Medicines, foods and supplements to avoid on alpelisib

Alpelisib can be affected by other medicines, and it can affect some of them in turn. The most important group to avoid are strong enzyme inducers, which speed up how the body breaks down alpelisib and can make it less effective. Examples include rifampicin, used for tuberculosis, some epilepsy medicines such as phenytoin and carbamazepine, and the herbal remedy St John's wort. Some medicines that block a transport protein called BCRP can raise alpelisib levels, so your pharmacist checks for these too. Alpelisib may also reduce the effect of certain medicines broken down by an enzyme called CYP2C9, such as warfarin, so blood thinning may need closer monitoring. Beyond these direct interactions, some products affect the same problems alpelisib causes. Steroid tablets raise blood sugar. Some herbal products, such as bitter gourd juice, fenugreek or cinnamon capsules, may lower sugar unpredictably and confuse readings. Bone-strengthening injections, such as zoledronic acid or denosumab, need care because jaw bone problems have been reported in people who had them alongside alpelisib. There is no single food you must avoid, but foods and drinks high in sugar matter a great deal for blood sugar control, and alcohol can affect sugar and the liver. The safest approach is to share a complete list of everything you take, including tonics and ayurvedic products, with your oncology team and pharmacist before starting and before adding anything new.

Enzyme inducers are the main concern

They can lower alpelisib levels and reduce its effect.

Sugar-affecting products matter

Steroids and some herbal remedies can upset blood sugar control.

Tell every prescriber

Doctors, dentists and pharmacists should know you take alpelisib.

Interaction advice is based on laboratory studies, the official prescribing information and experience, but gaps remain.

Not every product has been studied

A product missing from this page is not automatically safe with alpelisib.

Herbal products vary

Strength and contents differ between brands, making their effects hard to predict.

Sometimes a needed medicine continues

If a medicine is essential, your team may keep it and monitor you more closely.

What this page cannot tell you

It cannot check your personal medicine list. Ask your pharmacist or oncologist to do that.

Many people with breast cancer that has spread to bone receive zoledronic acid or denosumab. These can still be used with alpelisib, with some care.

Why care is needed

Jaw bone problems, where part of the jaw bone does not heal, have been reported in people who had these injections and alpelisib.

Protect your jaw

Have a dental check before bone treatment, keep your mouth clean and tell your dentist about both medicines.

Report early signs

Jaw pain, swelling, a loose tooth or exposed bone in the mouth should be reported promptly.