Phexxi (lactic acid/citric acid/potassium bitartrate)

Phexxi is a brand-name prescription medication. It’s approved by the Food and Drug Administration (FDA) for use by females* to prevent pregnancy. Females who have not started having periods should not use Phexxi.

It’s used as needed for birth control. Phexxi doesn’t have to be used every day.

This drug has a limitation of use. For details about this and how the drug is used to prevent pregnancy, see the “Phexxi: Use for birth control” section below.

* Sex and gender exist on spectrums. In this article, use of the term “female” refers to sex assigned at birth.

The following table provides key facts about Phexxi.

If you’re interested in using this medication, search here to find a doctor who might prescribe it.

Phexxi contains three active drugs: lactic acid, citric acid, and potassium bitartrate. It only comes as a brand-name medication. And it isn’t currently available as a generic drug.

A generic is an identical copy of the active drug found in a brand-name medication. Generics typically cost less than brand-name drugs.

Prescription drugs, such as Phexxi, are approved by the Food and Drug Administration (FDA) to be used for certain conditions.

Phexxi is a nonhormonal form of birth control and is FDA-approved to prevent pregnancy.

Females* who are able to become pregnant can use Phexxi. Females who have not started having periods should not use it.

Phexxi is a vaginal gel that can be used before having sex to prevent pregnancy. To learn more about using Phexxi, see “Phexxi: How to use” below. To find out how it works to prevent pregnancy, see “Phexxi: How it works” below.

It’s important to note that Phexxi has a limitation of use. It does not prevent pregnancy from occurring if it is used after sexual intercourse. This medication must be used before having sex to prevent pregnancy.

Additionally, Phexxi does not prevent sexually transmitted infections (STIs). (STIs are infections that can spread through sexual contact.) If you would like to prevent STIs, talk with your doctor. They may recommend using other forms of birth control, such as condoms, in combination with Phexxi.

* Sex and gender exist on spectrums. In this article, use of the term “female” refers to sex assigned at birth.

In some cases, your doctor may recommend that you use Phexxi in combination with other forms of birth control. Examples may include:

• condoms
• hormonal contraceptives
• vaginal diaphragms

It’s safe to use Phexxi in combination with many other forms of contraception. However, it is not recommended to use Phexxi with the hormonal vaginal ring called NuvaRing, which contains etonogestrel/ethinyl estradiol.

As described above, Phexxi does not prevent sexually transmitted infections (STIs). (STIs are infections that can spread through sexual contact.) Your doctor may recommend using other forms of birth control in combination with Phexxi to prevent STIs. This includes condoms.

You may need to use medications to treat vaginal infections while you are using Phexxi. These include bacterial and yeast infections. It’s safe to use these medications in combination with Phexxi, even if you use them vaginally. For example, you may use Phexxi even if you’re also using vaginal miconazole (Monistat).

If you have questions about using other medications with Phexxi, talk with your doctor.

Females* younger than 18 years of age who are able to become pregnant can use Phexxi. Females who have not started having periods should not use it.

If your child is interested in using Phexxi as a birth control method, talk with their doctor.

* Sex and gender exist on spectrums. In this article, use of the term “female” refers to sex assigned at birth.

If you have a family doctor or a gynecologist, they will be able to prescribe Phexxi for you. If you would like help finding a doctor or other healthcare professional near you, check out this page.

For information on what to expect at your appointment, see our appointment guide for birth control visits.

Here are some common questions about Phexxi and brief answers to them. If you’d like to know more about these topics, ask your doctor.

Phexxi is an effective form of birth control. In clinical studies, Phexxi was effective at preventing pregnancy from occurring. However, no birth control is 100% effective. When used as directed, Phexxi is 93% effective at preventing pregnancy.

Be sure you are using Phexxi properly to prevent pregnancy. Before using Phexxi for the first time, read its instructions for use. If you don’t use Phexxi properly, it may be less effective.

If you have questions or concerns about the effectiveness of Phexxi, talk with your doctor or pharmacist.

No, Phexxi is not a spermicide. Phexxi works in a different way than spermicide does to prevent pregnancy.

Phexxi works by changing the pH of your vagina to become more acidic. (pH describes acid-base balance.) The drug prevents pregnancy from occurring because sperm cannot move well in an acidic environment. In turn, sperm cannot move and reach an egg to fertilize, which means that pregnancy is unlikely to happen. For more details, see the “Phexxi: How it works” section below.

