Capivasertib (Truqap)

Capivasertib at a glance

The verified brand is Truqap. Capivasertib blocks proteins called AKT that help cells respond to growth signals. It is a targeted therapy, not conventional chemotherapy. It can still cause important effects in normal tissues, including changes in blood-sugar control.

The usual starting schedule is 400 mg twice daily for four consecutive days, followed by three days without capivasertib. This seven-day pattern repeats. The prescribed dose may be lower, but you must not change either the amount or the treatment days yourself.

Capivasertib is used with other prescribed medicines. These may include fulvestrant, or a plan containing abiraterone and prednisone. Partner medicines have different purposes, schedules and precautions. Your three days off capivasertib do not automatically mean three days off everything else.

How capivasertib works

AKT is part of a signalling network inside cells. Capivasertib inhibits three forms of the AKT protein: AKT1, AKT2 and AKT3. In some cancers, changes elsewhere in this network help growth signals remain active. Blocking AKT can interfere with those signals. It does not rewrite a gene or guarantee that the cancer will respond.

Hormone treatments given alongside capivasertib work on a different part of the cancer's growth system. Fulvestrant targets oestrogen-receptor signalling. Abiraterone reduces androgen production and is prescribed with a steroid such as prednisone. These medicines are not interchangeable partners; the oncologist chooses the complete plan.

AKT also helps normal cells respond to insulin. Interfering with this function can raise blood glucose, also called blood sugar, even in someone without diabetes. A treatment-related rise is not a personal failure or simply evidence of eating the wrong food. Monitoring and timely treatment matter.

How the team decides whether it is suitable

Your oncologist considers the exact diagnosis, previous treatment, hormone and other relevant test results, general health and current prescribing information. A test result is only one part of this decision. Ask what the expected benefit is and how it will be measured.

The selection test depends on the proposed treatment. It may look for changes in the PIK3CA, AKT1 or PTEN genes in tumour tissue, or assess loss of the PTEN protein in the tumour. A gene alteration and loss of protein are related biological concepts, but they are not automatically the same laboratory result. The appropriate validated test must match the proposed regimen. These tumour tests do not by themselves establish that a change is inherited.

Tell the team about diabetes, pre-diabetes, heart or rhythm problems, previous severe skin reactions, ongoing diarrhoea, infections and liver or kidney disease. Do not take it if you have had a severe allergy to capivasertib or its ingredients. Safety has not been established in people with type 1 diabetes or type 2 diabetes that is uncontrolled or already requires insulin at baseline. Such patients were excluded from the main studies and need specialist assessment.

Before treatment starts

You need fasting glucose and HbA1c checks. HbA1c gives an indication of glucose levels over the preceding months. Raised glucose should be addressed before starting. Ask exactly when to fast for tests and how this fits around morning medicines. Do not assume all blood tests require fasting.

Other checks commonly include blood counts, kidney and liver function and blood salts. Your team reviews your medicines and symptoms and arranges pregnancy testing when pregnancy is possible. Severe kidney or liver impairment needs particular consideration because adequate data are lacking.

Prepare your home-care plan

Before the first dose, obtain a written calendar showing treatment days, off-days, tablet strength and times. Ask for the glucose-check schedule, personalised action thresholds and an urgent contact route outside clinic hours. If a home meter is needed, arrange supplies and training rather than waiting for symptoms.

Have the prescribed diarrhoea medicine available and know when to begin it. Discuss moisturisers, mouth care and which skin changes need an immediate call. If you already take diabetes medicines, obtain separate instructions for capivasertib days, off-days and an unplanned pause.

How to take capivasertib

Dose, food and weekly pattern

At the usual 400 mg dose, take two 200 mg tablets in the morning and two 200 mg tablets in the evening, approximately 12 hours apart. Take doses for four consecutive days, then take no capivasertib for three days. For example, a Monday start means taking it Monday through Thursday and having Friday through Sunday off. Use this example only if it matches your actual calendar.

