Piqray® Tablets for HR-Positive, HER2-Negative, PIK3CA-Mutated Breast Cancer

What Piqray® Is and How It Works

Piqray (alpelisib) is an oral PI3K-alpha inhibitor used with fulvestrant for adults with hormone receptor-positive, human epidermal growth factor receptor 2-negative, PIK3CA-mutated advanced or metastatic breast cancer after progression on endocrine therapy. People compare Piqray buy online options and Piqray without insurance costs to manage expenses while staying on therapy. YouDrugstore is a licensed Canadian pharmacy headquartered in Manitoba; prescriptions are reviewed by licensed pharmacists before dispensing. We source through licensed, vetted international partner pharmacies to offer authentic brand medicines across many categories at affordable Canadian pricing.

Alpelisib blocks the phosphatidylinositol-3-kinase alpha (PI3Kα) pathway, which can be overactive in tumors with PIK3CA mutations. Inhibition helps slow cancer cell growth and survival. Piqray is taken by mouth once daily with food and is paired with fulvestrant injections given on a fixed schedule. Tumors should be tested for a PIK3CA mutation using an approved tissue or blood test before starting treatment.

Piqray tablets come in multiple strengths to enable dose adjustments. The commonly used daily dose is 300 mg (for example, two 150 mg tablets). Dose reductions to 250 mg or 200 mg daily are used when needed to manage side effects. Tablets should be swallowed whole.

Dosage and Usage

• Typical starting dose: 300 mg by mouth once daily with food, at about the same time each day.
• Swallow tablets whole; do not chew, crush, or split.
• Dose reductions (for example, to 250 mg or 200 mg once daily) may be used to manage adverse reactions.
• If a dose is missed by more than 9 hours, skip the dose and take the next day’s dose at the usual time.
• If vomiting occurs after a dose, do not take an extra tablet; resume with the next scheduled dose.
• Use Piqray with fulvestrant given as intramuscular injections (day 1, 15, 29, then once monthly) per the prescribing schedule.
• Glucose and other labs are monitored at baseline and during therapy; therapy may be interrupted and resumed at a lower dose for significant toxicity.
• Review potential interactions, including strong CYP3A inducers (which may lower alpelisib levels) and sensitive BCRP substrates (for example, rosuvastatin).

• Store Piqray at 20–25 °C (68–77 °F); short excursions 15–30 °C (59–86 °F) are acceptable.
• Keep tablets in the original container to protect from moisture. Close the cap tightly and store in a dry place.
• Keep out of reach of children and pets. Do not use if the packaging is damaged or expired.
• For travel, carry tablets in hand luggage with your prescription label. Keep them with you, not in checked bags.
• Pack extra doses for delays and time-zone changes. Use a pill organizer only if kept dry.
• Reorder from YouDrugstore 2–3 weeks before running out. A multi-month supply may lower the per-month cost.

Benefits and Savings

In the SOLAR-1 study, alpelisib plus fulvestrant improved progression-free survival in patients with a confirmed PIK3CA mutation compared with fulvestrant alone. The median progression-free survival was 11.0 months vs 5.7 months. This supports the role of targeted PI3Kα inhibition after endocrine therapy resistance in HR-positive, HER2-negative disease.

Convenience matters in long-term cancer care. Piqray is an oral tablet taken once daily with food, which can reduce clinic time compared with some intravenous options. Regular monitoring helps guide temporary holds or dose adjustments while maintaining efficacy.

Buying from a Canadian pharmacy can reduce costs by 60–80% versus typical U.S. prices. Patients paying without insurance often compare total out-of-pocket costs across pharmacies to stay on therapy consistently. Multi-month supplies and occasional bulk promotions can further lower the average monthly price.

Check the current Piqray discount information for any live offers.