Spermicide works by killing sperm. Spermicides can also block the cervical opening, preventing sperm from entering the uterus and reaching an egg.

Spermicide contains a chemical to kill sperm, which means it may carry a higher risk of vaginal irritation. Phexxi contains nontoxic ingredients, so it may be less likely to cause irritation.

Yes, Phexxi is considered a safe contraceptive. The Food and Drug Administration (FDA) has approved Phexxi as a nonhormonal form of birth control. This means the drug does not affect hormone levels to prevent pregnancy. Instead, Phexxi works in the vagina to create an acidic environment that helps prevent pregnancy.

Clinical studies have shown Phexxi to be a safe and effective form of birth control.

If you have additional questions about the safety of Phexxi, talk with your doctor or pharmacist.

Yes, you can use Phexxi with condoms. You can also use it with other forms of birth control, such as hormonal contraceptives or vaginal diaphragms. However, you should not use Phexxi in combination with a vaginal ring contraceptive. For more information, see “Using Phexxi with other therapies” in the “Phexxi: Use for birth control” section above.

If you have additional questions about using Phexxi and condoms, talk with your doctor.

As with other medications, prices for Phexxi may vary. The cost of Phexxi birth control will depend on factors such as:

• the pharmacy you use
• your insurance coverage

Here’s a list of things to consider when looking into the cost of Phexxi.

• Option for a 90-day supply. For some drugs, it’s possible to get a 90-day supply. If this option is approved by your insurance company, it can help lower the cost of the drug. It can also help you avoid frequent trips to your pharmacy. If you’d like to learn more about this option, ask your doctor, pharmacist, or insurance company.
• Need for prior authorization. Before insurance coverage for Phexxi is approved, your insurance company may require prior authorization. In this case, your doctor and insurance company will communicate about your prescription for Phexxi. Then, the insurance company will decide if the drug will be covered. To find out if you need prior authorization for Phexxi, contact your insurance company.
• Possible cost assistance options. Financial assistance to help lower the cost of Phexxi is available. Evofem Biosciences, Inc., the drug’s manufacturer, offers a savings program for this drug. To learn more and see if you’re eligible for support, visit the manufacturer’s website. Also, check out this article to learn about ways to save on prescription drugs.
• Use of a mail-order pharmacy. Phexxi may be dispensed through mail-order pharmacies. Getting your prescription through a mail-order pharmacy could lower its cost. It can also allow you to get the drug without leaving home. To find out more about this option, check with your doctor, pharmacist, or insurance company.
• Availability of a generic form. Phexxi doesn’t come in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Typically, generics cost less than brand-name drugs.

As with most drugs, it’s possible to have side effects with Phexxi. These can include some mild side effects but also some serious ones.

To learn more about Phexxi’s side effects, talk with your doctor or pharmacist. They may also provide information about managing certain side effects of this drug.

Note: The Food and Drug Administration (FDA) tracks side effects of drugs it has approved. If you would like to notify the FDA about a side effect you’ve had with Phexxi, you can do so through MedWatch.

Mild and serious side effects of Phexxi are listed in the table below. This table does not include all of Phexxi’s possible side effects.

* This is not a complete list of Phexxi’s mild side effects. To learn about other mild side effects of this drug, ask your doctor or pharmacist. Or you can view the drug’s prescribing information.
† To learn more about allergic reaction, see below.

Most times, mild side effects of a drug go away within a few days or a couple of weeks. Talk with your doctor or pharmacist if any side effects become severe or don’t go away.

Serious side effects from Phexxi aren’t common, but they are possible. If you have serious side effects, call your doctor right away. However, if you’re having a medical emergency or your symptoms feel life threatening, call 911 or a local emergency number.

Your doctor will recommend how you should use Phexxi. It’s important to use the gel exactly as your doctor instructs.

Phexxi comes as a vaginal gel inside a prefilled applicator. You’ll place the gel in your vagina using the applicator device.

You should apply the gel from one prefilled applicator vaginally right before having sex. You can use Phexxi up to 1 hour before sex. However, if you plan to have sex more than 1 hour after applying Phexxi, it will no longer be effective. So you’ll need to reapply it.