Capivasertib can be taken with or without food. Swallow tablets whole with water. Do not chew, crush, dissolve or split them, and do not take broken or cracked tablets. If swallowing is difficult or you use a feeding tube, ask the oncology pharmacist for a suitable plan before taking the medicine. Do not improvise a liquid preparation.

Lower prescribed doses may be 320 mg twice daily or 200 mg twice daily, with the same four-days-on, three-days-off pattern. The 320 mg dose uses two 160 mg tablets per dose. Check the new strength and number of tablets whenever the dose changes; old and new packs should not be confused.

Missed doses and vomiting

If a dose is missed, take it when remembered within four hours of the scheduled time. If more than four hours have passed, skip it and take the next dose at its normal time. Do not double a dose or extend the treatment week to make up for it.

If you vomit after a dose, do not take another dose. Take the next scheduled dose at the usual time. Contact the team for repeated vomiting, inability to drink or difficulty keeping essential medicines down. If you accidentally take too much, contact the team or emergency service immediately and bring the packaging.

Partner medicines and treatment pauses

Fulvestrant is given by injection on its own appointment schedule. Some patients also need injections that suppress hormone production. Continue each medicine only according to its individual plan; an instruction to pause capivasertib does not automatically cancel a hormone-treatment appointment.

If your plan contains abiraterone and prednisone, do not stop prednisone on capivasertib off-days or during a pause unless the team specifically instructs you. Abrupt steroid interruption can be dangerous. Abiraterone has its own food requirements: for example, Zytiga is taken on an empty stomach. Capivasertib's food flexibility must not be applied to every tablet. Hormone-suppression treatment may also need to continue.

Storage and safe handling

Keep tablets in the original packaging, away from children, pets, heat and moisture. Follow your dispensed label's temperature and expiry instructions. The US patient leaflet specifies 20–25°C (68–77°F) and discarding tablets after 45 days outside the original packaging. Ask the pharmacist to confirm the discard date for your supply before repackaging; professional and patient storage wording differ.

Do not share tablets. Return unwanted medicine through the hospital or pharmacy's disposal route. Ask how a caregiver should handle doses safely and wash hands after handling your medicine.

Monitoring and checking treatment response

Glucose checks early in treatment

The current US label checks fasting glucose on day 3 or 4 of the dosing week in weeks 1, 2, 4, 6 and 8, then monthly and whenever clinically needed. European guidance uses the same scheduled weeks and recommends checking before the dose on day 3 or 4. HbA1c is checked every three months. Do not wait until a routine scan to have these safety tests.

Additional testing may be needed between these dates. European information recommends regular glucose monitoring with particular attention during the first four weeks, especially the first two. For patients with diabetes, it recommends daily fasting checks for the first two weeks, then checks as often as needed. It also recommends an additional HbA1c at week four for diabetes, pre-diabetes or raised glucose at baseline. Your written plan should reflect your risk and the product guidance being followed.

If glucose rises

With treatment-related hyperglycaemia, meaning raised blood sugar, fasting glucose should be checked at least twice weekly on both capivasertib days and off-days until it returns to baseline. During treatment with diabetes medicines, the labels specify at least weekly fasting checks for two months, then every two weeks or as clinically needed. More frequent checks take priority when you are unwell.

Your team may add or adjust diabetes treatment, pause capivasertib, reduce its dose or stop it. Glucose-lowering medicines can sometimes cause low sugar on off-days. European guidance gives specific metformin scheduling and kidney-monitoring precautions, so ask for an individual written plan rather than starting, continuing or stopping it yourself.

Other checks and response assessments

Blood tests and symptom reviews look for dehydration, kidney problems, low blood salts, anaemia and other effects. Blood fats called triglycerides can also rise. When abiraterone is part of the regimen, blood pressure, potassium, fluid retention and liver monitoring are also important. Scans and other disease assessments are scheduled separately to judge benefit. Few side effects do not mean that treatment is ineffective.

