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When managing toxicity, it is important to look into the toxicity profile associated with Alpelisib. When toxicity levels are too high, the common side effects are hyperglycemia, rash, diarrhea, and fatigue. Understanding how to manage toxicity levels in a patient-centered manner is key to avoiding these adverse events.

Thinking about how to best prepare those patients, we found that within our clinic, utilizing the Duke University protocol, we have a hyperglycemia prophylactic protocol. That’s basically trying to identify what’s likely going to happen and how we prevent that or manage it. Taking it in chunks, with hyperglycemia being first, we start all our patients on immediate-release or extended-release metformin. We’ve gone more toward extended-release metformin because of the overlapping toxicity with diarrhea from alpelisib. This is another adverse effect that we see from that. Essentially, we start patients on prophylaxis to help prevent hyperglycemia. Via pharmacy times