For step-by-step instructions about how to use Phexxi, see its instructions for use. If you have additional questions, talk with your doctor or pharmacist.

Here’s a list of common questions related to using Phexxi.

• When should I use Phexxi? Use Phexxi only when needed, right before having sex. If you are not having sex, you do not need to use Phexxi. 
• Can I use Phexxi with other forms of birth control? Yes, you can use Phexxi with other forms of birth control, such as condoms, vaginal diaphragms, and hormonal contraceptives. However, you should not use it with the NuvaRing vaginal ring, which contains etonogestrel/ethinyl estradiol. For more information, see “Using Phexxi with other therapies” in the “Phexxi: Use for birth control” section above.
• Will it hurt when I apply Phexxi? You may notice vaginal pain, burning, or irritation when using Phexxi. These were side effects reported by people using this medication in clinical studies. However, not everyone using this medication will experience pain, burning, or irritation. If you have concerns about possible side effects of this medication, talk with your doctor.

Doctors may prescribe drugs other than Phexxi for birth control. Certain drugs may work better for you than others.

Phexxi is used to prevent pregnancy. Here’s a summary of other drugs that doctors sometimes prescribe for this purpose.

Your doctor can tell you about similar birth control options, such as spermicide and vaginal contraceptive films (VCF).

To learn more about alternatives to Phexxi, ask your doctor. They can tell you about other medications they could prescribe.

Phexxi is a nonhormonal form of birth control. It’s a vaginal gel that females* can use to prevent pregnancy. (For details about the drug’s use, see “Phexxi: Use for birth control” above.) 

For pregnancy to occur, an egg must be released by the ovary. Then, a sperm must fertilize the egg. The environment of the vagina must be ideal so that the egg can be fertilized.

Phexxi’s mechanism of action (the way the drug works) is to cause the pH of the vagina to become acidic. (pH describes acid-base balance.) This decreases the ability of sperm to move through the vagina to the cervix and uterus to fertilize an egg. So, if an egg cannot be fertilized, pregnancy is unlikely to occur. 

Phexxi is different from many other forms of contraception. This is because the drug is considered a nonhormonal contraceptive. It does not affect your hormone levels to prevent pregnancy.

* Sex and gender exist on spectrums. In this article, use of the term “female” refers to sex assigned at birth.

Phexxi will begin working right away to prevent pregnancy. It is considered an “on-demand” form of birth control. This means you can use the drug when you need it to prevent pregnancy.

Unlike many other forms of birth control, you do not need to use Phexxi every day. You should use Phexxi right before or up to 1 hour before having sex.

Phexxi is only available in one strength. Below, you’ll find the dosage that is commonly recommended.

Phexxi is available as follows.

• Form: vaginal gel
• Strength: 90 milligrams (mg) of lactic acid/50 mg of citric acid/20 mg of potassium bitartrate per single-use applicator

The recommended dosage for Phexxi is described below. This drug is approved for use in females* who are able to become pregnant, regardless of age. However, females who haven’t started having periods should not use Phexxi.

* Sex and gender exist on spectrums. In this article, use of the term “female” refers to sex assigned at birth.

The recommended dosage for Phexxi is as follows.

• Dose: 5 grams (g) of Phexxi, which is contained in each single-use applicator
• Frequency: right before sex or up to 1 hour before sex

If you plan to have sex more than 1 hour after using a dose of Phexxi, you will need to reapply it.

Below is something to consider about Phexxi’s dosage.

• Length of treatment. Doctors typically prescribe Phexxi as a long-term birth control option. You’ll likely use it long term if you and your doctor feel it’s safe and effective at preventing pregnancy.  

Phexxi is not known to interact with alcohol. If you are interested in drinking alcohol while using Phexxi, talk with your doctor about how much alcohol is safe.

Phexxi is not known to interact with other medications, supplements, or foods. However, that doesn’t mean interactions aren’t possible.

Different interactions can cause different effects. Some interactions can interfere with a drug’s effectiveness. Others can increase a drug’s side effects or cause them to be severe.

Talk with your doctor or pharmacist about any other medications or supplements you are planning to take in combination with Phexxi. Your doctor will be able to make sure that there are no interactions between Phexxi and your other medications or supplements.

Phexxi is a form of birth control that works to prevent pregnancy from occurring. So, there is no purpose in using Phexxi if you are pregnant.

