How does Brexafemme work? Learn how this antifungal kills yeast by targeting fungal cell walls — explained in plain English with comparisons to other treatments.
If your doctor has prescribed Brexafemme (Ibrexafungerp) for a yeast infection, you might be wondering: how does it actually work? Understanding the basics can help you feel more confident about your treatment and understand why your doctor chose this particular medication.
This guide explains Brexafemme's mechanism of action in plain, simple terms — no medical degree required.
To understand how Brexafemme works, it helps to know a little about yeast cells.
Yeast (specifically Candida species, the fungi that cause vaginal yeast infections) are living organisms surrounded by a protective cell wall. Think of this cell wall like a brick wall around a house — it holds everything together and keeps the yeast alive.
One of the key building blocks of that wall is a substance called 1,3-beta-D-glucan. Yeast cells need an enzyme called glucan synthase to produce this building block.
Here's where Brexafemme comes in: Brexafemme blocks glucan synthase. Without this enzyme, the yeast can't build or maintain its cell wall. It's like removing the mortar from a brick wall — the structure weakens and falls apart. Without an intact cell wall, the yeast cell dies.
This mechanism is called concentration-dependent fungicidal activity. In plain terms, it means Brexafemme doesn't just stop the yeast from growing — it actively kills it. The higher the concentration of the drug at the site of infection, the more effectively it kills the fungus.
Imagine a yeast cell is a building under construction. The construction crew (glucan synthase) is laying bricks (glucan) to build the walls. Brexafemme walks onto the job site and tells the construction crew to stop working. Without anyone laying bricks, the walls never get finished — and the building collapses.
Meanwhile, older medications like Fluconazole work differently. They target the interior of the cell (specifically, they block the production of a substance called ergosterol in the cell membrane). That's like cutting off the plumbing inside the building — it causes problems, but the walls stay standing. Brexafemme goes straight for the walls.
Brexafemme begins working on the day you take it. Because the entire treatment is completed in just one day (two doses taken about 12 hours apart), the drug starts reaching the yeast and disrupting cell wall production right away.
Most patients begin to notice symptom improvement within 1 to 3 days after treatment. Complete symptom relief may take up to a week as the damaged yeast cells die off and your body clears the infection.
If your symptoms haven't improved after a week, or if they get worse, contact your doctor. You may need further evaluation.
Even though you only take Brexafemme for one day, the drug continues to work in your body after you've finished the tablets. The medication is designed to reach effective concentrations in vaginal tissue and maintain its antifungal effect long enough to clear the infection.
For patients with recurrent vulvovaginal candidiasis (RVVC) — meaning 3 or more yeast infections per year — Brexafemme is taken as a one-day dose repeated monthly for 6 months. This ongoing dosing helps prevent yeast from re-establishing itself. To learn about the full dosing schedule, see our guide on Brexafemme uses and dosage.
There are several antifungal medications used to treat yeast infections. Here's how Brexafemme compares:
Fluconazole has been the go-to oral treatment for yeast infections for decades. It's an azole antifungal that works by blocking ergosterol production inside the yeast cell. It's effective, cheap ($4–$15 generic), and widely available.
Brexafemme targets a completely different part of the yeast cell (the cell wall vs. the cell membrane). This means Brexafemme can work against yeast strains that have become resistant to azole medications — a growing problem worldwide. If you've tried Fluconazole and it didn't work, Brexafemme offers a genuinely different approach.
These are topical over-the-counter antifungals (creams and suppositories). They also belong to the azole class and target ergosterol. They work well for many women but require multi-day application and can be messy. Brexafemme is an oral pill — no creams, no suppositories — and treatment is done in one day.
Oteseconazole is another newer oral antifungal approved specifically for preventing recurrent yeast infections. It's also different from Fluconazole, but it's still an azole (just a newer, more selective one). Brexafemme is the only triterpenoid antifungal — a completely different class — which gives it a unique advantage against azole-resistant strains.
Echinocandins are another class of drugs that target glucan synthase, similar to Brexafemme. However, echinocandins are only available as IV (intravenous) medications given in hospitals. Brexafemme is the first glucan synthase inhibitor available as an oral pill, making it far more convenient for outpatient treatment.
Brexafemme represents a genuinely new approach to treating yeast infections. By targeting the fungal cell wall through glucan synthase inhibition, it kills yeast in a way that's fundamentally different from traditional antifungals. This makes it especially valuable for women with recurrent infections or those who haven't responded to older treatments.
If you've been prescribed Brexafemme, you can feel confident that it works through a well-studied, effective mechanism. To learn about potential side effects, check out our side effects guide. And if you need help finding it, Medfinder can help you locate a pharmacy with Brexafemme in stock.
You focus on staying healthy. We'll handle the rest.
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