Phexxi will be a new "on-demand" Rx vaginal contraceptive gel.
It contains lactic acid, citric acid, and potassium bitartrate...and is touted as a nonhormonal "vaginal pH regulator."
But think of Phexxi as just a new type of spermicide. The gel maintains an acidic environment to reduce sperm motility.
Don't recommend Phexxi.
Explain that it isn't very effective...about 14 in 100 patients will get pregnant using Phexxi over 7 months. This is in the ballpark of other on-demand contraceptives (diaphragm, sponge, etc).
Point out that Phexxi should be avoided in patients with recurrent UTIs or vaginal infections...since use can increase risk. And it can cause local burning, itching, or pain...even in partners.
Plus Phexxi will cost about $270/box of 12 prefilled applicators.
Continue to recommend more effective contraceptive options. Educate that fewer than 1 in 100 patients will get pregnant per year with an IUD or implant...or 7 with the pill, patch, or ring.
But if patients get Phexxi, tell them to insert one applicatorful vaginally up to 1 hour before EACH episode of sex...even if intercourse occurs more than once within the hour window.
Remind patients to use condoms with Phexxi...to prevent STDs.
Advise that Phexxi can be used during menses...or with vaginal creams (miconazole, etc) if needed.
See our chart, New Drug: Phexxi, for more about dosing, administration, and use with other contraceptives.
- Contracept X 2020;2:100031
- Expert Opin Drug Saf 2018;17(9):935-43
- Contraception 2014;90(1):11-8
- Medication pricing by Elsevier, accessed Aug 2020
Mergima Al Arnaout October 7, 2020
I found it contradicting where it says "Phexxi should be avoided in patients with recurrent UTIs or vaginal infections" and then concluding with article with "Advise that Phexxi can be used during menses...or with vaginal creams (miconazole, etc) if needed." It seems conflicting whether or not to advise the use of Phexxi with vaginal yeast infection since at the end it says can be used with Miconazole cream.
If you find this content inappropriate and think it should be removed from this Letter site, let us know by clicking the Report button below. This information will be sent to TRC and we will take appropriate action.
Stephanie Ballard October 26, 2020
The miconazole won't affect the contraceptive effect, but the patient may want to choose a different agent, given that Phexxi may both worsen vulvar itching/irritation and increase risk for further yeast infections.
If you find this content inappropriate and think it should be removed from this Letter site, let us know by clicking the Report button below. This information will be sent to TRC and we will take appropriate action.