It is not known if Phexxi may be safe if used during pregnancy. It is also not known if the drug may affect a developing fetus.

If you find out that you’re pregnant, you should stop using Phexxi and talk with your doctor. If you are planning to become pregnant, talk with your doctor before using Phexxi.

Phexxi is a form of birth control. For more information, see “Phexxi: Use for birth control” above.

It’s not known if Phexxi may be safe to use while you are breastfeeding. There aren’t any clinical studies that show whether the drug is safe to use while breastfeeding. Also, it isn’t known if Phexxi may affect a breastfed child.

If you are breastfeeding or planning to breastfeed, talk with your doctor about the best form of birth control for you.

Tell your doctor about your health history before starting treatment with Phexxi. Your doctor may not recommend this medication if you have certain factors affecting your health or specific medical conditions.

These factors and conditions include those listed below.

• Kidney infections or urinary tract infections (UTIs). Your doctor likely won’t prescribe Phexxi if you have a history of recurrent (repeated) kidney infections or UTIs. Phexxi may increase your risk of these infections. Talk with your doctor to see if it’s safe to use Phexxi.
• Urinary tract abnormalities. If you have any abnormalities in your urinary tract, such as an enlarged bladder, tell your doctor before you start using Phexxi. If you have a urinary tract abnormality, you may be at an increased risk of developing a UTI or kidney infection. Talk with your doctor to see if Phexxi is safe for you.
• Allergic reaction. Your doctor will likely not prescribe Phexxi if you’ve had an allergic reaction to it or any of its ingredients. To find out about other treatment options, talk with your doctor.
• Pregnancy. Phexxi is used to prevent pregnancy. It is not known if it may cause harm to a developing fetus if used during pregnancy. If you’d like to learn more about using Phexxi while pregnant, view the “Phexxi: Using while pregnant” section above.
• Breastfeeding. It is not known if Phexxi is safe to use while you are breastfeeding. If you’d like more information about using Phexxi while breastfeeding, view the “Phexxi: Using while breastfeeding” section above.

To learn more about side effects of Phexxi that could be harmful, see the “Phexxi: Side effects” section above.

For some drugs, taking more than the recommended dosage may lead to unwanted side effects or overdose. Do not use more Phexxi than your doctor advises.

Call your doctor if you think you’ve used too much of this medication. Also, you can call the American Association of Poison Control Centers at 800-222-1222 or use their online tool. However, if your symptoms are severe, call 911 or your local emergency number. Or go to the nearest emergency room right away.

Here’s some information about Phexxi’s expiration date, as well as how to store and dispose of the drug.

• Expiration. Your pharmacist will add an expiration date to the label on Phexxi’s packaging. This date is usually 1 year from the date the medication was dispensed to you. Expiration dates help ensure that a medication is effective during a period of time. The Food and Drug Administration (FDA) advises Trusted Source Food and Drug Administration (FDA) Governmental authority Go to source that you avoid using expired drugs. If you have an unused medication and it’s past the drug’s expiration date, talk with your pharmacist. They can let you know whether you might still be able to use the medication.
• Storage. Many factors determine how long a medication remains good to use. These factors include how and where you store the drug. Phexxi should be stored at room temperature, between 68°F and 77°F (20°C to 25°C). If needed, you can store Phexxi between 59°F and 86°F (15°C to 30°C). You should keep Phexxi in its original foil packaging.
• Disposal. It’s important to safely dispose of Phexxi if you no longer need to take it and have unused medication. Doing so helps prevent others, including children and pets, from accidentally taking the drug. It also helps avoid causing harm to the environment. Ask your pharmacist for information about disposing of Phexxi. Also, check out this page for several tips on safe medication disposal.

If you have questions about Phexxi, talk with your doctor. They can help advise you on whether Phexxi could be a good treatment option for you.

Here’s a list of questions you may want to ask your doctor:

• Do I have to start using Phexxi during a certain time of my menstrual cycle?
• Do I need to use other forms of birth control with Phexxi?
• What should I do if I want to become pregnant while I am using Phexxi?
• How can I treat the side effects I experience from Phexxi?

Your doctor may also tell you about other treatment options for preventing pregnancy. You may find this article helpful in learning about alternative drugs. And check out our selection of videos on birth control options.

Disclaimer: Healthgrades has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.