Can't find Brexafemme? Explore effective alternatives for vaginal yeast infections including Fluconazole, Miconazole, Clotrimazole, and Vivjoa.
If your doctor prescribed Brexafemme (Ibrexafungerp) for a vaginal yeast infection but you can't find it at any pharmacy, you're not stuck. While Brexafemme has been extremely hard to find since 2023, there are several proven alternatives that can effectively treat vaginal yeast infections.
In this guide, we'll explain what Brexafemme is, how it works, and walk you through your best alternative options — including both prescription and over-the-counter choices.
Brexafemme is the brand name for Ibrexafungerp, a first-in-class triterpenoid antifungal medication. It was approved by the FDA in June 2021 for the treatment of vulvovaginal candidiasis (VVC) — vaginal yeast infections — in adult and postmenarchal females. It was also later approved for reducing the incidence of recurrent VVC (RVVC).
Brexafemme represented a major breakthrough because it was the first non-azole oral antifungal approved for yeast infections in more than 20 years. For a complete overview, see our post on what Brexafemme is and how it's used.
Brexafemme works differently from traditional antifungals like Fluconazole. It inhibits an enzyme called glucan synthase, which is responsible for building a key structural component of the fungal cell wall called 1,3-beta-D-glucan. Without this component, the fungal cell wall weakens and the fungus dies.
This mechanism is important because it means Brexafemme can work against yeast strains that have become resistant to azole antifungals (the class that includes Fluconazole). For more on the science, read how Brexafemme works.
Here are the most effective alternatives, organized by type:
Type: Prescription oral antifungal (azole class)
How it works: Fluconazole inhibits a fungal enzyme called lanosterol 14-alpha-demethylase, which disrupts the production of ergosterol — a critical component of the fungal cell membrane.
Dosing: Typically a single 150 mg oral dose for uncomplicated yeast infections. For recurrent infections, your doctor may prescribe a longer course (e.g., 150 mg once weekly for 6 months).
Cost: Very affordable. Generic Fluconazole costs approximately $4 to $15 at most pharmacies.
Who it's good for: Most women with vaginal yeast infections. Fluconazole is the first-line treatment and works well for the majority of cases.
Limitations: Not effective against azole-resistant Candida strains. Interacts with several medications. Contraindicated in pregnancy for most uses.
Type: Over-the-counter topical antifungal
How it works: Miconazole is an azole antifungal that disrupts the fungal cell membrane when applied directly to the affected area.
Dosing: Available as vaginal creams, suppositories, or combination packs in 1-day, 3-day, and 7-day treatment options.
Cost: Approximately $10 to $20 at most drugstores. No prescription needed.
Who it's good for: Women who want immediate treatment without needing to see a doctor first. Good for uncomplicated yeast infections.
Limitations: Topical application can be messy. May cause local irritation. Not ideal for recurrent or complicated infections.
Type: Over-the-counter topical antifungal
How it works: Similar to Miconazole, Clotrimazole disrupts the fungal cell membrane and is applied directly to the vaginal area.
Dosing: Available as vaginal cream or suppositories in 3-day and 7-day treatment courses.
Cost: Approximately $7 to $15 at most pharmacies and drugstores.
Who it's good for: Another convenient OTC option for uncomplicated yeast infections. Similar effectiveness to Miconazole.
Limitations: Same as Miconazole — topical application, potential local irritation, and not the best choice for complicated or recurrent cases.
Type: Prescription oral antifungal (azole class, but with a novel structure)
How it works: Oteseconazole targets the same fungal enzyme as Fluconazole but with a more selective mechanism that may result in fewer drug interactions.
Dosing: For RVVC prevention, the typical regimen involves a loading dose followed by weekly dosing for up to 11 weeks.
Cost: Significantly more expensive than Fluconazole — approximately $900 or more per treatment course without insurance. Manufacturer savings programs may be available.
Who it's good for: Women with recurrent vulvovaginal candidiasis (RVVC) who need a prevention strategy. Approved specifically for reducing recurrence.
Limitations: Contraindicated in pregnancy and women of reproductive potential not using contraception. High cost. Newer drug with less long-term data.
The best alternative depends on your specific situation:
If Brexafemme is specifically what you need — especially for azole-resistant infections — it's worth continuing to monitor availability. Use Medfinder to check pharmacy stock in real time, and read our tips on how to find Brexafemme in stock near you.
Losing access to Brexafemme is frustrating, especially if it was prescribed because other treatments hadn't worked for you. But you do have options. Fluconazole remains the go-to oral treatment for most yeast infections, OTC topicals like Miconazole and Clotrimazole offer convenient no-prescription solutions, and Oteseconazole (Vivjoa) provides a newer alternative for recurrent cases.
Talk to your doctor about which alternative makes the most sense for you. And if you're waiting for Brexafemme to return, keep checking Medfinder for updates on availability.
You focus on staying healthy. We'll handle the rest.
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