Piqray® Tablets for HR+ HER2- Breast Cancer

Piqray is alpelisib, a targeted oral PI3K inhibitor used with fulvestrant for certain HR+, HER2- metastatic or advanced breast cancers with a PIK3CA mutation. This page explains how it works, who may be eligible, and practical use points. We support US shipping from Canada and provide options for Piqray® without insurance.

What Piqray Is and How It Works

Border Free Health connects U.S. patients with licensed Canadian partner pharmacies; prescriptions are verified with prescribers before dispensing.

Alpelisib tablets selectively inhibit the phosphatidylinositol-3-kinase alpha isoform (PI3Kα). This pathway can drive tumor growth when PIK3CA mutations are present. By blocking PI3Kα, the treatment may help slow disease progression in appropriate patients.

It is used with a selective estrogen receptor degrader. Many patients will receive this medicine paired with fulvestrant; see our overview of Fulvestrant Injection for context. This combination targets both hormone signaling and PI3K pathway activity.

Who It’s For

This therapy is indicated for postmenopausal women and men with HR+, HER2- advanced or metastatic breast cancer that has a confirmed PIK3CA mutation and has progressed on or after endocrine therapy. Genomic testing is required to verify an eligible mutation.

It is not for everyone. People with poorly controlled diabetes, a history of severe cutaneous reactions, or hypersensitivity to components should review risks with a healthcare professional. Those who are pregnant or may become pregnant should avoid use and discuss contraception needs.

Learn more about the condition at Breast Cancer and explore related categories under Cancer.

Dosage and Usage

The usual starting schedule is once daily by mouth with food, taken at roughly the same time each day, alongside clinic-administered fulvestrant. Swallow tablets whole with water; do not crush, chew, or split. Your prescriber will advise on dose adjustments if side effects occur.

Baseline and ongoing checks often include fasting blood glucose, HbA1c, kidney and liver function, and rash monitoring. If you receive other therapies for symptom control, your care team will coordinate timing and monitoring. Always follow your clinician’s instructions and the official label.

Administration tips: take after a meal to reduce stomach upset, keep a consistent time, and record doses in a treatment diary. If nausea occurs, discuss supportive care options with your care team before making any changes.

Strengths and Forms

This medicine is supplied as film‑coated oral tablets in multiple strengths to support dose adjustments. Availability can vary by partner pharmacy and by current manufacturer supply.

• Alpelisib 200 mg tablets

Other strengths may also be available; your prescriber will select a strength and combination of tablets aligned to your plan.

Missed Dose and Timing

If you miss a dose, the general label guidance is to take it as soon as you remember on the same day. If it is close to the next scheduled time, skip the missed dose and resume your regular schedule the next day. Do not take two doses at once to make up for a missed dose. If vomiting occurs after dosing, do not take an extra dose; take the next dose as scheduled.

Storage and Travel Basics

Store tablets at room temperature in the original blister or bottle to protect from moisture and light. Keep out of reach of children and pets. When traveling, carry doses in your hand luggage along with a copy of your prescription and your oncologist’s contact information. Use a pill organizer only if you can keep the original labeling nearby for identification. Airport screening does not affect tablets. For sensitive items in your regimen, our partners use temperature-controlled handling when required.

Benefits

Targeted PI3Kα inhibition addresses a specific mutation that can drive tumor growth in HR+, HER2- disease. Taken by mouth once daily, the therapy avoids infusion visits and pairs with endocrine therapy in a coordinated plan. The regimen allows dose adjustments if side effects occur, helping clinicians individualize care.

Side Effects and Safety

Common side effects can include:

• High blood sugar, increased thirst, or frequent urination
• Rash, itching, or skin redness
• Diarrhea or loose stools
• Nausea, decreased appetite, or weight loss
• Stomatitis or mouth sores
• Fatigue and headache

Serious risks have been reported. These include severe hyperglycemia or ketoacidosis, severe cutaneous adverse reactions, hypersensitivity, pneumonitis, and severe diarrhea leading to dehydration. Report symptoms such as shortness of breath, widespread rash, signs of infection, confusion, or persistent vomiting promptly. Use of insulin or sulfonylureas may raise the risk of low blood sugar swings when glucose-lowering therapy is adjusted; your care team will monitor.

Drug Interactions and Cautions

Tell your clinician about all medicines, supplements, and herbals. Strong CYP3A4 inducers may reduce alpelisib exposure. Drugs that significantly raise blood glucose can complicate management. Acid-reducing agents are not known to meaningfully change exposure, but stomach upset may overlap. Because this therapy is used with fulvestrant, discuss any anticoagulants, antiplatelets, or other oncology treatments to avoid additive risks. Alcohol can worsen dehydration and blood sugar changes; use caution.

What to Expect Over Time

Your team will check fasting glucose frequently early in treatment, then at regular intervals. Skin checks and gastrointestinal symptom monitoring are common during the first weeks. If side effects emerge, clinicians may add supportive measures or adjust the dose per labeling. Many patients continue the regimen until disease progression or unacceptable toxicity. Keep a simple symptom diary, bring it to visits, and ask about labs before each cycle so you can plan your schedule.

Because it is paired with endocrine therapy, you may also read background on aromatase inhibitors such as What Is Anastrozole and consider patient tips from Exemestane Side Effects. For an overview of mTOR inhibition in metastatic settings, see Afinitor Uses.

Compare With Alternatives

Other targeted oral therapies may be used in different scenarios or earlier lines of therapy. CDK4/6 inhibitors, such as Verzenio, are used with endocrine therapy in many HR+ cases per labeling. Tumor-agnostic options for specific fusions include Vitrakvi; eligibility depends on genomic testing. Your clinician will decide on a sequence that matches your mutation profile and prior treatments.

Pricing and Access

We enable Canadian pharmacy access with US shipping from Canada. If you pay out of pocket, ask our team how the Piqray price compares to local options. Many patients explore manufacturer assistance or foundation support through their care centers. We can show current listings so you and your prescriber can choose a suitable dispensing partner.

For comparison across options, we list transparent details so you can estimate Alpelisib cost before you order. If you use a health savings or flexible spending account, confirm eligibility with your plan.

Availability and Substitutions

Supply can vary. If a selected strength or pack size is unavailable, your prescriber may recommend an alternative strength combination or a different therapy. Pharmacists will not substitute this targeted therapy without a prescriber’s authorization.

Patient Suitability and Cost-Saving Tips

People with confirmed HR+, HER2- disease and a documented PIK3CA mutation may be candidates if prior endocrine therapy no longer controls the cancer. Those with significant uncontrolled diabetes or a history of severe skin reactions may require additional caution. Discuss benefits and risks with your oncology team.

Practical ways to manage costs include requesting a multi-month fill when appropriate, aligning refill dates with clinic visits, and setting reminders so you do not miss reorders. Bring your medication list to appointments and ask if any lab schedules can be coordinated to reduce extra trips. To compare options or Buy Alpelisib through our partners, you can review listings together with your clinician.

Questions to Ask Your Clinician

• Eligibility check: Do my tumor results show a PIK3CA mutation?
• Treatment goal: How does this regimen fit with my current plan?
• Monitoring: How often will you check my blood sugar and labs?
• Side effects: What early signs should I report right away?
• Drug interactions: Should I change any current medicines or supplements?
• Supportive care: What can help with rash, diarrhea, or mouth sores?
• Access: Can we coordinate refills and lab visits to simplify my schedule?

Authoritative Sources

Manufacturer: Novartis

FDA Prescribing Information

Health Canada Database

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