Buprenorphine SC (weekly/monthly)
BRIXADI
What it isLong-acting partial mu-opioid agonist and kappa antagonist injection (BRIXADI, 2023); moderate-to-severe opioid use disorder.
Why this oneUnlike other buprenorphine depots, the weekly form allows initiation without prior transmucosal stabilization; apparent half-life 3-5 d (weekly) / 19-25 d (monthly).
What limits itInjection-site reactions and precipitated withdrawal can end treatment; benzodiazepines magnify respiratory risk.
FDA-approved for
- opioid use disorder (moderate-severe) (2023)
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Moderate-to-severe opioid use disorder (weekly) | Adults; after transmucosal buprenorphine tolerated | 16 mg SC (then +8 mg within 3 days to reach 24 mg) in first week | 24 mg weekly | 32 mg weekly |
| Moderate-to-severe opioid use disorder (monthly) | Adults already on buprenorphine | 64/96/128 mg SC q28 days (based on weekly-equivalent dose) | individualized (64-128 mg monthly) | 128 mg monthly |
Renal Undefined
Hepatic Not recommended in pre-existing moderate to severe hepatic impairment; not studied for Brixadi
Weekly may be given +/-2 days, monthly +/-1 week around the scheduled time point
Instructions
- Subcutaneous injection only — do NOT give IV/IM/intradermal
- Administered only by a healthcare provider; single injection, do not divide
- Weekly given q7 days, monthly q28 days; rotate weekly injection sites
- Weekly and monthly formulations are not interchangeable/combinable
- Strongly consider prescribing an opioid overdose reversal agent
Cautions
- Addiction, abuse, and misuse
- Life-threatening respiratory depression (esp. with benzodiazepines/CNS depressants)
- Neonatal opioid withdrawal syndrome
- Adrenal insufficiency
- Opioid withdrawal with abrupt discontinuation or in full-agonist-dependent patients
- Hepatitis/hepatic events
- Latex allergy (needle cap)
Adverse reactions
- Injection site pain
- Headache
- Constipation
- Nausea
- Injection site erythema/pruritus
- Insomnia
- Urinary tract infection
Pregnancy Limited human data do not indicate increased malformation risk from buprenorphine; prolonged use can cause neonatal opioid withdrawal syndrome; dose adjustments may be needed in pregnancy.
Lactation Buprenorphine and norbuprenorphine present in low levels in human milk; monitor breastfed infant for drowsiness and breathing difficulty.
⚠ BOXED WARNINGS
- Addiction, abuse and misuse
- Life-threatening respiratory depression
- Risk from concomitant use with benzodiazepines
Classes and tags
Clinical profile
Mechanism of action: Buprenorphine SC (weekly/monthly) ballicule
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Memory aids: mascots and interaction avatars
pinpoint pupils → opioid
SubuTEXAS flag
SUBmarine periscope on bumper car
Open Buprenorphine SC (weekly/monthly) in the interactive console ↗