. It is not suitable for use in children under 2 years of age.

Given that this medication can increase blood sugar, your doctor may require baseline fasting glucose and HbA1c tests before starting you on this medication, with frequent monitoring thereafter. Medications like rifampin, phenytoin, or St. John’s Wort can significantly lower the levels of alpelisib in your blood, potentially making the treatment ineffective. Therefore, before using this medication, inform your doctor about any other medications you are taking, including herbal medicines and supplements, to determine whether it is safe to use with Piqray. Also, grapefruit and its juice should generally be avoided, as they can interfere with how the drug is broken down, potentially leading to higher-than-intended levels in the system. Take one 300 mg dose of Piqray orally once daily. You must take the tablets with food to ensure your body absorbs the medicine properly. Swallow the tablets whole without chewing, crushing, or breaking them. If you vomit after a dose, skip that day and wait until your next scheduled time. Store the medication at room temperature in its original blister pack to protect it from moisture.

Do I need a prescription to order Piqray?

Yes, a prescription is required from your physician to order Piqray.