Side Effects and Safety

• Hyperglycemia (high blood sugar), which may require monitoring and antidiabetic therapy
• Rash and pruritus
• Diarrhea, nausea, vomiting
• Stomatitis (mouth sores)
• Fatigue, decreased appetite, weight loss
• Elevated creatinine, liver enzymes, or lipase on labs
• Headache or taste disturbance

Serious risks include severe hyperglycemia (rarely diabetic ketoacidosis), severe cutaneous reactions (such as Stevens-Johnson syndrome or toxic epidermal necrolysis), anaphylaxis, severe diarrhea and dehydration, and non-infectious pneumonitis. Embryo-fetal toxicity is a concern; effective contraception is recommended during treatment and for a period after the last dose. Patients with pre-existing diabetes need careful blood glucose management throughout therapy.

Onset Time

Blood glucose can rise early, often within the first 1–2 weeks. Rash and stomatitis also tend to appear within the first few weeks if they occur. Tumor response is typically evaluated by imaging after several treatment cycles, commonly around 8–12 weeks. Some people experience symptom relief earlier, but radiographic changes may take time. Dose adjustments are sometimes used to maintain treatment while improving tolerability.

Compare With Alternatives

For HR-positive, HER2-negative metastatic breast cancer, other targeted options include CDK4/6 inhibitors (palbociclib, ribociclib, abemaciclib) given with endocrine therapy earlier in the treatment course. After progression, everolimus with an aromatase inhibitor is an alternative in certain settings. Recently, AKT pathway inhibitors in combination with endocrine therapy have emerged for tumors with relevant pathway alterations.

Treatment selection depends on prior therapies, mutation testing (PIK3CA, ESR1, BRCA/HRD), comorbidities, and goals of care. Oncologists weigh efficacy, side effects, and patient preferences when choosing between targeted agents, chemotherapy, or clinical trials.

YouDrugstore also supplies other oncology medicines. Examples include Bavencio® (avelumab) for specific urothelial and Merkel cell indications, and Zytiga® (abiraterone) for metastatic prostate cancer. These are not substitutes for alpelisib but show the breadth of targeted and hormonal therapies available through our pharmacy.

Combination Therapy

• Piqray with fulvestrant: the approved combination for PIK3CA-mutated, HR-positive, HER2-negative advanced disease after endocrine therapy progression.
• Antidiabetic agents: metformin or other therapies may be used to control alpelisib-associated hyperglycemia under medical supervision.
• Supportive care: treatments for rash or stomatitis (for example, antihistamines or steroid mouth rinses) may be used as directed.
• Drug interactions: avoid strong CYP3A inducers when possible; review all medicines and supplements with the oncology team.
• Hypersensitivity or severe toxicity: therapy may be interrupted and resumed at a reduced dose per clinical guidance.

Patient Suitability and Cost-Saving Tips

Piqray is intended for adults with HR-positive, HER2-negative, PIK3CA-mutated advanced or metastatic breast cancer whose disease progressed on or after endocrine therapy. A validated test for a PIK3CA mutation should confirm eligibility using tumor tissue or plasma.

Piqray may not be appropriate for those with a history of severe hypersensitivity to alpelisib, prior severe cutaneous adverse reactions, uncontrolled diabetes, active or uncontrolled infection, or during pregnancy or breastfeeding. Renal or hepatic impairment may require closer monitoring. Clinicians individualize decisions based on overall health, prior treatments, and lab results.

To reduce costs, consider a multi-month supply when appropriate, as per-month pricing can be lower. Set reorder reminders so refills are placed on time. Patients comparing Piqray cost no insurance often find Canadian pricing more affordable than typical U.S. pharmacy quotes. Phone support and chat are available during posted hours for ordering help.

Authoritative Sources

Novartis Piqray (alpelisib) US Prescribing Information

Health Canada Drug Product Database: Piqray entry

FDA Label: Piqray (alpelisib) tablets

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This content is educational and does not replace advice from a licensed healthcare professional. Always follow the guidance of the treating clinician and the official prescribing information.