Alpelisib, as a PI3K alpha inhibitor, requires special attention to the management of adverse reactions such as hyperglycemia, rash, and diarrhea during its use. The following is a detailed explanation of the precautions for these three key issues, including monitoring requirements, dose adjustments, and response measures.

1. High blood sugar management

(1) Monitoring requirements

Before treatment, fasting blood glucose (FPG) and HbA1c should be evaluated. FPG should be monitored weekly during the initial stage of treatment, and once a month after stabilization; HbA1c is monitored every 3 months. High risk patients (such as BMI ≥ 30, diabetes history) need to strengthen monitoring.

(2) Intervention measures

When high blood sugar occurs, metformin is preferred (starting at 500mg/day, can be increased to 1000mg/day), and insulin may be used for a short period of time if necessary. If FPG persists above 250mg/dL or ketoacidosis occurs, administration should be suspended until recovery.

2 Skin rash management

(1) Graded processing

All levels of rash require consultation with a dermatologist. Grade 1 rash can continue to be treated with medication; Level 2 needs to be suspended until reduced after relief; Grade 3 or above or severe skin reactions (such as SJS) require permanent discontinuation of medication.

(2) Preventive measures

The use of antihistamines before treatment can reduce the incidence of rash. Patients need to have their skin checked daily, and any symptoms such as blisters or mucosal damage should be reported immediately.

3 Diarrhea/Colitis Management

(1) Grading standards

Grade 1 diarrhea does not require dose adjustment; Level 2 requires a pause until the original dose is restored after remission; Level 3 requires reduction and restoration; Grade 4 or recurrent grade 2 requires permanent discontinuation of medication.

(2) Support treatment

Timely fluid replacement and use antidiarrheal medication if necessary. Severe colitis requires systemic corticosteroid treatment. The patient needs emergency medical attention if they experience bloody stool or dehydration symptoms.

4 Other important tips

(1) Handling of missed services

Supplement can be taken within 9 hours after missed dose, and if exceeded, the daily dose will be skipped. After vomiting, there is no need to take additional medication. The next day, the medication will be administered according to the original plan.

(2) Taboo population

Prohibited during pregnancy, efficient contraceptive measures should be taken during childbearing age; Patients with severe liver and kidney dysfunction should use it with caution.