When You Can't Get Ibrexafungerp, What Are Your Options?

Your doctor prescribed Ibrexafungerp (brand name: Brexafemme) for a vaginal yeast infection, but now you're stuck — maybe your pharmacy doesn't stock it, maybe your insurance won't cover it, or maybe the $700 to $900 cash price is too steep.

Whatever the reason, you shouldn't have to wait in discomfort. There are several well-established alternatives that can effectively treat vulvovaginal candidiasis (VVC). In this guide, we'll explain what Ibrexafungerp is, how it works, and walk through four real alternatives your doctor might consider.

If you'd still like to try finding Brexafemme first, check out our guide on how to find Ibrexafungerp in stock near you.

What Is Ibrexafungerp?

Ibrexafungerp (Brexafemme) is a prescription antifungal made by Scynexis, Inc. It was FDA-approved in June 2021 as the first oral non-azole antifungal for vaginal yeast infections. It's prescribed for:

• Treatment of VVC — a single-day course of four tablets
• Prevention of recurrent VVC (RVVC) — a one-day course monthly for six months

It works by inhibiting glucan synthase, an enzyme that fungi need to build their cell walls. This is a different mechanism than azole antifungals like Fluconazole, which makes Brexafemme especially valuable for patients with azole-resistant yeast infections. To learn more, read how Ibrexafungerp works.

How Does Ibrexafungerp Compare to Alternatives?

The main advantage of Ibrexafungerp is that it's the only oral non-azole option. Most other antifungals for yeast infections are either azole-class drugs or topical treatments. Here's how the alternatives stack up.

1. Fluconazole (Diflucan)

Fluconazole is the most commonly prescribed oral antifungal for vaginal yeast infections. It's been around for decades, is available as a generic, and is highly affordable — often just $4 to $15 for a single-dose treatment.

• How it works: Fluconazole is an azole antifungal that blocks the production of ergosterol, a key component of fungal cell membranes
• Dosing: Typically a single 150 mg oral dose for uncomplicated VVC
• Pros: Cheap, widely available, effective for most yeast infections
• Cons: May not work for azole-resistant Candida strains; not recommended in pregnancy; can interact with other medications

For most patients with a straightforward vaginal yeast infection, Fluconazole is the first-line treatment and the most likely alternative your doctor will suggest.

2. Miconazole (Monistat)

Miconazole is an over-the-counter (OTC) topical antifungal available as vaginal creams, suppositories, and combination packs. It's one of the most accessible treatment options.

• How it works: Miconazole is a topical azole that disrupts fungal cell membranes on contact
• Dosing: Available in 1-day, 3-day, and 7-day treatment courses
• Pros: No prescription needed; available at any drugstore; affordable (typically $10 to $25)
• Cons: Topical application can be messy; may cause local irritation; requires multiple days for some formulations

3. Clotrimazole

Clotrimazole is another OTC topical azole antifungal available as a vaginal cream or suppository.

• How it works: Similar mechanism to Miconazole — disrupts fungal cell membranes
• Dosing: Available in 3-day and 7-day treatment regimens
• Pros: Widely available OTC; affordable (around $8 to $20); well-established safety profile
• Cons: Topical only; may cause mild burning or irritation; not ideal for recurrent infections

4. Terconazole

Terconazole is a prescription topical antifungal cream or suppository. It's often used for yeast infections that haven't responded to OTC treatments.

• How it works: Terconazole is an azole antifungal applied directly to the vaginal area
• Dosing: Available as a 3-day or 7-day course
• Pros: May work when OTC options haven't; prescription-strength
• Cons: Requires a prescription; may cause headache or local irritation; typically costs $30 to $80 with a coupon

Which Alternative Is Right for You?

The best alternative depends on your specific situation:

• If you have a straightforward yeast infection: Fluconazole or an OTC option like Miconazole is usually the simplest and cheapest choice
• If you have azole-resistant yeast: Talk to your doctor — Ibrexafungerp's non-azole mechanism makes it uniquely valuable in this situation, and it may be worth the extra effort to find it
• If you have recurrent infections (RVVC): Your doctor may recommend Fluconazole maintenance therapy or the Brexafemme RVVC prevention regimen
• If you're pregnant: Neither Ibrexafungerp nor oral Fluconazole should be used. Topical options like Clotrimazole are generally preferred — always check with your doctor

For more about Ibrexafungerp's side effects and safety profile, see Ibrexafungerp side effects: what to expect.

Final Thoughts

Ibrexafungerp (Brexafemme) is a groundbreaking medication, but it's not the only way to treat a vaginal yeast infection. If you can't find it or afford it, proven alternatives like Fluconazole, Miconazole, Clotrimazole, and Terconazole are widely available and effective for most patients.

Always talk to your doctor before switching medications. They can help you choose the best treatment based on your medical history, the type of Candida causing your infection, and your budget.

If you'd still like to try to find Brexafemme, use Medfinder to check pharmacy availability near you.