Piqray (alpelisib) is a prescription drug that’s used to treat breast cancer in adults in certain situations. Piqray can cause side effects that range from mild to serious. Examples include hair loss and nausea.

Specifically, it’s used in adults to treat breast cancer that has all of the following characteristics:

The active ingredient in Piqray is alpelisib. (An active ingredient is what makes a drug work.) The drug comes as a tablet you take by mouth. It’s used as a long-term treatment along with Faslodex (fulvestrant), a hormone therapy drug.

Keep reading to learn about the common, mild, and serious side effects that Piqray can cause. For a general overview of the drug, including details about its uses, see this article.

Some people may experience mild to serious side effects during their Piqray treatment. Some of the more common ones include:

* To learn more about this side effect, see the “Side effects explained” section below.

Piqray may cause mild side effects in some people. Examples of mild side effects that have been reported include:

* To learn more about this side effect, see the “Side effects explained” section below.

In most cases, these side effects should be temporary. And some may be easily managed. But if you have symptoms that are ongoing or that bother you, talk with your doctor or pharmacist. Do not stop using Piqray unless your doctor recommends it.

Piqray may cause mild side effects other than the ones listed above. See the Piqray prescribing information for details.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Piqray, visit MedWatch.

Serious side effects that have been reported with Piqray include:

* To learn more about this side effect, see the “Side effects explained” section below.

If you develop serious side effects while taking Piqray, call your doctor right away. If side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Below are answers to some frequently asked questions about Piqray’s side effects.

When do side effects from Piqray typically start?

Side effects from Piqray can start at any time while you’re taking the drug. But based on what was seen in the drug’s studies, some side effects often occurred within certain periods.

A few of the more common side effects arose within the following time frames:

  • hyperglycemia (high blood sugar): within 15 days of starting Piqray
  • mild rash: about 12 days into the treatment
  • diarrhea: within 46 days of starting Piqray

Your doctor may prescribe or suggest medications to help prevent or reduce some of Piqray’s side effects.

Will Piqray affect my sense of taste?

Some people notice changes in their sense of taste while taking Piqray. This side effect was reported in studies of the drug, but it was usually mild. Symptoms may include foods tasting different than they usually do or having little to no flavor.

It’s important to eat enough calories and nutrients while you’re being treated for cancer. Even if foods don’t taste as good as they once did, your body needs nourishment and energy. For help figuring out what to eat while taking Piqray, talk with your doctor or a dietitian.

Is vaginal dryness a side effect of Piqray?

Yes, Piqray may cause vaginal dryness as a side effect. The drug may cause dryness in other body areas as well. This can include your skin, mouth, and mucous membranes. (These membranes are surfaces of your body that are typically moist, such as the lining inside your nose.)

In most cases, vaginal dryness from Piqray is mild. A vaginal moisturizer such as Replens may help relieve this side effect. And a water-based lubricant may help make sex more comfortable when you have vaginal dryness.

Learn more about some of the side effects Piqray may cause.

Hair loss

Piqray may cause hair loss. In studies, this side effect was common. But hair loss doesn’t occur in everyone who takes Piqray.

What might help

There aren’t many effective options for managing hair loss from Piqray. Some people find that wearing a wig or other type of head covering makes them feel more comfortable.

Talk with your doctor if you have questions or are looking for other ways to manage this side effect.


Diarrhea is a common side effect of Piqray. For most people, this side effect is mild. But in rare cases, it may be severe. Fluid loss through severe diarrhea can lead to dehydration and serious kidney problems.

People have also reported colitis (inflammation of your large intestine) with Piqray treatment. But this side effect wasn’t reported during clinical studies of Piqray. Colitis was reported after the drug was approved. Symptoms of this condition can include abdominal pain, bloating, and blood in your stool.

What might help

If you start having diarrhea or colitis while taking Piqray, tell your doctor right away. Depending on how severe it is, they may have you temporarily stop taking the drug. Once the symptoms go away, they may have you restart Piqray at a lower dosage. If severe diarrhea or colitis returns, they may have you stop taking Piqray completely. You should not stop or change your treatment without talking with your doctor.

Your doctor may have you take Imodium (loperamide), an over-the-counter medication that helps reduce or stop diarrhea. It’s also a good idea to drink plenty of fluids while taking this medication. Try to aim for eight 8-ounce glasses of water per day. This may help decrease your risk of dehydration if severe diarrhea occurs.

Sticking to bland foods may also help ease diarrhea. Consider avoiding foods that are spicy or greasy and limiting your caffeine intake.

If you have questions about other ways to manage diarrhea or colitis, talk with your doctor or pharmacist.

High blood sugar

In studies, hyperglycemia (high blood sugar) was the most common side effect of Piqray treatment. This side effect was mild in most people.