Common side effects and practical care

Diarrhoea

Diarrhoea can start early and become severe. At the first loose stool, begin the anti-diarrhoea medicine according to your prescribed plan, increase fluids within your agreed limits and contact the team for advice. Do not wait until the next appointment. If you have heart or kidney problems, ask what fluid amount is appropriate.

Keep a record of stools compared with your normal pattern, and note pain, fever, blood, dizziness or reduced urine. Use oral rehydration products if recommended. Significant diarrhoea, inability to drink or feeling faint may require urgent assessment and a capivasertib pause. Repeatedly taking extra anti-diarrhoea medicine without reporting deterioration can delay treatment of a serious problem.

Rash, itching and tender skin

Report a new rash promptly, even when it seems mild. Notice whether it is spreading, painful, raised, blistering or associated with fever or a sore mouth. Photographs may help the team see changes, but they do not replace urgent assessment. Use a moisturiser recommended by the team and avoid products that irritate the skin.

The team may prescribe an antihistamine, steroid cream or other treatment and involve a dermatologist. Severe reactions can require a pause or permanent discontinuation. Do not start steroid tablets yourself: they have their own risks and can increase glucose.

Nausea, mouth soreness and appetite changes

Use prescribed anti-sickness medicine and try smaller meals if large meals are difficult. Sip drinks regularly. A soft toothbrush and gentle mouth care can help when the mouth is sore; avoid food that stings. Tell the team about ulcers or pain that limits eating or drinking. Weight loss, poor appetite or persistent taste changes may benefit from dietetic support.

Tiredness and other symptoms

Balance activity with rest and tell the team if fatigue limits normal tasks. Anaemia, poor sleep, dehydration and glucose changes may contribute. Headaches, urinary symptoms and other new problems deserve reporting rather than being automatically attributed to treatment. Partner medicines can add hot flushes, aches or injection-site soreness.

Important side effects needing prompt assessment

Severe hyperglycaemia and ketoacidosis

High glucose can cause excessive thirst, frequent urination, increased hunger, weight loss or blurred vision. Contact the treating hospital immediately if these occur. Do not simply avoid sugar and wait. Symptoms can develop despite previously normal glucose checks.

Diabetic ketoacidosis, or DKA, is a dangerous build-up of acids called ketones. Warning symptoms include nausea or vomiting, tummy pain, fruity-smelling breath, deep or rapid breathing, confusion and unusual sleepiness. Stop capivasertib and get urgent emergency assessment if DKA is suspected. Confirmed DKA requires permanently stopping capivasertib under the treating team's care.

Acute illness or a suspected serious infection can increase this risk. Current US advice is to withhold capivasertib in these situations. Contact the oncology team urgently for instructions, including when it may restart. Do not stop essential insulin or prescribed steroids on your own.

Severe skin or allergic reactions

A widespread painful rash, peeling or blistering skin, mouth or eye sores, or rash with fever or facial swelling needs urgent assessment. Some reactions affect internal organs as well as the skin. Facial or throat swelling, breathing difficulty or collapse requires emergency care. Do not take further capivasertib until urgent medical advice has been obtained.

Dehydration, kidney injury and low blood salts

Severe diarrhoea or vomiting can reduce circulating fluid and disturb salts such as potassium. This can affect the kidneys and heart rhythm. Very little urine, marked dizziness, muscle weakness or palpitations needs prompt assessment; collapse or severe chest or breathing symptoms needs emergency care. Kidney blood-test changes require interpretation, because capivasertib can also affect how creatinine, a kidney-test marker, is transported. Do not dismiss an abnormal result as harmless.

Infection and effects of accompanying medicines

Report fever, shaking chills, painful urination, a new cough or feeling suddenly unwell. Serious illness can occur without a high temperature. Follow your hospital's threshold and urgent-contact instructions. If abiraterone is prescribed, yellow eyes or skin, new swelling or severe weakness also needs prompt review because the complete regimen carries additional liver, fluid and hormone-related risks.

