Brexafemme Drug Interactions: What You Need to Know Before Taking It

Before you take Brexafemme (Ibrexafungerp) for a yeast infection, it's important to know how it interacts with other medications. Some drugs can make Brexafemme less effective, while others can increase its levels in your body and raise the risk of side effects.

This guide covers the key drug interactions you should know about, plus what to tell your doctor to keep your treatment safe.

How Drug Interactions Work with Brexafemme

Brexafemme is processed (metabolized) in your liver by an enzyme system called CYP3A. Many other medications also use this same enzyme system. When two drugs compete for or affect the same enzymes, interactions can happen:

• CYP3A inhibitors slow down the breakdown of Brexafemme, causing more of the drug to stay in your body → may require a dose reduction
• CYP3A inducers speed up the breakdown of Brexafemme, causing the drug to leave your body too quickly → makes Brexafemme less effective

Additionally, Brexafemme itself can inhibit several enzymes and transporters (CYP2C8, CYP3A4, P-gp, and OATP1B3), though the clinical significance is considered low because treatment duration is so short (one day).

Medications That Interact with Brexafemme

Major Interactions — Strong CYP3A Inhibitors (Dose Reduction Required)

If you take any of these medications, your Brexafemme dose must be reduced from 300 mg to 150 mg twice in one day:

• Ketoconazole (Nizoral) — antifungal
• Itraconazole (Sporanox) — antifungal
• Clarithromycin (Biaxin) — antibiotic
• Ritonavir (Norvir) and other HIV protease inhibitors — HIV treatment
• Nefazodone — antidepressant
• Cobicistat (Tybost) — HIV treatment booster

Your doctor will know to adjust your dose if you're taking any of these. Make sure to mention them at your appointment.

Major Interactions — Strong CYP3A Inducers (Avoid Completely)

These medications are contraindicated with Brexafemme. Taking them together significantly reduces Brexafemme levels, making the treatment potentially ineffective:

• Rifampin (Rifadin) — antibiotic used for tuberculosis
• Phenytoin (Dilantin) — seizure medication
• Carbamazepine (Tegretol) — seizure/mood medication
• Long-acting barbiturates (e.g., Phenobarbital) — sedatives/seizure medications
• St. John's Wort — herbal supplement (also a strong CYP3A inducer)

If you take any of these, your doctor will need to choose a different antifungal treatment. Do not take Brexafemme with these drugs.

Moderate Interactions — Moderate CYP3A Inducers (Avoid)

These medications should also be avoided when taking Brexafemme:

• Bosentan (Tracleer) — pulmonary hypertension medication
• Efavirenz (Sustiva) — HIV medication
• Etravirine (Intelence) — HIV medication
• Modafinil (Provigil) — wakefulness medication

Low-Risk Interactions

Weak and moderate CYP3A inhibitors generally do not require a dose adjustment. However, you should still tell your doctor about all medications you take. Examples include:

• Fluconazole (Diflucan) — moderate CYP3A inhibitor
• Erythromycin — moderate CYP3A inhibitor
• Diltiazem (Cardizem) — moderate CYP3A inhibitor
• Grapefruit juice — weak CYP3A inhibitor

Supplements and OTC Products to Watch

Several over-the-counter products and supplements can interact with Brexafemme:

• St. John's Wort — This is the most important supplement interaction. St. John's Wort is a strong CYP3A inducer and should not be taken with Brexafemme. It can make the medication ineffective.
• Grapefruit and grapefruit juice — While classified as a weak CYP3A inhibitor, large amounts of grapefruit could theoretically increase Brexafemme levels slightly. This is unlikely to be clinically significant, but it's worth mentioning to your doctor if you regularly consume large quantities.

Most common OTC medications (Acetaminophen/Tylenol, Ibuprofen/Advil, antihistamines) do not have known significant interactions with Brexafemme. However, always check with your pharmacist if you're unsure.

Food and Drink Interactions

Brexafemme has no significant food interactions. You can take it with or without food. Some patients find that taking it with a light meal helps reduce nausea or stomach discomfort.

As mentioned above, grapefruit juice is a weak CYP3A inhibitor, but the effect is generally not clinically significant at normal consumption levels. There's no need to avoid it unless your doctor specifically advises otherwise.

There are no known interactions with alcohol. However, since both Brexafemme and alcohol can cause nausea and dizziness, it's reasonable to avoid heavy drinking on the day you take your medication.

What to Tell Your Doctor

Before your doctor prescribes Brexafemme, make sure they know about:

1. All prescription medications you currently take — especially antifungals, antibiotics, HIV medications, seizure medications, and blood pressure medications
2. All over-the-counter medications and supplements — including herbal products like St. John's Wort
3. Your pregnancy status — Brexafemme is contraindicated in pregnancy
4. Any liver conditions — Brexafemme is metabolized by the liver and may affect liver enzymes
5. Any allergies — especially to antifungal medications

Your pharmacist is also a great resource. When you pick up your Brexafemme prescription, ask the pharmacist to run an interaction check against all your current medications.

Final Thoughts

Brexafemme has a manageable interaction profile, but there are some important medications to watch out for — particularly strong CYP3A inducers (which are contraindicated) and strong CYP3A inhibitors (which require a dose reduction). The simplest way to stay safe is to give your doctor and pharmacist a complete list of everything you take.

For more about Brexafemme, explore our guides on how it works, side effects, and how to find it in stock. Ready to fill your prescription? Search Medfinder to find a pharmacy near you.