[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [Other antifungals](https://durgical.com/en/pharmacology/classes/other-antifungals/) › Ibrexafungerp

# Ibrexafungerp

## Other antifungals?

Other antifungals

## Pregnancy: contraindicated?

Contraindicated: it caused fetal harm in animals. A pregnancy test is required before each cycle and effective contraception until 4 days after the last dose.

First triterpenoid antifungal, oral, that blocks glucan synthase like the echinocandins; for vulvovaginal candidiasis. Contraindicated in pregnancy.

Updated Nov 1, 2026

## Quick facts

**Group**
[Other antifungals](https://durgical.com/en/pharmacology/classes/other-antifungals/)

**Target**
Fungal β-1,3-D-glucan synthase (Fks1)

**Used for**
Vulvovaginal candidiasis

**Key effects**
Diarrhoea · Dizziness and headache

**Monitor**
Pregnancy test before starting

**ATC**
J02AX07

No doses: the clinician sets them by the current guideline.

On this page

- The basics Mechanism of action
- Indications
- Adverse effects
- Pharmacokinetics
- Memory aid

- Clinical What the labels mean

- Safety Contraindications
- Key interactions
- What is monitored
- Administration and safety
- Pregnancy and breastfeeding
- Nursing care

- Study Test yourself

- Connections Connections

## Mechanism of action

Ibrexafungerp, the first triterpenoid, inhibits synthesis of the wall's β-1,3-D-glucan, like the echinocandins, but with a different molecule that is absorbed by mouth. The wall is destabilised and the fungus dies. It is fungicidal, in a concentration-dependent way, against almost all Candida species, including azole-resistant strains.

- Absorbed by mouth
- Inhibits the fungal glucan synthase
- The wall lacks β-1,3-D-glucan
- The wall is destabilised and Candida dies

## Indications

- Vulvovaginal candidiasis and prevention of its recurrences in adult women and adolescents after menarche [Vulvovaginal candidiasis →](https://durgical.com/en/conditions/vulvovaginal-candidiasis/)

## Adverse effects

### Common

- Diarrhoea, nausea, vomiting and abdominal pain
- Dizziness and headache
- Urinary discomfort and tiredness

### Serious (rare, important)

- Fetal harm: it is contraindicated in pregnancy

## Contraindications

- Pregnancy
- Use with moderate or strong CYP3A4 inducers, such as rifampicin

## Key interactions

**Moderate or strong CYP3A4 inducers (rifampicin, St John's wort)**
Lower its levels; not combined.

**Strong CYP3A4 inhibitors**
Raise its levels and require a change in the regimen.

**Grapefruit and grapefruit juice**
May interact; advice is sought before having it.

## What is monitored

- Pregnancy test before starting and before each monthly prevention dose
- Response of the vulvovaginal symptoms

## Administration and safety

- Oral, with or without food
- To prevent recurrences it is repeated once a month for several months, with a pregnancy test before each cycle

## Pregnancy and breastfeeding

Contraindicated: it caused fetal harm in animals. A pregnancy test is required before each cycle and effective contraception until 4 days after the last dose.

## Nursing care

- Confirm a negative pregnancy test before each cycle
- Explain effective contraception during treatment and for 4 days after
- Review medicines and herbal products for CYP3A4 inducers and inhibitors
- Teach to report symptoms that do not improve

## Pharmacokinetics

**Absorption**
Oral, with or without food.

**Metabolism**
Hydroxylation by CYP3A4, then conjugation.

**Elimination**
Mainly in the faeces.

**Half-life**
About 20 hours.

## Memory aid

«IBREXA-FUNGERP, an echinocandin in a pill»: the same target as caspofungin, but by mouth; and since pregnancy rules it out, a test before every cycle.

## Test yourself

Think of the answer, then tap the question to see it.

## How is ibrexafungerp like the echinocandins, and how is it different?

It inhibits the same wall glucan synthase, but it is a different triterpenoid molecule that is absorbed by mouth.

## Which test is required before each ibrexafungerp cycle?

A pregnancy test, because it is contraindicated in pregnancy after fetal harm in animals.

## Why is ibrexafungerp not combined with rifampicin?

Rifampicin induces CYP3A4, the enzyme that metabolises it, and lowers its levels.

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[More Pharmacology questions →](https://durgical.com/en/practice/?f=pharmacology)

## What the labels mean

**Pregnancy: contraindicated**
Contraindicated: it caused fetal harm in animals. A pregnancy test is required before each cycle and effective contraception until 4 days after the last dose.

## Connections

## Related drugs 2

- [Fluconazole](https://durgical.com/en/pharmacology/fluconazole/)
- [Caspofungin](https://durgical.com/en/pharmacology/caspofungin/)

## Related conditions 1

- [Vulvovaginal candidiasis](https://durgical.com/en/conditions/vulvovaginal-candidiasis/)

[← Back to the class: Other antifungals](https://durgical.com/en/pharmacology/classes/other-antifungals/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [Ibrexafungerp: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a621039.html) (MedlinePlus (U.S. National Library of Medicine), 2026).

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Representative model, for educational purposes only.

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