Other medicines, supplements and vaccinations

Capivasertib interacts with medicines that affect enzymes used to process it, particularly CYP3A. Strong inhibitors can raise capivasertib levels and are usually avoided; moderate inhibitors can require dose reduction. Strong or moderate inducers can lower its effect and should be avoided. Examples include some antibiotics, antifungals, antivirals and epilepsy medicines, rifampicin and St John's wort. The pharmacist must check the exact product rather than relying on a short example list.

Avoid grapefruit and grapefruit juice. Tell the team about every prescription, over-the-counter medicine, supplement and herbal preparation, including occasional medicines for pain, sleep or sickness. Capivasertib can also affect the levels of some other medicines. Do not alter an essential prescription independently.

Discuss vaccination timing with the oncology team. Whether a live vaccine is suitable and how well a vaccine may work depend on your overall treatment and immune status. No single fixed waiting interval applies to all capivasertib combinations.

Everyday life during treatment

Use a calendar or reminders to distinguish the four dosing days from the three off-days. Mark each dose after taking it. If several people help with medicines, agree who records it to avoid duplicate dosing. Bring your calendar, glucose readings and symptom notes to reviews.

There is no special food that makes capivasertib work better. Aim for a manageable, balanced intake and ask for personalised advice if appetite, diarrhoea or glucose changes make eating difficult. Do not start a restrictive diet to manage a high glucose reading without contacting the team.

Do not drive or operate machinery when dizzy, faint, unusually sleepy or unable to concentrate. Discuss flexible work, rest periods and travel around tests. Carry medicines in their labelled packaging and check how you would obtain urgent help away from home. Tell dentists and other clinicians about the full treatment plan before procedures.

Treatment can affect mood, body image, sex and relationships. Ask for practical or psychological support when needed. You do not have to wait until a problem becomes severe before raising it with your team.

Fertility, contraception, pregnancy and breastfeeding

Capivasertib can harm a developing baby. Pregnancy status should be checked before treatment when relevant. Discuss fertility preservation before starting; effects on human fertility are not fully known, and animal findings suggest a possible effect on male fertility. Contact the team promptly if pregnancy occurs in you or a partner.

For capivasertib itself, US guidance specifies effective contraception during treatment and for one month afterwards for patients who can become pregnant, and four months for male patients with partners who can become pregnant. European guidance uses at least four weeks and 16 weeks; its leaflet specifies condoms for men with a pregnant partner or a partner who could become pregnant, plus suitable contraception for the latter. Obtain exact methods and end dates from your team.

Partner medicines may require substantially longer precautions. US Faslodex guidance requires contraception for one year after the last fulvestrant dose; current European Faslodex guidance requires two years. These longer fulvestrant instructions must not be replaced by capivasertib's shorter interval. The team should provide the applicable full-regimen plan.

Do not breastfeed during capivasertib treatment. Its labels do not provide a single fixed post-treatment breastfeeding interval. US fulvestrant guidance requires avoiding breastfeeding for one year after the last dose, so do not restart based solely on when capivasertib stopped. Confirm the full plan with the team.

After treatment stops or changes

Ask for a revised written calendar whenever treatment is paused, reduced or stopped. Clarify each partner medicine separately and keep the old calendar out of use. Do not restart capivasertib because symptoms improve without confirming the plan.

Glucose may change when capivasertib is withheld, so diabetes medicines and monitoring may also need review. The same prescription may not be appropriate on all treatment and off-days. Continue glucose checks and follow-up until the team advises otherwise, and retain all applicable reproductive precautions.

Some symptoms need continuing care after tablets stop. Ask who will review persistent diarrhoea, skin problems or fatigue and when the next assessment of the cancer is due. A safety pause alone does not show that treatment has failed.

Frequently asked questions