While it’s rare, severe hyperglycemia from Piqray can lead to serious complications. These may include:

Mild hyperglycemia doesn’t typically cause symptoms. But very high blood sugar levels may cause the following symptoms:

What might help

Your doctor will check your blood sugar level before you start Piqray. If needed, they may also ask that you check your blood sugar at home. They’ll also have you get other blood tests (such as A1C tests) frequently during your Piqray treatment. If your blood sugar readings become higher than usual, tell your doctor.

Your doctor may have you manage your mild hyperglycemia by:

  • decreasing your dosage of Piqray
  • having you pause Piqray treatment
  • prescribing a medication, such as metformin, to lower your blood sugar
  • suggesting changes to your diet

Severe hyperglycemia may require treatment with insulin, hospitalization, or both. If you have severe high blood sugar, your doctor may have you temporarily or permanently stop Piqray.

Lung problems

While less common than the side effects described above, serious lung problems can happen during Piqray treatment. These problems include:

Both of these conditions involve inflammation (swelling) and scarring of the lungs. Symptoms may include:

What might help

Tell your doctor right away if you have any of the symptoms listed above. They’ll likely have you stop taking Piqray until they determine the cause of your symptoms. They may take an X-ray of your lungs.

If your doctor confirms you have pneumonitis or interstitial lung disease, they’ll have you permanently stop taking Piqray. They’ll treat your lung condition and talk with you about other breast cancer treatment options.

Allergic reaction

Like most drugs, Piqray can cause an allergic reaction in some people. Symptoms can be mild or serious and may include:

  • skin rash
  • itchiness
  • flushing (temporary warmth, redness, or deepening of skin color)
  • swelling under your skin (typically in your eyelids, lips, hands, or feet)
  • swelling of your mouth, tongue, or throat, which can make it hard to breathe

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest an over-the-counter oral antihistamine, such as Benadryl (diphenhydramine). Or they may recommend a topical product, such as hydrocortisone cream, to help you manage your symptoms.

If your doctor confirms you had a mild allergic reaction to Piqray, they’ll decide if you should continue taking it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you had a serious allergic reaction to Piqray, they may have you switch to a different treatment.

Keeping track of side effects

During your Piqray treatment, consider keeping notes on any side effects you’re having. You can then share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things such as:

  • what dose of drug you were taking when you had the side effect
  • how soon after starting that dose you had the side effect
  • what your symptoms were
  • how it affected your daily activities
  • what other medications you were taking
  • any other information you feel is important

Taking notes and sharing them with your doctor will help them learn more about how Piqray affects you. Your doctor can then use this information to adjust your treatment plan if needed.

Piqray may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Piqray. Below are factors to consider.

Diabetes. Hyperglycemia (high blood sugar) is a common side effect of Piqray. If you already have diabetes, it’s possible that taking this drug could make your condition worse. If your doctor decides that Piqray is right for you, they may need you to check your blood sugar or get blood tests more often. If needed, your doctor may adjust your diabetes treatment to help manage your blood sugar.

Allergic reaction. If you’ve had an allergic reaction to Piqray or any of its ingredients, your doctor will likely not prescribe it. Ask them what other medications are better options for you.

Alcohol and Piqray

Alcohol doesn’t interact with Piqray. But drinking alcohol during Piqray treatment could worsen some of the drug’s side effects. Some examples may include:

If you drink alcohol, talk with your doctor about how much, if any, is safe while you’re taking Piqray.

Pregnancy and breastfeeding while taking Piqray

Piqray is not safe to take during pregnancy. Your doctor may have you take a pregnancy test to confirm you’re not pregnant before you start Piqray. If you’re pregnant, your doctor can talk with you about your options.

If you or your partner can become pregnant, talk with your doctor about your birth control needs while taking Piqray.

There are no studies looking at Piqray and safety while breastfeeding. Because of this, it is considered unsafe to use. If you’re breastfeeding a child, talk with your doctor about other treatment or feeding options.

Like other cancer treatments, Piqray causes side effects in most people. In many cases, these side effects can be monitored and treated with your doctor’s help.

Before starting treatment with Piqray, you may want to ask your doctor the following questions:

  • If I have a family history of diabetes, is it safe for me to take Piqray?
  • Do my other medications increase my risk of side effects from Piqray?
  • Will you recommend or prescribe medications for me to help prevent Piqray’s side effects?

To learn more about Piqray, see these articles:

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Does Piqray cause diabetes as a long-term side effect?



Piqray may cause an increase in blood sugar. This can happen because of how Piqray works in the body to treat cancer. Your doctor will monitor your blood sugar level while you’re taking Piqray, especially if you were diagnosed with diabetes before starting treatment. In studies, all patients who had hyperglycemia due to Piqray had their blood sugar return to normal after stopping this drug.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
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Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.